1. Respiratory Emergency - Choking

2. objectives At the end of this session, each student should be able to:
List signs of choking.
Explain the procedures for managing choking incidents among adults and infants.

3. Airway obstruction is the most common respiratory emergency.
Types of Airway Obstruction
Anatomical: An anatomical airway obstruction occurs if the airway is blocked by the tongue or swollen tissues of the mouth or throat.
Mechanical: A mechanical airway obstruction occurs if the airway is blocked by a foreign object.

4. Common Causes of Choking
Eating while talking or laughing, or eating too fast.
Walking, playing or running with food or objects in the mouth.
Trying to swallow large pieces of poorly chewed food.
Wearing dentures.

5. Choking Signs
The Universal Sign for Choking is hands clutched to the throat.

6. If the person doesn't give the Universal Sign for Choking, look for these indications:
Inability to talk.
Difficulty breathing or noisy breathing.
Inability to cough forcefully.
Skin, lips and nails turning blue (cyanosis) or dusky.
Loss of consciousness.

7. Management of Choking
The American Heart Association recommends the Abdominal Thrust (Heimlich Maneuver) procedures.

8. To perform abdominal thrusts (Heimlich maneuver) on someone else who is more than 1-Year Old:
Check Signs of Choking (e.g. Universal Sign of Chock).
Ask “Are you choking, can you speak?”
If the victim can’t speak say “I am going to help you.”
Stand behind the victim.
Wrap your arms around the waist.
Tip the victim forward slightly.
Make a fist with one hand.
Position it slightly above the victim’s navel.

9. Grasp the fist with the other hand.
Press hard into the abdomen with a quick, upward thrust — as if trying to lift the victim up.
Repeat the abdominal thrust till the blocking object is removed (or can be cleared by hand) or the victim becomes unresponsive.

10. To perform abdominal thrusts (Heimlich maneuver) on someone else who is INFANT:
Note Signs of Choking.
A combination of 5 back blows followed by 5 abdominal thrusts is an effective way to clear an airway obstruction.
Assume a seated position and hold the infant face-down on your forearm, which is resting on your thigh.
Give 5 back slaps (at 1-second per slap) forcefully between shoulder blades using heel of hand.
Note: The combination of gravity and the back blows should release the blocking object.

11. If the above doesn't work, hold the infant face-up on your forearm with the head lower than the trunk.
Give five quick chest compressions (at 1-second per compression) using two fingers placed at just below the nipple line on the infant's breastbone.
Repeat the 5 back blows and 5 chest thrusts till the blocking object is removed (or can be cleared by hand) or the victim becomes unresponsive.

12. Notes:
If another person is available, have that person call for help while you perform first aid.
Begin CPR if the airway is opened but the victim doesn't resume breathing.
If the victim becomes unresponsive you need to
call 997 (activate EMS) ,
get AED, and
start CPR checking for foreign object every time you open airway to give breaths.
NEVER PERFORM BLIND FINGER SWEEP.

13. Notes:
Always help a conscious choking adult or child who becomes unconscious to the floor.
If you are (yourself) a choking victim and alone, you may have to give abdominal thrusts to yourself.
This can be done by (1) leaning over a firm object and pressing your abdomen into it, or (2) making a fist and giving yourself quick, upward thrusts.

14. Notes:
To clear the airway of a pregnant woman or obese victim:
Position your hands a little bit higher than with a normal Heimlich maneuver, at the middle of breastbone’s base, 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 victim becomes unconscious.