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Choking (Foreign Body Airway
Obstruction)
Choking occurs when an object blocks
the passage that allows air in and out of the lungs Children
are particularly at risk for choking because of the small
size of their air passages, inexperience with chewing, and
the natural tendency to put objects In their mouths. In children
aged 5-14 years, the majority of choking episodes are associated
with food, especially candy. For children aged 1-.4 years,
coins were involved in 18% of all choking-related emergencies.
Nuts and peanuts also commonly cause choking. Children under
3 years of age should never be fed nuts or other hard, crunchy
foods. Adults commonly choke on large pieces of food, often
while drinking alcohol. Elderly persons frequently choke on
semisolid foods. When the air passages are blocked, the patient
cannot breathe. Rapid first aid for choking can save a life.
ADULTS & CHIIDREN > 1 YEAR
Air exchange=Good Signs and Symptoms
Mild blockage Conscious/responsive
Can breathe in and out and can speak
Strong coughing or gagging as food/liquid “goes down
the wrong pipe”
May hear high-pitched squeaking or whistling noise (wheezing)
between strong coughs.
Treatment guidelines
Encourage patient to cough
Stay with the patient
Watch closely
Be ready to take action if symptoms worsen
If blockage continues, activate EMS.
Note: An incomplete obstruction of the airway may have less
severe symptoms and be confused with other causes of upper
airway obstruction such as an asthma/reactive airway disease
or croup. If the patient is coughing forcefully, help them
into a comfortable position. Alert EMS or activate your emergency
action plan.
Adults and Children > 1 year
Air Exchange=poor or none Signs and
Symptoms
Severe Blockage Clutching throat
Patient cannot cough or make any sound
Responsive Blue lips, nails skin.
Treatment guidelines
Quickly ask “are you choking?”
If the patient nods yes or is unable to speak, cough, or cry-act
quickly!
Stand behind an adult or kneel behind a child.
Make a fist. Place the thumb side against the patient’s
abdomen, just above the navel.
Give quick inward and upward thrusts until the object is expelled
or the patient becomes unresponsive. (See skill guides #8
and #9)
Late stages of pregnancy
Or obese Treatment Guidelines
Perform chest thrusts, Stand behind
the patient.
Place your arms under the patient’s armpits, encirclingthe
chest. Place the thumb side of your fist on the middle of
the sternum.
Grasp your fist with your other hand and thrust backward.
Continue until the object is expelled or the patient becomes
unresponsive.
Self Treatment Guidelines
Give yourself abdominal thrusts until
the object is expelled.
If that doesn’t work, press your abdomen quickly over
any firm surface (back of a chair, side of a table, etc).
ADULTS & CHILDREN > 1 YEAR cont.
Air Exchange=poor or none signs and
Symptoms
Unresponsive Treatment Guidelines
Carefully get the adult to the ground,
immediately alert EMS or activate your emergency action plan.
If you are alone with a child, give about 5 cycles (about
2 min.) or CPR, then alert EMS.
Open the airway, remove the object
if you see it. Begin CPR.
Each time the airway is opened for rescue breaths, look for
an object in the patient’s throat. If you see it, remove
it.
Continue CPR until the AED or EMS arrives
or the patient shows signs of life.
Caution: Abdominal thrusts have been
associated with severe and fatal complications. Complications
may occur even when abdominal thrusts are performed correctly
DO NOT perform the Heimlich Maneuver on an adult or child
unless It is necessary. A patient who has had an airway obstruction
that was removed by abdominal or chest thrusts should be evaluated
by a physician to assure no Internal injuries resulted from
the event.
Infants
Air Exchange=Good Signs and Symptoms
Mild blockage
Responsive Can breathe in and out
Crying gagging
Strong coughing
May hear high-pitched whistling or squeaking noise (wheezing)
between strong coughs.
Treatment Guidelines
Stay with the patient
Watch closely
Be ready to take action if the symptoms worsen.
If the blockage continues, activate EMS.
Air Exchange= Signs and Symptoms
Poor or none
Severe Blockage Patient cannot cough
or make any sound.
Responsive Blue lips, nails, skin.
Passing out.
Treatment guidelines
Keep the infants head lower than the chest.
Give 5 back slaps between the shoulder blades with enough
force to expel the object.
Turn the infant face up onto your lap or thigh.
Give 5 downward chest thrusts just below the nipple line with
enough force to expel the object.
Repeat until the object is expelled or the infant becomes
unresponsive.
Unresponsive Treatment Guidelines
Place the infant on a firm, flat surface. Open the airway.
Remove the object if you see it. Begin CPR.
Each time the airway is opened for
rescue breaths, look for an object in the infant’s throat.
If you see it, carefully remove it.
Do not blindly sweep your finger through an infant or child’s
throat. Blind finger sweeps can cause injury and push the
object deeper into the airway.
Continue CPR for about 5 Cycles (about 2 min.). Alert EMS
or activate your emergency action plan.
Caution!!
The Heimlich maneuver is not recommended
for infants because it may damage internal organs. An infant
who has had an airway obstruction that was removed by back
slaps or chest thrusts should be evaluated by EMS and seen
by a physician to assure no internal injuries resulted from
the event.
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