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Choking / Airway obstruction


Reporters ;
1- SOTOUDEH , MARYAM 2- AZIZI, NAVID 3- AMINKHAH, SOHEIL 4- ROSTAMKHANI, SIMIN 5- MELAT ARDEKHANI, HAMIDREZA

Information On Choking
Almost 4,000 deaths occur each year. Choking is respiratory distress that occurs when the airway is partially or totally obstructed by the foreign body or the tongue (most cause )

Airway obstruction
Trauma
foreign bodies inflammation hematomas

CNS disease
secretions

Drug overdose Infections


glottitis

Obstructive sleep apnea

Foreign bodies
Types- inorganic or organic. - Inorganic materials -plastic or metal eg; beads and small parts from toys. - Organic foreign bodies including: food, rubber, wood, and sponge, - more irritating to the nasal mucosa and thus may produce earlier symptoms.

Etiology
They lack molars for proper grinding of food. They tend to be running or playing at the time of aspiration

They tend to put objects in their mouth more frequently.


They lack coordination of swallowing and glottis closure.

Foreign Body Aspiration


Complete airway obstruction
Respiratory distress Inability to speak or cough

Partial airway obstruction


Coughing Gagging Throat clearing Back blows/probing hypopharynx not recommended

Foreign Body Airway Obstruction in Adults


Airway obstruction may be caused by:
Relaxation of throat muscles Vomited stomach contents Blood Damaged tissue

Dentures
Foreign bodies

In adults, usually occurs during a meal.

In children, usually occurs during a meal or at play.


Patient with mild airway obstruction is able to exchange air but with signs of respiratory distress.

Signs and Symptoms


Decreased or absent breath sounds Stridor Retractions Difficulty speaking

Signs of Severe Airway Obstruction


Signs and symptoms
Ineffective cough (no sound) Inability to cry Increasing respiratory difficulty, with stridor Cyanosis (blueness of lip/nail bed) Loss of consciousness - Showing Universal Sign of choking (victim clutches his neck between his thumb and index finger)

Removing a Foreign Body Airway Obstruction


In unconscious patient, suspect obstruction if maneuvers to open airway and ventilate are ineffective. Abdominal-thrust maneuver (Heimlich) is recommended in conscious adults and children older than 1 year.

How to Stop Choking With Adults and Teenagers


Wrap your arms around the persons waste. Next put your thumb side of your wrist against the midline of the persons abdomen and the ribcage. Grasp your fist with your other hand and apply pressure inward and toward the persons diaphragm in one smooth movement. Do it 5 times. Monitor the victim after the item is dislodged.

How to Stop Choking With Infants and Young Children


Hold the child down on your forearm with the head lower than your knee. Put support on the childs head. Put your hand on their lower jaw and chest. Give the child 4 gentle blows with the heel of your hand. Turn the victim on your thigh. Give 4 slow distinct chest thrust on the middle of the victims chest. Press your index finger right between there chest.

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 twenty. 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.

Abdominal thrusts
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.

Abdominal thrusts, also known by the proprietary name the Heimlich maneuver

Instead of abdominal-thrust maneuver (Heimlich), use chest thrusts in:


Women in advanced stages of pregnancy Very obese patients

The rescuer places their


hand in the center of the chest to compress, rather than in the abdomen.

When victim is found unconscious:


Determine unresponsiveness. Open airway. Attempt ventilation. Perform 30 compressions, open airway, and look in mouth.
Attempt to carefully remove any visible object.

Foreign Body Airway Obstruction in Infants and Children


Common problem
On conscious, standing or sitting child, perform Heimlich maneuver.

In an unconscious child:
Place the child on a firm, flat surface.

Open airway using head tilt-chin lift maneuver.


Inspect the upper airway and remove any visible object.

If unsuccessful, reposition head and try again.


If ventilation is still unsuccessful begin CPR.

Place heel of one hand on lower half of sternum between the nipples. Administer 30 chest compressions at a depth of 1/3 to 1/2 the depth of the chest.

In a conscious child:
Kneel behind the child. Give the child five abdominal thrusts. Repeat the technique until object comes out.

Management of Airway Obstruction in Infants


Hold the infant facedown. Deliver five back slaps. Bring infant upright on the thigh. Give five quick chest thrusts. Check airway. Repeat cycle as often as necessary.

Treatment

Infants under 1 year of age: A combination of 5 back blows (with the flat of the hand) and 5 abdominal thrusts (with 2 fingers on the upper abdomen).

How can I clear my own airway if I am alone and choking?

If you are alone and choking, bend over and press your abdomen against any firm object, such as the back of a chair, a railing or the kitchen sink.

Do not bend over anything with a sharp edge or corner that might hurt you, and be careful when leaning on a rail that is elevated.

Alternatively, give yourself abdominal thrusts, using your hands, just as if you were administering the abdominal thrusts to another person.

Finger sweeping
the fingers across the back of the throat to attempt to dislodge airway obstructions, once the choking victim becomes unconscious.
Do tongue-jaw lift and remove foreign body if you can see it

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.

COMPONENTS OF CPR
The skill of cardiopulmonary resuscitation consists of three parts:

A (airway) skills. B (breathing) skills. C (circulation) skills.

To perform CPR, you must combine the airway and breathing skills with the circulation skills. You do this by checking for a pulse. If there is no pulse, you must correct the patient's circulation by performing external chest compressions. The airway and breathing components push oxygen into the patient's lungs. The external chest compressions move the oxygenated blood through the body. External chest compressions are done by depressing the patient's sternum (breastbone). This causes a change in the pressure of the patient's chest and causes enough blood to flow to sustain life for a short period of time.