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Choking

 

 

 

 Choking Overview

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Breathing is an essential part of life.

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

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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. Without oxygen, the brain begins to die within 4-6 minutes. It is during this time that first aid must take place. Irreversible brain death occurs in as little as 10 minutes.

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Choking is among the true medical emergencies that require fast, appropriate action by anyone who is available. Emergency medical teams may not arrive in time to save the choking person's life.
 

 

 

                                

 

                       The abdominal thrust                                                   Pat on back to remove foreign body

 

 

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If a person is choking, you should not interfere as long as he is coughing.

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If coughing does not dislodge the object from the trachea and the victim is breathing with extreme difficulty, or if he turns a bluish color and appears to be choking but is unable to cough or speak, quickly ask, "Are you choking?" A choking victim can nod his head "yes," but will be unable to talk. It is important to ask this question because a person suffering from a heart attack will have similar symptoms, but he will be able to talk.

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Someone who cannot answer by speaking and can only nod the head has a complete airway obstruction and needs emergency help.

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The treatment for a choking person who begins to turn blue or stops breathing varies with the person's age.

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In adults and children older than 1 year, the Heimlich maneuver should be attempted. This is an abdominal thrust that creates an artificial cough. It may be forceful enough to clear the airway.

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The quick, upward thrust of the Heimlich maneuver forces 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.

 

 

 The abdominal thrust (Heimlich maneuver)

 If the victim is chokingÖ. 

 

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Stand behind him with your arms around his waist.

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Place one fist, with the knuckle of the thumb against the victim's midsection, slightly above the navel but well below the breastbone.

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Hold your fist firmly with the other hand and pull both hands sharply toward you with an upward-and-inward jab.

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This procedure should be administered continually until either the object is forced out or the victim becomes unconscious.

Due to the force with which the abdominal thrust is given, it should be used only in an actual emergency. 

 Pat on back to remove foreign body 

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In case of choking due to foreign body, tap on back mid chest in prone position. foreign body may  come out

 

 Choking in small babies

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Hold baby upside down, holding by legs and pat firmly at the back. This will dislodge the foreign body responsible for choking.

 

 

 

 Choking in adults
 

 

                    

    Sub Diaphragmatic abdominal thrusts                   Chest thrusts.                                                   CPR

 

             (Heimlich maneuver)                                                              (Cardiopulmonary resuscitation)

 

 

 If you observe an "conscious" adult choking:

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Ask, "Are you choking?"

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If the victim can speak, cough, or breathe, do not interfere. It is best not to do anything if the person is coughing forcefully and not turning a bluish color. Ask, "Are you choking?" If the person is able to answer you by speaking, it is a partial airway obstruction. Stay with the person and encourage him or her to cough until the obstruction is cleared. Do not attempt to hit the person on the back because this may only hamper the person's attempts to cough up the object. Do not give the person anything to drink because fluids may take up space needed for the passage of air.

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If the victim cannot speak, cough, or breathe, give sub diaphragmatic abdominal thrusts (the Heimlich maneuver) until the foreign body is expelled or the victim becomes unconscious. (Or in case of extreme obesity or late pregnancy, give chest thrusts.)

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Be persistent.

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Continue uninterrupted until the obstruction is relieved or advanced life support is available.

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In either case the victim should be examined by a physician as soon as possible.

 

     

      




   Choking in children above 1 yr
 

 

   

 

 

 Conscious Child (over 1 year old)
 To dislodge an object from the airway of a child:
 

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Perform sub diaphragmatic abdominal thrusts (the Heimlich maneuver) as described for adults.
 

 

 Unconscious Child

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If the child becomes unconscious, Continue as for an adult, except

DO NOT PERFORM BLIND FINGER SWEEP IN CHILDREN UP TO 8 YEARS OLD.
Instead, perform a tongue-jaw lift and remove foreign body ONLY IF VISUALIZED.

Note: Abdominal thrusts are not recommended in infants. Blind finger sweeps should not be performed on infants or small children

 

When there are signs of choking in an INFANT or CHILD 

IF...
the infant or child is breathing and continues to be able to speak or cough

THEN...
do not interfere, but take to an advanced life support facility

IF...
the infant or child has a fever and a history of illness (the air passages may be swollen)

THEN...
transport immediately to an emergency care facility

IF...
the infant or child has ineffective coughing, high pitched inspirations, and the inability to speak or cry,

THEN...
immediately begin the obstructed airway sequence described below.

 

 

  Choking in children below 1 yr

 

 

 

Cardiopulmonary resuscitation in Unconscious infant
 

 

 Unconscious Infant:

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Call for help, or if others respond, call emergency number.

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Perform tongue-jaw lift. If foreign body is visualized, remove it.

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Open the airway (head-tilt/chin-lift), and attempt rescue breathing.

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Perform 4 back blows, then 4 chest thrusts.

 

 If foreign body is not removed, persist with this sequence:

  • Attempt to visualize,

  • Attempt rescue breathing,

  • Give back blows,

  • Give chest thrusts until successful.

  • If foreign body is removed and victim is not breathing, begin the ABC's of CPR (cardiopulmonary resuscitation):
     

  1. AIRWAY -open the airway;

  2. BREATHING -if still no breaths, attempt rescue breathing.

  3. CIRCULATION -if no pulse, perform chest compressions.

 

   When successful, have victim examined by physician as soon as possible.
 

 

 

                               

4 Back Blows and 4 Chest Thrusts in conscious infant

 

 

 Conscious Infant (under 1 year old)
 

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4 Back Blows and 4 Chest Thrusts
 

 

 To dislodge an object in the airway of an infant:
 Procedure

 

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Supporting the head and neck with one hand, straddle infant face down, head lower than trunk, over your forearm, supported on your thigh.

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Deliver four back blows, forcefully, with the heel of the hand between the infant's shoulder blades.

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Immediately, while supporting the head, sandwich the infant between your hands and turn onto its back, head lower than trunk, Using 2 fingers, deliver four thrusts in the sternal region.

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Repeat both back blows and chest thrusts until foreign body is expelled or the infant becomes unconscious.

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Finger position for chest thrusts: Depress the sternum 1/2 to 1 inch for each thrust. Avoid the tip of the sternum.

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Alternate method: Lay the infant face down on your lap, head lower than trunk, and firmly supported. Perform 4 back blows, turn infant as a unit to the supine position, and perform 4 chest thrusts.
 


 

Prevention tips

Adults:

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Cut food into small pieces.

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Chew food slowly and thoroughly, especially if wearing dentures.

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Avoid laughing and talking during chewing and swallowing.

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Avoid excessive intake of alcohol before and during meals.

 

Infants and Children:

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Keep marbles, beads, thumbtacks, and other small objects out of their reach and prevent them from walking, running, or playing with food or toys in their mouths.

 

 

 Choking Causes

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

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Here's how and why choking occurs: In the back of the mouth are 2 openings. One is the esophagus, which leads to the stomach. Food goes down this pathway. The other is the trachea, which is the opening that 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.

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Any object that winds 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

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When food is not chewed properly.

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Talking or laughing while eating may cause a piece of food to "go down the wrong pipe."

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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 disease.

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In older adults, risk factors for choking include advancing age, poorly fitting dental work, and alcohol consumption.

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Sometimes a person choking in a restaurant is thought to be having a heart attack, when, in fact, the person has food stuck in his or her throat. Choking has nothing to do with a heart attack, but the term cafe coronary is still commonly used to refer to someone choking on food.


 In children, choking is often caused by

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Chewing food incompletely,

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Attempting to eat large pieces of food or too much food at one time, or

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Eating hard candy.

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Children also put small objects in their mouths, which may become lodged in their throat. Nuts, pins, or coins, for example, create a choking hazard.


 

 Choking Symptoms

 If an adult is choking, you may observe the following behaviors:
 

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Sudden inability to talk

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Clutching the throat: The natural response to choking is to grab the throat with one or both hands. This is the universal choking sign and a way of telling people around you that you are choking.

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Hand signals and panic

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Wheezing

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Coughing

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Passing out

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Turning blue: Cyanosis, a blue coloring to the skin, can be seen earliest around the face, lips, and fingernail beds. You may see this, but other critical choking signs would come first.


If an infant is choking, more attention must be paid to an infant's behavior. They cannot be taught the universal choking sign.
 

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Difficulty breathing

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Weak cry or weak cough or both

 


 How to perform the Heimlich maneuver

 Conscious adults

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Lean the person forward slightly and stand behind him or her.

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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.

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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.

 

 Unconscious adults

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If the person loses consciousness, gently lay him or her flat on their back on the floor.

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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.

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Place your other hand on top and press inward and upward 5 times with both hands.

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If the airway clears and the person is still unresponsive, begin CPR.


 Infants less than 1 yr.

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For babies (younger than 1 year), the child will be too small for the Heimlich maneuver to be successful.

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Instead, the infant should be picked up and 5 back blows should be administered, followed by 5 chest thrusts.

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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.

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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 ambulance crew when they arrive. If something may still be 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 the basic Heimlich maneuver for special circumstances


 The victim is seated:

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The maneuver may be performed with the victim seated.

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In this instance, the back of the chair acts as a support for the victim.

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The rescuer still wraps his or her arms around the victim and proceeds as described.

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The rescuer will often have to kneel down.

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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:

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Instead of standing behind the victim, have the victim lie down on his or her back.

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Straddle the victimís waist.

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Place one hand on the belly, halfway between the belly button and the edge of the breastbone.

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Thrust inward and upward.

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This is the same technique used in unconscious people.


 You are choking and you are alone:

 You may deliver a Heimlich maneuver on yourself. This can be done in one of 2 ways.

 

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You can deliver a true "self"-Heimlich 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.

 

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Another option is to bend your belly over a firm object, such as the back of a chair, and thrusting yourself into the object.

 

Pregnant/obese people:

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If at all possible, sub diaphragmatic abdominal thrusts should be used in the pregnant woman, especially if there is still room between the enlarging uterus and the rib cage to perform the maneuver.

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Abdominal thrusts may not be effective in people who are in the later stages of pregnancy or who are obese.

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In theses instances, chest thrusts can be administered. For the conscious person sitting or standing, take the following steps:

  • Place your hands under the victimís armpits.

  • Wrap your arms around the victimís 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:

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The sequence of events is the same as those for an unconscious adult.

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Chest thrusts, rather than abdominal thrusts, are delivered.

 

 To position yourself for chest thrusts, take the following steps:

 

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Kneel on one side of the victim.

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Slide 2 fingers up the bottom edge of the rib cage until you reach the edge of the breastbone called the xiphoid process.

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With your 2 fingers on the xiphoid, place your other hand on the breastbone, just above your fingers.

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The thrusts should be quick and forceful to remove the object.

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Care should be taken because complications such as rib fractures and heart muscle damage have been known to occur with chest thrusts.

 

 Emergency medical help procurement policies and procedures:

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You may pass out before you expel the object and before help arrives.

 

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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.

 

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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"-Heimlich maneuver 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.

 

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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 for both the emergency number, and to find out if they follow these procedures.
 

 

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