First aid - Choking

Choking Overview

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.

Choking is a true medical emergency that requires fast, appropriate action by anyone available. Emergency medical teams may not arrive in time to save a choking person's life.

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.

Choking Causes

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

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.

Choking Symptoms

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

Coughing or gagging

Hand signals and panic (sometimes pointing to the throat)

Sudden inability to talk

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.

Wheezing

Passing out

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 appear first.

If an infant is choking, more attention must be paid to an infant's behavior. They cannot be taught the universal choking sign.
- Difficulty breathing
- Weak cry, weak cough, or both

Choking Self-Care at Home

To perform abdominal thrusts on someone else:

Stand behind the person. Wrap your arms around the waist. Tip the person forward slightly.

Make a fist with one hand. Position it slightly above the person's navel.

Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust — as if trying to lift the person up.

Perform a total of 5 abdominal thrusts, if needed. If the blockage still isn't dislodged, repeat the five-and-five cycle.

Pictures of Abdominal Thrusts:

To perform abdominal thrusts (Heimlich maneuver) on yourself:

First, if you're alone and choking, call or your local emergency number immediately. Then, although you'll be unable to effectively deliver back blows to yourself, you can still perform abdominal thrusts to dislodge the item.

Place a fist slightly above your navel.

Grasp your fist with the other hand and bend over a hard surface — a counter top or chair will do.

Shove your fist inward and upward.

To clear the airway of a pregnant woman or obese person:

Position your hands a little bit higher than with a normal Heimlich maneuver, at the base of the breastbone, just above the joining of the lowest ribs.

Proceed as with the Heimlich maneuver, pressing hard into the chest, with a quick thrust.

Repeat until the food or other blockage is dislodged or the person becomes unconscious.

To clear the airway of an unconscious person:

Lower the person on his or her back onto the floor.

Clear the airway. If a blockage is visible at the back of the throat or high in the throat, reach a finger into the mouth and sweep out the cause of the blockage. Be careful not to push the food or object deeper into the airway, which can happen easily in young children.

Begin cardiopulmonary resuscitation (CPR) if the object remains lodged and the person doesn't respond after you take the above measures. The chest compression used in CPR may dislodge the object. Remember to recheck the mouth periodically.

To clear the airway of a choking infant younger than age 1:

Assume a seated position and hold the infant face down on your forearm, which is resting on your thigh.

Thump the infant gently but firmly five times on the middle of the back using the heel of your hand. The combination of gravity and the back blows should release the blocking object.

Hold the infant face up on your forearm with the head lower than the trunk if the above doesn't work. Using two fingers placed at the center of the infant's breastbone, give five quick chest compression.