Choking: Recognising and Responding to Airway Obstructions

by Keith -

Choking:
Recognising and Responding to Airway Obstructions

Choking occurs when the airway becomes blocked by a foreign object, preventing the person from breathing properly. Choking can happen quickly and requires immediate action to prevent serious injury or death from suffocation. Knowing how to recognise the signs of choking and how to provide first aid, including abdominal thrusts and back blows, can save a life.

What is Choking?

Choking occurs when a foreign object, such as food, a toy, or another item, becomes lodged in the airway, blocking airflow to the lungs. The lack of oxygen can quickly lead to unconsciousness, brain damage, or death if the blockage is not removed. Choking is a medical emergency that requires immediate intervention.

Causes of Choking

Choking can occur for a variety of reasons, including:

  • Eating Too Quickly: Swallowing large pieces of food without chewing properly can cause the food to become lodged in the throat.
  • Small Objects: Children are especially prone to choking on small objects like toys, coins, or buttons.
  • Improperly Chewed Food: Eating tough, dry, or improperly chewed food (like meat or bread) can lead to choking.
  • Alcohol Consumption: Consuming alcohol may impair coordination and increase the risk of choking on food.
  • Medical Conditions: Certain medical conditions, such as neurological disorders or weakened swallowing muscles, can increase the risk of choking.

Signs and Symptoms of Choking

Choking can cause different symptoms depending on whether the airway is partially or fully blocked. Signs of choking include:

Mild Airway Obstruction (Partial Blockage):

  • Coughing: The person may be able to cough forcefully, which helps to clear the blockage.
  • Wheezing or Whistling Sounds: The person may make high-pitched sounds as air struggles to pass through the partially blocked airway.
  • Breathing with Difficulty: They may be able to breathe, but with noticeable effort and distress.
  • Panic or Distress: The person may appear anxious or panicked due to the difficulty in breathing.

Severe Airway Obstruction (Complete Blockage):

  • Inability to Cough or Speak: The person may be unable to make any sound or speak due to the complete blockage.
  • Silent Struggle: They may clutch their throat or try to gesture for help but are unable to cough, speak, or breathe.
  • Bluish Skin (Cyanosis): The skin, particularly around the lips and face, may turn blue due to a lack of oxygen.
  • Loss of Consciousness: If the blockage is not removed quickly, the person may lose consciousness due to oxygen deprivation.

First Aid for Choking

The steps for providing first aid to a choking person vary depending on whether they are conscious or unconscious.

For a Conscious Adult or Child (Over 1 Year Old):

  1. Encourage the Person to Cough:
    • If the person has a mild airway obstruction and is able to cough, encourage them to continue coughing to try to dislodge the object. Do not hit their back at this stage, as it may move the object deeper into the airway.
  2. Give 5 Back Blows:
    • If the person is unable to clear the blockage with coughing or if they have a severe airway obstruction, stand behind them and give upto  5 firm back blows between their shoulder blades using the heel of your hand. Checking after each blow
    • Lean the person forward slightly so the object has a better chance of being expelled.
  3. Perform 5 Abdominal Thrusts:
    • If the back blows do not clear the blockage, stand behind the person, wrap your arms around their waist, and place a fist just above their navel (belly button).
    • Grasp your fist with your other hand and give up to 5 quick, inward and upward abdominal thrusts. These thrusts are designed to create enough pressure to force the object out of the airway. Check after each thrust to see if the item has been dislodged
    • Repeat the cycle of 5 back blows and 5 abdominal thrusts until the object is dislodged or the person becomes unconscious.

For an Unconscious Adult or Child (Over 1 Year Old):

  1. Call 999 Immediately:
    • If the person becomes unconscious, call 999 immediately for emergency help.
  2. Begin CPR:
    • Begin CPR with chest compressions, even if you suspect the airway is still blocked. Chest compressions may help dislodge the object.
      • Place your hands in the centre of the chest and give 30 chest compressions at a rate of 100-120 compressions per minute.
      • Open the airway and check for the object after every set of compressions. If you can see the object, attempt to remove it, but be careful not to push it deeper into the airway.
      • Give 2 rescue breaths if the object is removed, and continue CPR until emergency help arrives.

For a Conscious Infant (Under 1 Year Old):

  1. Give 5 Back Blows:
    • Sit down and hold the infant face-down along your forearm, supporting their head and neck. Use the heel of your hand to give up to 5 firm back blows between the infant’s shoulder blades.
  2. Give 5 Chest Thrusts:
    • Turn the infant face-up, still supporting their head. Using two fingers, give up to 5 quick chest thrusts in the centre of their chest, just below the nipple line.
  3. Repeat the Cycle:
    • Continue alternating between 5 back blows and 5 chest thrusts until the object is dislodged or the infant becomes unconscious.

For an Unconscious Infant (Under 1 Year Old):

  1. Call 999 Immediately:
    • Call 999 immediately if the infant becomes unresponsive.
  2. Begin Infant CPR:
    • Begin CPR with 30 chest compressions using two fingers in the centre of the chest. Check for the object in the mouth after every set of compressions. If you can see the object, remove it carefully.
    • Give 2 rescue breaths and continue CPR until help arrives or the object is dislodged.

When to Seek Medical Help

You should always seek medical help after a choking incident, even if the object is expelled, to ensure there are no lingering complications:

  • Call 999 if the person cannot speak, breathe, or loses consciousness.
  • Seek medical attention if the person continues to have difficulty breathing or if abdominal thrusts or back blows were performed, as internal injuries can occur.
  • If the person has fainted, is unconscious, or has chest pain, call 999 immediately.

Prevention of Choking

  • Chew Food Thoroughly: Encourage people to take small bites and chew food properly before swallowing.
  • Keep Small Objects Away from Children: Small toys, buttons, coins, and other objects should be kept out of reach of young children, as they are a common cause of choking.
  • Supervise Mealtimes: Always supervise young children while they are eating, and avoid giving them foods that can easily block the airway, such as whole grapes, hard sweets, and nuts.
  • Avoid Talking While Eating: Discourage talking, laughing, or moving around while eating, as this increases the risk of choking.

Key Points to Remember

  • Encourage the person to cough if they have a partial blockage. If they cannot breathe or cough, begin back blows and abdominal thrusts.
  • If the person becomes unconscious, call 999 immediately and begin CPR.
  • Infants require special care, with back blows and chest thrusts used to clear the airway.
  • Always seek medical attention after a choking incident, even if the object is expelled.

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