Choking: HCA Education Continuing Care Alena Thompson, RN, BScN Reviewed by Professional Practice Dept. Adaptations by Berni Baer RN GNC(c), Education Coordinator – St. Joseph’s Auxiliary Hospital Aug 9, 2016

Who do we help? WE HELP ANY ONE WHO IS CHOKING i.e. Resident Client Patient Visitor Co-worker i.e. If a patient on palliative care is choking, we help them, even with a GOA of C2

Signs of poor air exchange and difficulty breathing Mild Airway Obstruction – signs: Good air exchange Can cough forcefully May wheeze between coughs

How can you help the Resident who has mild airway obstruction? Rescuer Actions: Encourage the victim to continue spontaneous coughing and breathing efforts Do not interfere with the residents efforts to cough up what they are choking on (ie. Do not slap them on the back, give a drink of water, etc.) Stay with the resident and monitor their condition. If mild airway obstruction persists, call CODE BLUE.

Signs of poor air exchange and difficulty breathing Severe Airway Obstruction – signs: Poor or no air exchange High pitched noise while inhaling or no noise at all Increased difficulty breathing Weak ineffective cough or ‘silent’ cough mouth opening and closing repeatedly as if they are trying to speak but no sound.  Think “guppy”

Signs of poor air exchange and difficulty breathing Severe Airway Obstruction - signs: (continued) Cyanosis (turning blue) Unable to speak May show the universal choking sign (clutch neck with both hands) Tell a co-worker to call Code Blue. Clipart: www.medtrng.com

Does the resident with Severe Airway Obstruction need your help? Rescuer Actions: Ask the resident if she/he is choking: If yes, begin abdominal thrusts. If no, stay close and allow them to try to get it out themselves. If they are showing signs of severe airway obstruction but are unable to confirm or deny that they are choking, begin abdominal thrusts

How to do abdominal thrusts Stand or kneel behind the resident Wrap your arms around their waist Locate their navel (belly button) Make a fist with one hand and place it thumb side inward between the navel and breastbone Grasp fist with other hand and press into abdomen with QUICK, FORCEFUL, UPWARD thrusts QUICK, FORCEFUL, INWARD & UPWARD thrusts , as if trying to lift the person off the floor (but not forceful enough to lift them off the floor). Click on link for a quick (1 min. 43 sec.) YouTube video on the Abdominal Thrust Maneuver Demonstration of Abdominal Thrust: https://www.youtube.com/watch?v=DE45ks9miIw

Clipart: www.nursing411.org Abdominal thrusts Clipart: www.nursing411.org

How abdominal thrusts work “When you choke on something, your body tries to clear your airway by coughing. Abdominal thrusts try to do the same thing with an artificial cough. The illustration on the right shows how an abdominal thrust creates a cough. An abdominal thrust pushes the diaphragm up towards the lungs very quickly - this forces air from the lungs up the airway and, hopefully, blows the object out. For the best effect, your fist has to be in the right place, the forearms off the abdomen and each thrust a strong and sudden movement.” Source of quote & associated illustration  http://www.familyhealthonline.ca/fho/firstaid/FA_choking_FHa06.asp

Abdominal thrusts for person in a wheelchair Push the wheelchair to a wall, lock the brakes, kneel in front of the victim and give abdominal thrusts from the front by pushing inward between the navel and breastbone. Note: Abdominal thrusts are not as effective for a person in a seated position. Chest Thrusts are the preferred method. Abdominal Thrusts may not produce enough force to expel the obstruction. NOTE: With either the Chest Thrust or the Abdominal Thrust maneuvers it is important to remember to keep your head down, mouth closed. The object could come flying out if you are successful.

Abdominal thrusts - alternative method Carefully lower the conscious resident to the floor and give abdominal thrusts Straddle the person and put the heel of one hand mid abdomen, just below the ribcage. Place your other hand on top of this hand, interlocking your fingers, then press in and up in a smooth, forceful movement. Do this until object is expelled or the person becomes unconscious. Abdominal Thrust on floor clip art from: http://www.infoplease.com/ipa/A0194633.html

Chest thrusts If victim is obese or rescuer cannot reach around to victim’s abdomen, chest thrusts can be done either standing or with the victim seated (ie. wheelchair): From behind the person wrap your arms around their chest just under the armpits. Make a fist with one hand and place it thumb side inward in the middle of the victims chest Grasp fist with other hand and forcefully press inward in centre of chest. Alternatively Cross arms over one shoulder and under other arm to reach centre of chest and give chest thrusts Emphasize that with this method you press straight back, just like with CPR chest compressions. You do not use the “J” motion of the abdominal thrust. Clipart: www.cc.utah.edu

Chest thrusts for person in a wheelchair Push the wheelchair against the wall, lock the brakes and kneel in front of the victim. Place the heel of one hand on the breast bone, at the nipple line, place the other hand on top of it and interlock the fingers. Forcefully press straight back.

Chest thrusts - alternative method Carefully lower the conscious resident to the floor and give chest thrusts Kneel at person’s side, place heel of one hand on chest at the nipple line. Place your other hand over it and interlock your fingers. Press straight down until object is expelled or the person becomes unconscious. Chest Thrust on floor clip art from: http://nursing411.org/Courses/MD0532_Cardiopulmonary_Resuscitation/MD0532/images/md0532_img_24.jpg

When to stop: Continue abdominal/chest thrusts until: Object is expelled (comes out) Resident collapses/becomes unresponsive

If resident collapses and becomes unresponsive Carefully get them to the floor (if not already there) Make sure a co-worker has called Code Blue & 911 Start CPR (if you’ve had the training) NOTE: Abdominal thrusts will only work if the person is conscious. Unconscious begin CPR per Heart & Stroke Foundation of Canada BLS for Healthcare Providers Student Manual , page 53 If you are CPR trained move person to the floor and begin CPR.

Self-Help Abdominal Thrusts If there are others nearby, get their attention.  If you are alone do whatever you must do to get someone's attention. Call 911. Do not allow anyone to slap you on the back. If there is no one else to give you abdominal thrusts, give them to yourself (see illustrations on this slide). If you are alone and you are choking, you must get help quickly - you will be unconscious within minutes. Do whatever you must do to get someone's attention. Use either your hands or a piece of furniture, whichever works best (the back of a chair, a table or the edge of a counter). Position yourself so the object is just above your pelvis. Press forcefully to produce an abdominal thrust - keep giving yourself thrusts until you can cough forcefully, breathe or speak. Source of information  http://www.familyhealthonline.ca/fho/firstaid/FA_choking_FHa06.asp You only have 2-3 minutes before you lose consciousness, and another 2-3 minutes before your heart stops. Source of information & associated illustration  http://www.familyhealthonline.ca/fho/firstaid/FA_choking_FHa06.asp

Important note Seek medical attention after abdominal/chest thrusts are performed. There could be injuries from this maneuver i.e. bruised/broken ribs; punctured liver; etc.

References American Heart Association (2011). BLS for Healthcare Providers Student Manual. First Heart and Stroke Foundation of Canada Printing May 2011. Covenant Health Policy VII-C-30: Choking Prevention and Management http://www.familyhealthonline.ca/fho/firstaid/FA_choking_FHa06.asp

Time to practice With a partner practice correct land marking and hand placement. DO NOT DO ACTUAL PERFORMANCE OF THE MANEUVER as it could injure your partner.