This week on DD First Aid, we address the issue of choking. Aiden Thompson of Donegal Safety Training Solutions examines all aspects of what can be a life or death situation.
Choking is a life-threatening emergency that can kill within minutes. We have all probably had a near miss ourselves at some point in our lives or we know someone who needed some intervention whenever they began choking in a restaurant or during a lunch break.
So what is choking?
Choking occurs whenever a person’s airway is fully blocked by an object which prevents them from breathing. If you are sitting reading this article now, I would invite you to take a deep breath and try to hold your breath for as long as possible. If you are very fit you may be able to hold your breath for over a minute. If you are unfit then your breath hold will be significantly shorter. So why are we doing this exercise?
When someone chokes, they don’t plan to do it, they don’t take a deep breath beforehand and sit comfortably while they are not breathing. They panic. They panic because they cannot breathe and they know they are in serious imminent danger of dying. When the casualty panics what often happens is that a parent/ guardian or bystander who witnesses this incident also panics and tries to intervene as best as they can. However, sometimes we choose to do can potentially make the casualties condition worse.
What should we do if we suspect that someone is choking?
Our first immediate step is to always ensure that we are safe!
This person may have a sharp steak knife in their hands or there could be scaling liquids or broken glass or delph in the area. Once we are happy we are safe to continue, we ask the person 4 simple questions.
1. Are you choking?
2. Can you cough?
3. Can you speak?
4. Can you breathe?
If the person answers YES to any of these questions, they are not choking!
However they may have a partial airway blockage which is very uncomfortable and requires our attention. In this instance most people will give back slaps or attempt the Heimlich manoeuvre on the casualty, but we should not do this! The danger here is that we might cause the partial blockage to move and become a complete airway blockage, therefore making the condition much more serious and potentially life threatening.
So what should we do for a partial airway blockage?
In the event a person tells us that they are choking, if they are coughing and breathing, we simply encourage the casualty to sit down, leaning slightly forward. Ask them to take a slow deep breath and try to forcefully cough the object out. Repeat this several time until successful or we realise that the object is well and truly lodged in the airway. If the person cannot clear their own airway, we simply call the emergency services and try to keep the casualty calm and reassured that help is on its way. Once the emergency services arrive, they will assess the casualty at the scene and will transport the casualty to hospital in order for the doctors in A+E or Resus to remove the partial blockage in a controlled environment with ample medical staff and equipment, should it become necessary or required.
What should we do if it really is a choking incident?
Remember to ensure your own safety and ask the above questions to determine if they really are choking. Someone who really is choking cannot cough, breath or speak because they cannot shift air past the blockage. They often hold their hands up to their neck, their colour changes and they appear in distress. A person may also run to the bathroom because they are afraid of getting sick in front of others. If you are ever concerned in this situation follow the person to the bathroom and check that they are ok. This person is now in a life-threatening situation that will kill them if we do not intervene.
1. Encourage the person to stand up and lean forward. Support them with your hand.
2. With your dominant hand we are going to deliver 5 solid back blows between the shoulder blades. Remember we must use enough force to dislodge this object, being gentle on the casualty at this point is not helping them. Give solid back blows that may dislodge the object. If you are an adult doing this on a child, use enough force proportional to the size of the choking child. If after 5 solid back blows the object does not become dislodged, we need to become even more aggressive and do the Heimlich manoeuvre.
3. We go behind the casualty and feel their tummy for their belly button. This is what we call a land-mark site because it sits just below the Diaphragm muscle which we use to breathe. Place one finger into the belly button and place your other fist above the finger in the belly button. Once we have the hand over the Diaphragm, we take the finger away from the belly button and clasp the fist above. Lean the person forward and pull inwards and upwards forcing the Diaphragm up. This is a very successful technique in most instances and the person will often cough up the choking object or get sick, which means we have cleared their airway and they can now breath again.
What if the Heimlich Manoeuvre doesn’t work or we are too late and the casualty has already collapsed?
If a person collapses in our arms or we are told they have choked and collapsed, call for help and ask for a defibrillator immediately and place your phone on loud speaker. Begin CPR by delivering 30 chest compressions in the centre of the breastbone. By doing compressions we are also compressing the lungs and are forcing 30 jets of the residual air trapped in the lungs up the persons airway. If we are lucky this will be enough to make the person cough up the object or possibly get sick. If this happens immediately place them onto their side to protect their airway and inform the emergency operator who will then guide you on the next course of action while the emergency services are enroute.
If the compressions don’t work, we will then tilt the persons head back and look inside the mouth for the choking object. If we see it, use our little finger to scoop the object out but do not go “fishing” for an object that we can’t see in case we lodge the object further back down the airway.
If the airway is clear of visible obstructions, we attempt to breath into the person’s mouth. If the first breath goes in, we deliver a second breath and continue CPR with 30 compressions followed by 2 breaths until the person recovers, the defibrillator arrives and the operator is ready to take over or the emergency services arrive and take over from you.
If, however, the breath does not cause the chest to rise then we reposition the persons head back down into a neutral position and then reopen the airway and attempt a second breath. This repositioning does two things. It helps us confirm the airway is opened correctly the second time and the repositioning movement may dislodge the object for us. If we attempt the second breath and the breath still does not go in, we know the person is still choking, so we begin another cycle of CPR with 30 more compressions.
Because of COVID 19 I would not encourage a lay person to deliver breaths to a stranger during choking unless they have access to a barrier device and they are trained in its correct use during this pandemic. However, if this is a family member then the decision to attempt breaths lays with the family members themselves.
Choking is a common emergency and can be avoided by ensuring we cut our food into bite sized pieces and we chew it before attempting to swallow it. Regrettably, some parents will attempt to feed their children food that is simply too large for their little airways or the child may attempt to swallow food whole with chewing it adequately. Children have been known to choke on many objects such as grapes, orange segments, coins, toys, pen tops and pieces of food. But this is not simply a child emergency, adults often choke too because they are talking as they are eating and something goes down the “wrong way”.
If you are a parent of a small child, please see a British Red cross video below that gives clear instructions on how to alleviate a choking baby’s airway. I would always advise that if you ever have to administer back blows or do the Heimlich Manoeuvre to a child or baby that we take them to the local A+E to be assessed by a Paediatric Consultant just in case we have used too much force when trying to relieve the choking object.
Thank you for reading this article, next week we will discuss how we deal with burns.
Aiden Thompson is a PHECC registered paramedic and former Search And Rescue winchman with the Irish Coastguard helicopter, R118, based in Sligo. As a PHECC registered first aid instructor and an Irish Heart Foundation training site coordinator Aiden delivers the highest standard of training to members of the public.
If you would like any further information on courses available in your area, please contact Aiden on 0863111661 or visit his website www.dsts.ie for further details.