Choking - unconscious adult or child over 1 year

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Alternative names
Heimlich maneuver - unconscious adult or child over 1 year

Definition
Choking is the stoppage or hindrance of breathing by obstruction of the throat or windpipe.

Considerations

Without oxygen, the brain begins to die within 4 to 6 minutes. Rapid first aid for choking can save a life.

Following the expulsion of the object that caused the choking, keep the victim still and get medical help. All choking victims should have a medical examination, since complications can arise not only from the choking incident, but also from the first aid measures that were taken.

Occasionally an object will enter the lung instead of being expelled. While the victim may appear to improve and breathe normally, in a few days signs and symptoms of a foreign body in the lung, such as wheezing, persistent cough, and pneumonia, may develop. If this happens, get medical help immediately.

Causes

• Eating (especially eating and laughing at the same time, eating with improperly fitted dentures, eating too fast, and failing to chew food well enough)
  
• Alcohol consumption (even a small amount of alcohol affects awareness)
  
• Trauma to the head and face (swelling or bleeding can cause choking)
  
• Small objects swallowed by young children

Symptoms

• Unconsciousness
  
• Inability to talk
  
• Lack of breathing
  
• Inability to move air into the lungs with mouth-to-mouth resuscitation
  
• Bluish discoloration of the lips and nails

First Aid

1. Roll the victim onto their back on a hard surface, keeping their back in a straight line, firmly supporting their head and neck. Expose the victim’s chest.

2. Open the victim’s mouth with your thumb and index finger, placing your thumb over his tongue and your index finger under his chin. If the object is visible and loose, remove it. If the person is older than age 8, sweep two fingers from one side of the throat to the other to attempt to remove the object.

3. Lift the victim’s chin while tilting the head back to move the tongue away from the windpipe. If a spinal injury is suspected, pull the jaw forward without moving the head or neck. Don’t let the mouth close.

4. Place your ear close to the victim’s mouth and watch for chest movement. For 5 seconds, look, listen, and feel for breathing.

5. If the victim is breathing, give first aid for unconsciousness.

6. If the victim is not breathing, begin rescue breathing. Maintain the head position, close the victim’s nostrils by pinching them with your thumb and index finger, and cover the victim’s mouth tightly with your mouth. Give two slow, full breaths, with a pause in between.

7. If the victim’s chest does not rise, reposition the head and give two more breaths.

8. If the victim’s chest still doesn’t rise, begin abdominal thrusts, as follows. Kneel at the victim’s feet or astride the thighs (or to the side if the victim is obese or pregnant). Place the heel of your hand in the middle of the abdomen just above the navel, well below the tip of their breastbone. (If the victim is obese or pregnant, place the heel of your hand in the middle of the victim’s breastbone. Do not place your hand on the ribs or on the tip of the breastbone.) Place your other hand on top of the first hand.

9. Give five quick thrusts, pressing your hands inward and upward. Do not press to either side. Each thrust is a separate attempt to clear the victim’s airway by forcing air out through the windpipe.

10. Open the victim’s mouth with your thumb and index finger. If the object is visible and loose, remove it. Observe the victim’s breathing. If the person is older than age 8, sweep two fingers from one side of the throat to the other to attempt to remove the object.

11. If the object is not dislodged, give two breaths, then five abdominal thrusts, and then check for the object. Repeat this sequence until the object is dislodged or help arrives.

12. If the object is removed, but the victim has no pulse, begin CPR with chest compressions.

13. If the victim starts having convulsions or seizures, give first aid for this problem (see convulsion, first aid).

Do Not

• DO NOT try to grasp an object that is lodged in the victim’s throat. This might push it farther down the airway. If the object is visible in the mouth, it may be removed.
  
• DO NOT begin the chest compressions of CPR (if heartbeat has stopped) until the airway is cleared.

Call immediately for emergency medical assistance if

• a person if found unconscious.

If you are not alone, have one person call the local emergency number while another person begins CPR. If you are alone, shout for help. If you are trained in CPR, call the local emergency number and then administer CPR.

Prevention

• Eat slowly and chew food thoroughly.
  
• Make sure dentures fit properly.
  
• Avoid excessive alcohol consumption before or during eating.
  
• Keep small objects away from young children.