Choking is defined as sudden obstruction of the upper airway, either partially or completely by foreign material, it can be solids or liquids.
Choking can present as simple cough or on the other hand complete obstruction that compromises breathing entirely leading to death within few minutes. It is a medical emergency and urgent intervention is needed usually on first aid basis to save the life of the patient.
Choking is common among two extremities of life; those who are debilitated or have impaired cough impulse due to disease are mostly in danger.
Causes can be classified broadly in to three groups:
- Mechanical obstruction – foreign body, food particles, secretions, tumors in upper airway.
- Respiratory diseases leading to upper airway obstruction (e.g. epiglottitis)
- Compression of larynx or trachea by outside
Choking due to foreign body obstruction inside pharynx/larynx is by far the commonest way and can present at any time with minimal/no prior warning. Commonly encountered scenarios are;
- Choking on large food particles obstructing larynx – commonly seen among children and drunk/mentally subnormal adults when trying to eat hastily without chewing.
- Small children putting objects in mouth unknowingly.
- A denture can slip-off and obstruct airway suddenly.
- A blow to mouth can dislodge tooth/denture or if while chewing food can be forced down airway.
Symptoms of choking:
- Sudden inability to talk
- Grab the throat with one or both hands
- Cyanosis ( turning into blue )
- In children inability to cry
- In partial obstruction: – difficulty in breathing, distinctive sound on inhaling (stridor) and vigorous attempts to cough out will be present.
First aid management of Choking
- Partial obstruction :
a) Reassure the patient and calm him/her down.
b) If the victim is able to cough, encourage him/her to cough and try to expel the foreign body.
c) Open the mouth and see whether the object is visible and can be removed safely; if so try to remove it carefully.
d) If unable to cough (e.g. children)/not relieved by cough, give blows to back (see below).
e) Obstruction may go into total anytime, keep monitoring the respiration.
f) If the obstruction is not relived soon, call for emergency services.
g) Stay with the patient until full recovery.
2. Complete obstruction:
a) Call for emergency services immediately.
b) Talk to the patient and check whether conscious or not.
c) If conscious give five back blows – for adult or older child help victim to stand or sit and ask to lean forward. Using the heel of your hand give five stiff blows in between victims’ shoulder blades.
For a baby, place him/her on your lap and keep face down while supporting babies head and give gentle back blows without harming the baby.
The mechanism of back blow is to create pressure behind the blockage and assisting patient to dislodge the foreign body. Sometimes physical vibration of the back blow is enough to clean the airway.
d) Check whether the obstruction is relived after each back blow.
- Stand behind the victim and make him slightly bend forward.
- Wrap your hands around the waist. Make a fist from your one hand and place slightly above the patients naval.
- Then grasp the fist with your other hand and press upward quickly and firmly. Do not forget to check the state of the victim after each abdominal thrust.
- Mechanism behind this maneuver is; pressure on the diaphragm compresses lungs and creates a pressure on object forcing it to dislodge from airway.
- This procedure can end up with some additional injurious to the victim like abdominal bruising and fracture of ribs and/or xiphoid process.
f) If obstruction is still not settled give back blows and abdominal thrust alternatively until the emergency medical team arrives.
g) If the victim is unconscious place him on his back with hands on either side and check airway, look at victims mouth for any visible obstruction, if so remove it quickly.
h) Check breathing and circulation and give cardio pulmonary resuscitation until the emergency services arrive.
i) For pregnant and obese individuals with choking are treated with a separate maneuver called modified chest thrust as an alternative to abdominal thrust.
- Here keep the hand on the center of the chest instead to abdomen and compress as previously.