Choking is the mechanical obstruction of the flow of air from the environment into the lungs.

Choking prevents breathing, and can be partial or complete, with partial choking allowing some,
although inadequate, flow of air into the lungs. Prolonged or complete choking results in
asphyxia which leads to hypoxia and is potentially fatal.

Choking can be caused by:

 Respiratory diseases that involve obstruction of the airway.

 Compression of the laryngopharynx, larynx or trachea in strangles.

Contents
 1 Foreign objects
 2 Symptoms and Clinical Signs
 3 Treatment
o 3.1 Encouraging the victim to cough
o 3.2 Back slaps
o 3.3 Abdominal thrusts
 3.3.1 Self treatment with abdominal thrusts
 3.3.2 Other uses of abdominal thrusts
 3.3.3 Modified chest thrusts
o 3.4 CPR
o 3.5 Finger sweeping
o 3.6 Direct vision removal
 4 Notable victims
 5 References
 6 External links

Foreign objects
The type of choking most commonly recognised as such by the public is the lodging of foreign
objects in the airway. This type of choking is often suffered by small children, who are unable to
appreciate the hazard inherent in putting small objects in their mouth. In adults, it mostly occurs
whilst the patient is eating.

Symptoms and Clinical Signs

 The person cannot speak or cry out, or has great difficulty and limited ability to do so.
 Breathing, if possible, is labored, producing gasping or wheezing.
 The person has a violent and largely involuntary cough, gurgle, or vomiting noise, though
more serious choking victims will have a limited (if any) ability to produce these
symptoms since they require at least some air movement.
  The person desperately clutches his or her throat or mouth, or attempts to induce
vomiting by putting their fingers down their throat.
 If breathing is not restored, the person's face turns blue (cyanosis) from lack of oxygen.
 The person does any or all of the above, and if breathing is not restored, then becomes
unconscious.

Treatment
Choking can be treated with a number of different procedures, with both basic techniques
available for first aiders and more advanced techniques available for health professionals.

Many members of the public associate abdominal thrusts, also known as the 'Heimlich
Maneuver' with the correct procedure for choking, which is partly due to the widespread use of
this technique in movies, which in turn was based on the widespread adoption of this technique
in the USA at the time.

Most modern protocols (including those of the American Heart Association and the American
Red Cross, who changed policy in 2006[1] from recommending only abdominal thrusts) involve
several stages, designed to apply increasingly more pressure.

The key stages in most modern protocols include:

Encouraging the victim to cough

This stage was introduced in many protocols as it was found that many people were too quick to
undertake potentially dangerous interventions, such as abdominal thrusts, for items which could
have been dislodged without intervention. Also, if the choking is caused by irritating liquids
(alcohol, spice, mint, gastric acid, drugs, etc.) or anything without a solid shape, and if
conscious, the patient should be allowed to drink water on their own to try to clear the throat.
Since the airway is already closed, there is very little danger of water entering the lungs.
Coughing is normal after most of the irritant has cleared, and at this point the patient will
probably refuse any additional water for a short time.

Back slaps

The majority of protocols now advocate the use of hard blows with the heel of the hand on the
upper back of the victim. The number to be used varies by training organization, but is usually
between five and 20.

The back slap is designed to use percussion to create pressure behind the blockage, assisting the
patient in dislodging the article. In some cases the physical vibration of the action may also be
enough to cause movement of the article sufficient to allow clearance of the airway.

Almost all protocols give back slaps as a technique to be used prior to the consideration of
potentially damaging interventions such as abdominal thrusts,[2][3] but Henry Heimlich, noted for
promulgating abdominal thrusts, wrote in a letter to the New York Times that back slaps were
proven to cause death by lodging foreign objects in to the windpipe.[4]

The findings of a 1982 Yale study by Day, DuBois, and Crelin that "persuaded the American
Heart Association to stop recommending back blows for dealing with choking...was partially
funded by Heimlich's own foundation."[5] According to Roger White MD of the Mayo Clinic and
American Heart Association (AHA), "There was never any science here. Heimlich overpowered
science all along the way with his slick tactics and intimidation, and everyone, including us at the
AHA, caved in."[6]

Abdominal thrusts, also known as the Heimlich Maneuver (after Henry Heimlich, who first
described the procedure in a June 1974 informal article entitled "Pop Goes the Cafe Coronary",
published in the journal Emergency Medicine). Edward A. Patrick, MD, PhD, an associate of
Heimlich, has claimed to be the uncredited co-developer of the procedure.[7] Heimlich has
objected to the name "abdominal thrusts" on the grounds that the vagueness of the term
"abdomen" could cause the rescuer to exert force at the wrong site.[citation needed]

Performing abdominal thrusts involves a rescuer standing behind a patient and using their hands
to exert pressure on the bottom of the diaphragm. This compresses the lungs and exerts pressure
on any object lodged in the trachea, hopefully expelling it. This amounts to an artificial cough.

Due to the forceful nature of the procedure, even when done correctly it can injure the person on
whom it is performed. Bruising to the abdomen is highly likely and more serious injuries can
occur, including fracture of the xiphoid process or ribs.[8]

In some areas, such as Australia, authorities believe that there is not enough scientific evidence
to support the use of Abdominal thrusts and their use is not recommended in first aid.[9]

Self treatment with abdominal thrusts

A person may also perform abdominal thrusts on themselves by using a fixed object such as a
railing or the back of a chair to apply pressure where a rescuer's hands would normally do so. As
with other forms of the procedure, it is possible that internal injuries may result.

Other uses of abdominal thrusts

Dr. Heimlich also advocates the use of the technique as a treatment for drowning[10] and
asthma[11] attacks, but Heimlich's promotion to use the maneuver to treat these conditions
resulted in marginal acceptance. Criticism of these uses has been the subject of numerous print
and television reports which resulted from an internet and media campaign by his son, Peter M.
Heimlich, who alleges that in August 1974 his father published the first of a series of fraudulent
case reports in order to promote the use of abdominal thrusts for near-drowning rescue.[12]

Modified chest thrusts

A modified version of the technique is sometimes taught for use with pregnant women and obese
casualties. The rescuer places their hand in the center of the chest to compress, rather than in the
abdomen.

CPR

In most protocols, once the patient has become unconscious, the emphasis switches to
performing CPR, involving both chest compressions and artificial respiration. These actions are
often enough to dislodge the item sufficiently for air to pass it, allowing gaseous exchange in the
lungs.

Finger sweeping

Some protocols advocate the use of the rescuer's finger to 'sweep' foreign objects away once they
have reached the mouth. However, many modern protocols recommend against the use of the
finger sweep as if the patient is conscious, they will be able to remove the foreign object
themselves, or if they are unconscious the rescuer should simply place them in the recovery
position (where the object should fall out due to gravity). There is also a risk of causing further
damage (for instance inducing vomiting) by using a finger sweep technique.

Direct vision removal

The advanced medical procedure to remove such objects is inspection of the airway with a
laryngoscope or bronchoscope, and removal of the object under direct vision, followed by CPR if
the patient does not start breathing on their own. Severe cases where there is an inability to
remove the object may require cricothyrotomy.