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Choked Airway

Information about Choked Airway

We Have to Know about the Choked Airway

  • Foreign bodies in the airway and in the upper esophagus are a very common ENT emergency
  • Choking happens when an object, which is often a piece of food, gets stuck in the airway. Young children and babies are likely to choke on food or something they have put into their mouth
  • A foreign body aspirated into air passage can lodge in the larynx, trachea, or bronchi
  • The site of lodgment would depend on the size and nature of the foreign body

Could be dangerous, if the answer is YES for any one of the following questions

  • Is there severe breathlessness?
  • Is the person turning blue?

First Aid

  • A person who is choking will instinctively grab at the throat. The person may cough and gasp, go red in the face, have difficulty speaking and get very distressed. If there is an only partial obstruction, the person might still be able to cough. A complete obstruction will lead to a blue, dusky face and unconsciousness

Home treatment

  • If the person is coughing, encourage him or her to keep doing this. Don’t interfere – the person should be able to cough up the object
  • If the person cannot speak, or only has a weak cough, follow the instructions below

Conscious adult (9 years and older) – abdominal thrusts (Heimlich maneuver):

  • Do not remove the object unless it can be clearly seen and reached. If it can be clearly seen, remove with a hooked finger. Do not blindly put your fingers into the victim’s mouth
  • If the victim only has a weak cough or stops breathing, bend the victim forward and give 5 firm slaps with the flat of your hand, between the shoulder blades. Only do this if you can place the head lower than the chest level. Check to see whether the object has dislodged
  • If this is unsuccessful, start with the abdominal thrusts (Heimlich maneuver). Stand behind the person with your foot between the person’s feet
  • Reach around the waist. Place a clenched fist, thumb inside in, between slightly above the naval
  • Grab your fist with the other hand. Keeping your arms off the person’s rib cage, give 5 quick inwards and upwards thrusts. This might cause the object to pop out. Check the victim’s mouth
  • If the Heimlich maneuver does not work, repeat the procedure of 5 back slaps and 5 abdominal thrusts Repeat the procedures until the object is dislodged or the person becomes unconscious. If the person becomes unconscious, prepare to start CPR
  • Call an ambulance if the procedure is not successful after two tries

If you are alone:

  • Try to cough up the object
  • If this doesn’t help, do abdominal thrusts on yourself using your fists, or lean over the back of a chair and press down forcefully

Conscious child (1 – 8 years)

  • Encourage the child to cough. If this is ineffective, stand or kneel behind the child and let the child bend forwards; or place a small child face down across your lap with head low
  • Give five back slaps between the shoulder blades with the flat of your hand
  • If you can see the object clearly, remove it with a hooked finger
  • If this does not help, kneel behind the child. Place a clenched fist, thumb inside in, on the lower breastbone
  • Grab your fist with the other hand. Keeping your arms off the person’s rib cage, pull inwards sharply up to 5 times (chest thrusts). This might cause the object to pop out. Check the victim’s mouth
  • If this is unsuccessful, do five abdominal thrusts (see above)
  • If it still fails, start the sequence of 5 black slaps, 5 chest thrusts and 5 abdominal thrusts. Call an ambulance
  • Repeat the procedures until the object is dislodged or medical help arrives
  • If the child becomes unconscious, start CPR

Conscious baby (under 1 year)

A choking baby may attempt to cry, make strange sounds or no sounds at all

  • Lay the baby facedown on your forearm or lap, with the head lower than the trunk and support the head with your hand. Don’t cover the baby’s mouth or twist the neck
  • Give 5 hardback slaps between the shoulder blades
  • Check if the object is clearly visible, then remove with a hooked finger. Do not do blind finger sweeps
  • If an object cannot be removed, lay the baby face upwards along your forearm or your lap, with head lower than the trunk. Place two fingers on the breastbone a finger’s width below the nipples and give 5 downward chest thrusts to a depth of 2.5 cm
  • Check the mouth again and remove the object if visible
  • Repeat the sequence of back slaps and chest thrusts. If it remains unsuccessful, call an ambulance and start mouth-to-mouth breathing (2 breaths).
  • Continue with the sequence of 5 back slaps, 5 chest thrusts, and 2 mouth-to-mouth breathing until help arrives. If the baby becomes unconscious, start CPR

Note: Do not perform abdominal thrusts on a baby under than 1 year old

Unconscious choking victim (all ages)

  • Gently lower the person to the ground. Call a 108 ambulance immediately
  • Assess the ABC’s and start CPR Each time, before you start mouth-to-mouth breathing, check whether the object is visible in the mouth. Do not perform blind sweeps. Chest compressions might dislodge the object
  • Continue with CPR until the victim is breathing on his or her own or until the ambulance arrives

If the above measures are successful, call your doctor if:

  • Abdominal thrusts were performed as they can cause internal injuries
  • Swelling of the airway from an infection, injury or allergic reaction caused choking
  • Pregnant or obese persons
  • Give 5 back slaps as described above
  • If this is not successful, stand behind the person and place hands under the armpits around the chest
  • Place your fist at the base of the breastbone
  • Grab your fist with your other hand and give five inward thrusts
  • Check the victim’s mouth to see if the object has dislodged
  • Repeat the procedure until the object becomes dislodged

Just a word of caution: make sure that the person is actually choking before you attempt to save their life

Heimlich’s Maneuver for Beginners

In the case of adults:

  • Encourage the person to cough if he/she can still follow orders
  • Stand behind the person and wrap your arms around his/her waist
  • Make a fist with one hand and grasp the fist with the other hand
  • Place the thumb side of your fist against the person’s abdomen in the midline just above the navel and below the sternum
  • Make sure that your hand is not against the breastbone or lower rib cage as you might end up breaking the person’s rib. Also make sure that you stay in the center of the abdomen, as you don’t want to hurt the person’s liver or spleen
  • Administer a series of upward thrusts until the food dislodges (up to 10)

Unconscious people:

  • Lay the person on his/her back
  • Kneel astride the person’s thighs facing his/her face
  • Place the heel of your hand in the midline just above the person’s navel as mentioned in the steps above
  • Place the one hand on top of the other
  • Administer a series of quick upward thrusts until the food dislodges (up to 10)
  • Remove the food from the person’s mouth with your finger, taking care not to push it in any deeper

Small children or babies

  • Hold the baby with its abdomen over your arm and resting on your thigh (face and head down)
  • Deliver 4 blows to the back in-between the shoulder blades in quick succession with your other hand or until the food dislodges. If the food dislodges, but the person doesn’t start breathing immediately, you will have to start with mouth-to-mouth resuscitation
  • This is very seldom necessary because as soon as the food dislodges, the person will inhale deeply

Just remember, if you do this properly you will save someone from choking to death (something that happens more often than you’d think). Take them to the hospital immediately afterward to check for any damage caused by the procedure. Damage is likely

Causes of Choked Airway

  • Children are more often affected; more than half of them are below 4 years
  • Accidents occur when they suddenly inspire during play or fight, having something in the mouth
  • In adults, foreign bodies are aspirated during coma, deep sleep, or alcoholic intoxication
  • Loose teeth or dentures may be aspirated during anesthesia

Signs & Symptoms of Choked Airway

  • The initial period of choking, gagging and wheezing
  • Late Symptoms: They are caused by obstruction to the airway, inflammation or trauma induced by the foreign body and would depend on the site of its lodgement

Medical advice for Choked Airway

  • All cases of foreign bodies in the airway are medical emergencies particularly in children

Treatment for Choked Airway

  • Manual removal where feasible
  • Bronchoscopic removal

Do’s and Don’ts of Choked Airway

  • Do not talk while eating. Drink alcohol in moderation (alcohol impairs coordination of the muscles used for swallowing)
  • Chew food properly, and be especially careful if you wear dentures
  • Always supervise young children while eating. Make sure they sit quietly while eating. Insist that children eat at the table, or at least while sitting down. They should never run, play or lie down with food in their mouths
  • Do not give foods to a small child that can break off into hard pieces
  • Do not give popcorn, nuts, chunks of meat and cheese, whole grapes, hard, or sticky sweets, corn chips, raw vegetables, raisins, or chewing gum, until the age of 4
  • Check toys for small parts that may come off. Follow the age recommendations on toy packages
  • Cut foods for infants and young children into pieces no larger than 2cm and teach them to chew well
  • Before a child begins to crawl, go down on his level and look for dangerous items.
  • Beware of older children’s actions. Many choking accidents occur when older siblings give dangerous foods, toys or small objects to a younger child
  • Be aware that balloons and coins pose a big choking risk. Check under furniture and between cushions for small items

Investigations for Choked Airway

  • The use of a probe
  • Vasoconstrictor spray
  • Blowing the nose
  • X-ray
Causes Choked Airway
                      Choked Airway