choking

Etiology

• trapping of a foreign object (generally food) at the back of the throat blocking the airway or causing muscle spasm

Clinical manifestations

symptoms

• difficulty speaking
• trouble breathing

signs of mild airway obstruction:

• good air exchange
• forceful cough
• wheezing during coughs , signs of severe airway obstruction:
• poor or no air exchange
• Weak, ineffective cough or no cough at all
• high-pitched noise while inhaling or no noise at all
• difficulty breathing or unable to breath
• cyanosis (face turn a gray-blue color)
• unable to speak
• universal choking sign (clutching neck with thumb & fingers)

Management

choking adult of child

• ask "are you choking?"
• if victim can speak or cough, no need to treat (observe)
• if unable to speak or cough, obtain consent (if possible)
• begin Heimlich maneuver
• discontinue Heimlich maneuver if victim can speak, cough or loses consciousness
• if victim loses consciousness, call 911
  • lay victim supine on floor/ground
  • depress tongue with thumb, lift jaw, look in mouth
    • remove foreign object from mouth with index finger of other hand
    • do NOT blindly sweep the victim's throat
  • open airway with head tilt, chin lift
  • attempt to ventilate
  • if ventilation unsuccessful (chest does not rise). reposition head & make 2nd attempt to clear throat & ventilate
  • if 2nd attempt to ventilate unsuccessful, begin chest compressions
  • 15 compressions for adult, 5 for child 1-7 years of age
  • make another attempt to clear the throat & ventilate
  • discontinue compressions when the object is ejected, ventilation is successful, or if victim able to breathe independently
  • place revived victim in recovery position

choking infant

• obtain consent (if possible)
• place baby face down on forearm, support head & chest
• tilt head downward (use gravity)
• give 5 blows to back with heel of palm
• turn baby over & look in mouth
• remove foreign object with index finger
• do NOT blindly sweep back of throat
• with infant now supine, use 2 fingers to give 5 compressions as in CPR
• check baby's mouth again
• repeat sequence 3 times before calling 911