Choking

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Introduction

Choking is a blockage of the upper airway by food or other objects, which prevents a person from breathing effectively. In adults, choking most often occurs when food is not chewed properly. The risk factors for choking in older adults include advancing age, poor dental fitting and excessive alcohol consumption. In children, choking is often caused by eating large pieces of food or too much food at one time, eating hard candy or putting small objects such as nuts, marbles, small toys or coins in the mouth, which gets lodged in the throat.1

The condition is a true medical emergency that requires immediate, appropriate action by anyone available.2 Coughing may be the first symptom. Subsequently, the person may grasp both hands near the throat, become breathless and may not be able to talk. The skin, lips and nails may turn blue or dusky and the person may lose consciousness.

First Aid

When a person chokes, the following approach of first aid is recommended:

  • First, deliver five back blows between the person’s shoulder blades with the heel of your hand.
  • Next, perform five abdominal thrusts (Heimlich maneuver).
  • Alternate between five back blows and five abdominal thrusts until the blockage is dislodged.

Heimlich maneuver on someone else:

  • Stand behind the person. Wrap your arms around the waist.
  • Make a fist with one hand and place your fist with thumb side in, just above the navel but below the person’s rib cage in the front.
  • Grasp the fist with the other hand. Keeping your arms off the person’s rib cage, give four quick inward and upward thrusts.
  • Repeat this several times (four to five times) until the object is coughed out or the person becomes unconscious.
  • If choking continues, seek medical help.

Clearing the airway of an unconscious person:

  • Lay the person onto the floor. Straddle the person with your knees.
  • Clear the airway. Pull the tongue and jaw forward and with your index finger, dislodge any visible matter. Be cautious as not to push the blockage deeper into the airway.
  • Place the heel of your hand just above the waistline. Place the other hand on top of this hand. Keeping your elbows straight, give four quick upward thrusts.
  • Begin CPR if the object remains lodged and the person doesn’t respond after the above measures. Continue checking the mouth periodically.

Heimlich maneuver on yourself:

  • Place a fist slightly above your navel.
  • Grasp your fist with the other hand and bend over a hard surface (such as chair).
  • Shove your fist inward and upward.

Heimlich maneuver on a pregnant woman or obese person:

  • Keep the position of your hands a bit higher than that with a normal Heimlich maneuver, at the base of the breastbone, just above the joining of the lowest ribs.
  • Proceed as with the Heimlich maneuver (giving chest thrusts instead of abdominal thrusts).

Clearing the airway of an infant:

  • Assume a seated position and hold the infant facedown on your forearm, which is resting on your thigh.
  • Thump the infant gently but firmly four times on the middle of the back using the heel of your hand.
  • Immediately, turn the baby over and give four forceful thrusts to the chest to a depth of 1 inch with two fingers one finger width below an imaginary line connecting the nipples.
  • Repeat both back blows and chest thrusts until foreign body is expelled or the infant becomes unconscious.
  • Start infant CPR if the blockage is removed but the infant is not breathing.

Do’s and Don’ts to Prevent Choking

  • While eating, chew food slowly and thoroughly, especially if wearing dentures.
  • Avoid laughing and talking during chewing and swallowing.
  • Avoid excessive intake of alcohol before and during meals.
  • Give easily chewable, soft food in small quantity to children.
  • Do not leave tiny objects or toys within the reach of children.
  • Supervise mealtime for infants and young children.

References

1.Eren S, Balci AE, Dikici B, Doblan M, Eren MS. Foreign body aspiration in children: Experience of 1160 cases. Ann Trop Pediatr. 2003; 23: 31–37.

2.Soroudi A, Shipp HE, Stepanski BM, Ray LU, Murrin PA, Chan TC et al. Adult foreign body airway obstruction in the prehospital setting. Prehosp Emerg Care. 2007; 11(1): 25–29.

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Written by: healthplus24 team
Date last updated: May 02, 2015