Foreign-Body Airway Obstruction (Choking)


Definition

Choking occurs when food especially a piece of meat or other foreign object such as a marble, a button gets lodged in the windpipe. When someone is choking, there is either a PARTIAL or a COMPLETE airway obstruction.

Causes

Large, poorly chewed pieces of food.
Loose dentures.
Playing, crying, laughing or talking while food or foreign bodies are in the mouth.
Elevated blood alcohol levels.



How to Recognize Choking

Foreign bodies may partially block the airway but still allow adequate air movement.

1)         Choking Victim with Partial Airway Obstruction

Signs and Symptoms

Victim remains conscious
Can cough forcefully and usually can speak
Breath sounds may be noisy

Management

Do not interfere with the victim’s attempts to cough, because a strong cough is the most effective way to expel a foreign body.

Stay with the victim and monitor his or her condition. Be prepared to act if the airway obstruction worsens.

2)         Choking Victim with Complete Airway Obstruction

Victim may die from lack of oxygen due to total blockage in the windpipe unless emergency action is taken. The rescuer has only 4 to 6 minutes to save victim’s life.

Recognizing and assisting the choking victim IMMEDIATELY is vital. Determine whether the victim is choking by asking. “Are you choking?”



Universal Choking Sign

Signs and Symptoms

  • "Universal Choking Sign" or " Universal Distress Signal" - Victim is clutching the throat or neck with one or both hands. This indicates that victim is choking and needs help. 
  • Victim cannot speak or cough forcefully.
  • Victim cannot breathe
  • Bluish skin colour (cyanosis)
  • Loss of consciousness if not treated immediately


 Relief of Complete Foreign-Body Airway Obstruction

1)         Choking Adult and Child – Victim is Conscious

Perform the abdominal thrusts or Heimlich maneuver to relieve severe airway obstruction caused by a foreign object while the victim is still conscious and standing. You must act quickly to relieve the obstruction.

Abdominal thrusts (Heimlich maneuver)

Stand behind the victim. Make a fist with one hand and place the thumb side of the fist on the Victim’s abdomen,  slightly above the navel and well below the xyphoid or breastbone. Grasp the fist with the other hand and deliver quick inward and upward thrusts into the victim’s abdomen. Repeat thrusts and continue until object is expelled or the victim becomes unconscious.

2)         Choking in Pregnant and Obese Victims – Conscious
Chest thrusts


If the choking victim is in the late stages of pregnancy or is obese, use Chest thrusts instead of abdominal thrusts. Stand behind victim and wrap your arms around her chest. Position your fist on the center of the chest or breastbone, between the nipples. Grab your fist with your other hand and deliver firm backward thrusts until the object is removed or the victim becomes unconscious.

3)         Choking Infant (less than 1 year)

It is important to determine the complete airway obstruction is caused by a foreign body. If obstruction is caused b swelling due to infection or other medical problem and the infant stops breathing, immediate basic and advanced life support is necessary.

Infant with severe or complete airway obstruction will not be able to move enough air to make much sound, may make very soft, high-pitched or wheezing sounds when the infant tires to breathe in, unable to cough or cry, and blueness of the lips and skin can be seen. You must act quickly to remove the object.

Infant is Conscious

To relief of choking in the conscious or responsive infant, perform 5 back blows and 5 chest thrusts.

Deliver 5 Back Blows

Support infant’s head and neck with one hand, straddle infant on your forearm with infant face down, head lower than body and supported on your thigh. Deliver 5 back blows forcefully between the shoulder blades with the heel of one hand.



Deliver 5 Chest Thrusts

If the foreign object is not expelled, continue to support the head, turn the infant on his back, head lower than body. Deliver 5 chest thrusts using 2 fingers positioned over the breastbone (sternum) in the same position used for chest compression during CPR.



·                Alternate the 5 back blows and 5 chest trusts until the object is dislodged or the infant becomes unconscious.

·                Relief of Complete Foreign-Body Airway Obstruction in an Unconscious Victim – For Adult, Child and Infant:

·                Place the unconscious victim on his or her back. Call for help and begin CPR. Follow the steps of ABCs:

·                Open the Airway and look for the choking object in the mouth. Perform a tongue-jaw lift and if you see an object, remove it using finger sweeps. However, do not perform blind finger sweeps.

·                Check for Breathing – if the victim is not breathing normally, give 2 slow rescue breaths. If you are unable to see the chest rise after the first breath, reposition the victim’s head and reattempt two rescue breaths.

·                Check for Circulation – After the 2 rescue breaths, look signs of circulation such as normal breathing, coughing or movement.

·                If the victim has no signs of circulation, begin CPR starting with chest compressions.

·                Each time you open the airway to provide rescue breathing after the chest compressions, look into the victim’s mouth for any object. If you see an object, remove it. Do not perform blind finger sweeps.

·                If the foreign object is removed, check for signs of circulation, if victim is breathing normally, turn into the recovery position.

·                Administer oxygen, monitor and record the vital signs. Seek urgent medical attention.