Choking

 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 anoxia and is
potentially fatal. Oxygen stores in the blood and lungs
keep the victim alive for several minutes after breathing
is stopped completely.[1]
 Choking can be caused by:
 Physical obstruction of the airway by a foreign body.
 Respiratory diseases that involve obstruction of the
airway.
 Compression of the laryngopharynx, larynx or trachea
Foreign objects
 The type of choking most commonly
recognised as such by the public is the lodging
of foreign objects (also known as foreign
bodies, but consisting of any object which
comes from outside the body itself, including
food, toys or household objects) in the airway. [2]
 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.[3] In adults, it mostly occurs whilst the
patient is eating. In one study, peanuts were
the most common obstruction.[4]
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
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 United States at the time.
 Most modern protocols (including those of the American
Heart Association and the American Red Cross, who
changed policy in 2006[5] 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 an irritating substance rather
than an obstructing one, 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
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.
 Almost all protocols give back slaps as a
technique to be used prior to the
consideration of potentially damaging
interventions such as abdominal thrusts, [6][7]
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.[8]
Abdominal thrusts
Abdominal thrusts, also known as theHeimlichManeuver
 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.
 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.
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.
Modified chest thrusts
 A modified version of the technique is
sometimes taught for use with pregnant
and/or obese patients. The rescuer places their
hand in the center of the chest to compress,
rather than in the abdomen.
Finger sweeping
 The American Medical Association advocates sweeping
the fingers across the back of the throat to attempt to
dislodge airway obstructions, once the choking victim
becomes unconscious
 Some protocols advocate the use of the rescuer's finger
to 'sweep' foreign objects away once they have reached
the mouth.[citation needed] 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.