Choking

Treatment

• The treatment for a choking person who begins to turn blue or stops breathing varies with the person’s age. In adults and children older than one year of age, abdominal thrusts (formerly referred to as the “Heimlich maneuver”) should be attempted. This is a thrust that creates an artificial cough. It may be forceful enough to clear the airway.
• The quick, upward abdominal thrusts force the diaphragm upward very suddenly, making the chest cavity smaller. This has the effect of rapidly compressing the lungs and forcing air out. The rush of air out will force out whatever is causing the person to choke.

How to perform abdominal thrusts

• Lean the person forward slightly and stand behind him or her. Make a fist with one hand. Put your arms around the person and grasp your fist with your other hand in the midline just below the ribs. Make a quick, hard movement inward and upward in an attempt to assist the person in coughing up the object. This maneuver should be repeated until the person is able to breathe or loses consciousness.
• If the person loses consciousness gently lay him or her flat on their back on the floor. To clear the airway, kneel next to the person and put the heel of your hand against the middle of the abdomen, just below the ribs. Place your other hand on top and press inward and upward five times with both hands. If the airway clears and the person is still unresponsive, begin CPR.

For babies (younger than one year of age), the child will be too small for abdominal thrusts to be successful. Instead, the infant should be picked up and five back blows should be administered, followed by five chest thrusts. Be careful to hold the infant with the head angled down to let gravity assist with clearing the airway. Also be careful to support the infant’s head. If the infant turns blue or becomes unresponsive, CPR should be administered.

If you are in doubt about what to do, and you are witnessing someone choking, call for emergency help immediately, do not delay. You may be able to successfully stop the choking before help arrives using techniques discussed here, but it is best for the choking person to be evaluated by the emergency medical team when they arrive. If something is still in the person’s throat, the emergency medical team can begin care immediately and take the person to the hospital for further treatment.

Variations of abdominal thrusts for special circumstances:

• The victim is seated: The maneuver may be performed with the victim seated. In this instance, the back of the chair acts as a support for the victim. The rescuer still wraps his or her arms around the victim and proceeds as described above. The rescuer will often have to kneel down. In the event that the back of the chair the victim is sitting in is too high, either stand the victim up or rotate the victim 90 degrees, so that the back of the chair is now to one side of the victim.
• For small rescuers and large victims, particularly children rescuing an adult: Instead of standing behind the victim, have the victim lie down on his or her back. Straddle the victim’s waist. Place one hand on the belly, halfway between the belly button and the edge of the breastbone. Thrust inward and upward. This is the same technique used in unconscious people.

You are choking and you are alone: You may deliver an abdominal thrust on yourself. This can be done in one of two ways.

• You can deliver a true “self”-abdominal thrust with your own hands. This is done by positioning your hands in the same fashion as if you were performing the maneuver on another person and delivering an inward and upward thrust.
• Another option is to bend your belly over a firm object, such as the back of a chair, and thrust yourself into the object.
• You may pass out before you expel the object and before help arrives. In most communities, the 911 emergency system has what is known as enhanced 911. Whenever a call is placed through 911 to the dispatch center, the dispatcher has the phone number, address of the telephone, and owner of the line of the incoming call. This allows for rapid location of an incident and allows interrupted calls to be investigated.
• By dialing 911 and leaving the phone line open in communities where this protocol is followed, you could be ensuring the arrival of rescue personnel in the event your “self”-abdominal thrust fails to clear the foreign body and you do pass out. If the dispatcher has no response on an open line, the call must be investigated.
• Check with your local police department and find out if your 911 dispatch center follows these procedures. If you live in a community that does not have a 911 system, check with your local police department both for the emergency number, and to find out if they follow these procedures.

Pregnant/obese people: Abdominal thrusts may not be effective in people who are in the later stages of pregnancy or who are obese. In these instances, chest thrusts can be administered. For the conscious person sitting or standing, take the following steps:

• Place your hands under the victim’s armpits.
• Wrap your arms around the victim’s chest.
• Place the thumb side of your fist on the middle of the breastbone.
• Grab your fist with your other hand and thrust backward. Continue this until the object is expelled or until the person becomes unconscious.

For the unconscious pregnant or obese person: The sequence of events is the same as those for an unconscious adult. Chest thrusts, rather than abdominal thrusts, are delivered. To position yourself for chest thrusts, take the following steps:

• Kneel on one side of the victim.
• Slide two fingers up the bottom edge of the rib cage until you reach the bottom edge of the breastbone called the xiphoid process.
• With your two fingers on the xiphoid, place your other hand on the breastbone, just above your fingers. The thrusts should be quick and forceful to remove the object.
• Care should be taken because complications such as rib fractures and heart muscle damage have been known to occur with chest thrusts.
• If at all possible, subdiaphragmatic (below the ribcage) abdominal thrusts should be used in the pregnant woman, especially if there is still room between the enlarging uterus and baby, and the rib cage to perform the maneuver.

Choking is a blockage of the upper airway by food or other objects, which prevents a person from breathing effectively. Choking can cause a simple coughing fit, but complete blockage of the airway may lead to death.

Breathing is an essential part of life. When we inhale, we breathe in a mix of nitrogen, oxygen, carbon dioxide, and other gases.

• In the lungs, oxygen enters the bloodstream to travel to the rest of the body. Our bodies use oxygen as a fuel source to make energy from the food we eat. Carbon dioxide, a waste product, enters the bloodstream and travels back to the lungs.
• When we exhale, we breathe out carbon dioxide, nitrogen, and oxygen.
• When someone is choking with a completely blocked airway, no oxygen can enter the lungs. The brain is extremely sensitive to this lack of oxygen and begins to die within four to six minutes. It is during this time that first aid must take place. Irreversible brain death occurs in as little as 10 minutes.

What Causes Choking?

Choking is caused when a piece of food or other object gets stuck in the upper airway.

• In the back of the mouth are two openings. One is the esophagus, which leads to the stomach; food goes down this pathway. The other is the trachea, which is the opening air must pass through to get to the lungs. When swallowing occurs, the trachea is covered by a flap called the epiglottis, which prevents food from entering the lungs. The trachea splits into the left and right mainstem bronchus. These lead to the left and right lungs. They branch into increasingly smaller tubes as they spread throughout the lungs.
• Any object that ends up in the airway will become stuck as the airway narrows. Many large objects get stuck just inside the trachea at the vocal cords.

In adults, choking most often occurs when food is not chewed properly. Talking or laughing while eating may cause a piece of food to “go down the wrong pipe.” Normal swallowing mechanisms may be slowed if a person has been drinking alcohol or taking drugs and if the person has certain illnesses such as Parkinson’s disease.

• In older adults, risk factors for choking include advancing age, poorly fitting dental work, and alcohol consumption.
• In children, choking is often caused by chewing food incompletely, attempting to eat large pieces of food or too much food at one time, or eating hard candy. Children also put small objects in their mouths, which may become lodged in their throat. Nuts, pins, marbles, or coins, for example, create a choking hazard.