When taking a any first aid or CPR class, candidates will learn how to react to and rescue choking victims The following is a short introduction to how to determine if an adult or child victim is choking and how to react. These methods do not apply for a choking infant. That will be presented in an upcoming blog. People can choke on a number of items. The tongue is the most common cause of airway obstruction. Other causes include, blood from facial and head injuries, vomit and food. A victim can be conscious and unconscious with a obstruction. In this post the focus will remain on CONSCIOUS choking victims. It is important to differentiate between the two types of conscious choking victims: partial (mild) and fully (severe) obstructed.
Mild Obstruction on a conscious victim
Definition: A mild obstruction is an obstruction in the airway that allows some air to pass but can be very distressing to the victim.
Signs and Symptoms of a mild obstruction include: coughing forcefully, can speak, wheezing between coughs and flushed skin color.
Treatment: Identify yourself to the victim. If the victim leaves the room follow them. Typically, to avoid embarrassment in a public setting, choking victims will leave the area in search for a more secluded and private area. Unfortunately, if the partial obstruction leads to a full obstruction and nobody is notices the first aid emergency can quickly become fatal. So it is important to follow your victim if they leave. Introduce yourself and ask if they are choking. It can be very reassuring to the victim if you tell them you know first aid. If the victim is coughing and clearing the airway on there own do not physically interfere. Typically the body’s reflex mechanisms will remove the obstruction and the situation will improve dramatically.
However, if the situation deteriorates into a full obstruction the Signs and Symptoms will change.
Full Obstruction / Severe Obstruction
Definition: A severe or full obstruction does not allow any air to pass through the airway.
Signs and Symptoms: Poor or no air exchange, inability to speak, weak coughing, may be holding the throat, difficulty breathing, grey/ blue (cyanosis) lips and gums.
Treatment: In this first aid emergency, the rescuer should shout for help, especially if in a secluded area, and may send someone to contact E.M.S. The victim is very likely in shock and any reassurance can improve the situation. The rescuer should then position him/her self behind the victim and landmark. A popular land-marking method is to find the hips of the victim and bring both hands together onto the stomach. This method should bring the victims hands over top of the belly button. Slightly higher than the belly button is the most effective area for J-Thrusts. The rescuer will make a fist with one hand and place the palm of the other hand over-top of the fist. Unlike the popular Heimlich maneuver taught decades ago, the rescuer will pull back into the victims stomach and then up towards the lungs and under the ribs. This maneuver will be forceful and difficult, especially for small rescuers on large victims. Repeat these “J-Thrusts” until they are successful or the victim becomes unconscious. Go until “POP” or “Drop”. If the victim goes unconscious immediately send someone to contact E.M.S. if they haven’t been sent already.
If the victim is significantly smaller, the rescuer can position themselves on there knees to do effective “J-Thrusts”. If the victim is too large or pregnant rescuers may place your arms over the chest instead of the stomach and pull inwards instead of doing “J-Thrusts”. If the victim is too large to reach around the chest, rescuers can place the victim against a wall and do chest compressions on the victims chest instead of “J-Thrusts”.
If you are the one choking, attract people around you by placing your hands on your neck. This is an international sign of choking and is understood almost anywhere in the world. If you are alone, use hard objects such as a desk, the corner of a chair or a counter-top to give ourself abdominal thrusts.
The treatment for an unconscious victim includes CPR with visual inspections of the airway for the obstruction. This topic will be covered in a later CPR blog. For more information and to receive hands on Choking training take a standard first aid course in Vancouver or a CPR course. For updated chocking guidelines following the latest CPR standards visit this post on 2011 choking standards and techniques.