Choking is one of the top five leading causes of unintentional, injury-related deaths in the U.S., according to the National Safety Council, a nonprofit safety advocacy organization focused on eliminating leading causes of preventable death.
Recognizing the signs of choking, knowing how to act and administering a simple technique – like the Heimlich maneuver – can make a difference between life or death.
Signs of Choking
There are some key signs to recognize when someone is choking:
Clutching the throat.
Looking distressed or panicked.
Ineffectively coughing or unable to cough at all.
Making high-pitched noises or no noise at all while they’re inhaling.
Having respiratory difficulty.
Skin or lips turning blue.
Unable to speak or cry.
Typically when someone is choking, "they're making that universal choking sign where they have their hands grasping their throat around their neck,” says Kristin Bernstein, clinical nurse manager of the Cleveland Clinic Main Campus emergency department in Ohio. “Often they become very panicked while they’re perhaps making that clutching-of-the-throat motion."
Usually, mechanisms, like coughing, help to keep your airway clear. However, when someone is experiencing severe airway obstruction due to choking, they may have an ineffective cough – meaning the coughing reflex may be impaired and isn’t effectively clearing the object – or they may be entirely unable to cough.
“They look like they’re trying to catch their breath, and you can’t really hear any air movement,” Bernstein says, meaning you're observing little to no air exchange.
Certain signs of choking, like respiratory distress, could mimic symptoms of another health event, such as stroke, heart attack, seizure or overdose. Confirming they’re choking is key to determining the next steps.
“If it’s an adult – or a child that’s able to answer you – you ask them, ‘Are you choking?’” Bernstein says. They would likely nod if they can’t talk or, for babies, cry to indicate choking.
What to Do If Someone Is Choking
Once you’ve confirmed someone is choking, you should immediately take steps to relieve that obstruction. At this point, you may be nervous or concerned and may not know what to do. “Try to remember a set of steps that works in every emergency,” says Dr. David Markenson, co-chair of the American Red Cross Scientific Advisory Council.
Those three steps of emergency care are:
Check.
Call.
Care.
The first step is to check for signs of choking. “Immediately, once you know they’re choking, call 911,” Markenson says. “Get help there immediately.”
This is important for more than one reason.
“Sometimes people don’t call 911 for choking, which is a big mistake because they could get worse,” he says, adding that the last thing you want is for someone to get worse and you don’t have help there already. “Many of the 911 operators can tell you what to do and help you." Once you’ve called for help, you should begin administering first aid.
First Aid for Choking
Adults and children.
Pregnant women or individuals with obesity.
Infants.
You’re alone.
Adults and children
When it comes to technique, guidance is mixed. The American Heart Association teaches Basic Life Support, or BLS, training, which includes a series of abdominal thrusts, while the American Red Cross's technique includes a combination of five back blows and five abdominal thrusts.
Ultimately, there’s no scientific evidence proving that one method is more effective than the other.
Abdominal thrusts
Following guidance from the American Heart Association, you’ll perform a series of abdominal thrusts, traditionally known as the Heimlich maneuver:
Make a fist with your dominant hand.
Turn your first so that your thumb and pointer finger are inward. Place your fist against the choking person’s abdomen.
Your fist should be just above the belly button and below the breastbone.
Grasp around the waist with your other hand on the outside of that fist.
Press the fist up into the abdomen with a forceful, quick thrust.
On children, you can perform the same technique as adults. You may have to kneel to get down to their level to do it correctly, Markenson says. You’re making “quick, distinct thrusts in an upward motion,” Bernstein says. “You would repeat those thrusts until the object is expelled or that person becomes unresponsive.”
With a small child, you don’t need to do abdominal thrusts as hard as you would for a full-sized adult, she adds. You repeat this technique until the object is forced out, the person can breathe or make sounds or the person becomes unresponsive.
Here's how to perform a chest thrust:
Stand behind the individual.
Place a fist with the thumb side against the middle of the person’s chest
Cover your fist with your other hand and give five quick chest thrusts directly toward you.
You may need to place your fist slightly higher on the chest if they are pregnant.
Now, lets watch a video from a trusted source [Mayo Clinic]
When someone is overweight or has obesity, you should do an abdominal thrust, as long as you can get the hands around the abdomen, Markenson says.
Infants
Typically, an infant is identified as under one year old, but because some infants may be smaller in size, it is not necessarily a hard cut-off for using this technique.
If you suspect an infant is choking, you’ll want to take the infant in what Bernstein refers to “a football hold.”
If an infant is choking, follow these steps:
In a seated position, rest your forearm on your own leg.
With the infant resting face down on your forearm, hold the infant's chest with the palm of your hand, keeping their head and chin supported with your fingers.
With your free hand, administer five quick back blows between their shoulder blades.
If the infant is still choking, flip the infant over face up and rest them against your forearm while supporting the head with your hand.
Using two fingers, locate the center of the breastbone between the infant's nipples.
Apply five chest compressions by pressing down about 1½ inches.
You would keep repeating that process of five back blows and five chest thrusts, until they either get relief or become unresponsive.
If you’re alone
If you’re by yourself and begin choking, call 911 immediately. Even if you're unable to speak, the 911 operator will recognize they’ve received a call and send help.
If there’s no way to call, follow the same steps for abdominal thrusts on yourself:
Make a fist and place it above your belly button.
Wrap your free hand over your fist.
Thrust your fist inward and upward into your abdominal area five times.
If you need extra support, find a hard surface – such as a countertop or the back of a chair – and thrust yourself against the edge.
Risks of the Heimlich Maneuver
Potential injuries resulting from the choking itself or the actions to clear the obstruction include:
Damage to the airway.
Bruising or injury to your back or organs.
Fractured rib.
Punctured lung.
“Even if done correctly, the clearing maneuvers use a lot of force to get the object out, and so there is a small chance of injury,” Markenson says. “Obviously you want to use it with full force because it’s more important to get the object out than any potential minor injury, but you want to be checked.” Most injuries that occur are minimal. However, because you’re still at risk for serious injury, it’s important to contact a health professional, even after the object is cleared.
“Take their advice if they want to see you immediately, or they may just give you advice for things to watch for,” Markenson says. “The object itself may have caused damage as it was in place and dislodged, and the procedure to dislodge it has the chance to cause an issue."
When to Administer CPR for Choking
At times, the object may be difficult to dislodge, and administering first aid techniques may not be successful. If the object is compromising their airway enough, the person is likely going to become unresponsive and will need cardiopulmonary resuscitation or CPR for short. “You’d want to lower that person to the ground once they become unresponsive,” Bernstein says. “At this point, you’d begin CPR.”
To perform CPR:
With the person lying on their back on a flat surface, place two hands – one on top of the other – on the center of their chest.
In a kneeling position, position your shoulders directly over your hands and lock your elbows.
Using your body weight, push down at least 2 inches on the chest.
Apply chest compressions at a rate of 100 to 120 per minute, which is approximately the same beat as the Bee Gees' song, "Stayin' Alive."
After each compression, allow the chest to return to its normal position.
Alternate between 30 chest compressions and giving two rescue breaths. But before you do,
you’ll want to open the individual's mouth and make sure that the object is not visible in the mouth as to avoid pushing the object back into the airway.
If you are able to visually locate the object, Bernstein says, you may use your fingers to reach for it. However, this is not advised if you can't see it.
“You never want to blindly sweep the mouth for an object unless you see it,” Bernstein says.
With an infant, you’ll want to use a pinky to sweep the visible object out of the mouth.
First Aid and CPR Training
Finding yourself in a choking situation can be scary, but the best way to master the steps is to get proper training.
There are several places in the community or online that typically offer basic first aid or CPR training for the public or health care professionals:
Schools.
Community health centers.
Local fire departments.
Nonprofit organizations, such as the American Heart Association or the American Red Cross.
“The best way to learn is with hands-on practice because you get to practice it," Markenson says. In these courses, an instructor will guide you through the steps and let you know whether or not your technique is correct until you've built up the confidence to know how to act in an emergency situation.
There are different formats for training courses. Most classes with the American Red Cross use a blended learning method.
“You take some of the learning online before you show up, and then you come to a class and practice everything with your hands-on mannequins and simulated devices,” Markenson says. “The Red Cross also offers online-only programs. If you want to take a first step to know what to do in emergencies, you could start with an online-only course.”
Sources:
1. https://health.usnews.com/wellness/articles/heimlich-maneuver-for-adults-and-infants#expert-sources
Kristin Bernstein, MSN, APRNBernstein is the clinical nurse manager of the Cleveland Clinic Main Campus emergency department in Ohio.
David Markenson, MD,Markenson is co-chair of the American Red Cross Scientific Advisory Council and director and medical director of the Center for Disaster Medicine at New York Medical College.
2. YouTube [https://www.youtube.com/watch?v=2dn13zneEjo]
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