Choking prevention

As part of a Choking Prevention and Quality Improvement Initiative, we would like to inform physicians that:

• Any patient who presents with coughing and/or wheezing after oral exposure to a high-risk object (such as a nut or nut fragment, piece of raw carrot, apple or pear, unpopped popcorn kernel, seed, dried bean, plastic toy part, thumbtack, or pin) should be considered to have a bronchial foreign body until proven otherwise.

• For patients with a round metallic disc in the esophagus, a disc battery must be urgently ruled out.

• To prevent complete laryngeal obstruction, hotdogs and grapes should be cut lengthwise into quarter sections until a child is at least 5 years old and has no development delay in terms of swallowing. Deflated balloons and gel candies (a.k.a. “fruit poppers;” available in many Asian markets) should be kept out of reach of young children. Please advise parents of these issues.

For more information, please refer to the BC Children’s Hospital Clinical Practice Guidelines for Bronchial and Esophageal Foreign Bodies.

P. Ludemann, MDCM, FRCSC,. Choking prevention. BCMJ, Vol. 49, No. 9, November, 2007, Page(s) 504 - News.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

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