Choking in children and adults

In first aid, choking is a life-threatening medical emergency that occurs when an object or food becomes lodged in the airway, obstructing the flow of air to the lungs. Choking can lead to unconsciousness or even Cardio Respiratory Arrest if the obstruction is severe enough. The quick recognition and proper management of a casualty who is choking are of key importance. Statistically, young children 4 years and under are most at risk of choking by food and toy parts as they make up the highest number of deaths.

Is Airway Obstruction the same as Choking?

Both are related concepts, but they are not exactly the same. Airway obstruction refers to the blockage or partial blockage of the airway, which prevents the normal flow of air into and out of the lungs. This obstruction can occur due to various reasons, such as the:

• inhalation of a foreign object
• swelling of the airway
• presence of excess mucus or fluids

If the casualty is able to cough and talk, then this is not considered serious choking, as this is a Mild Airway Obstruction. The casualty with an effective cough should be reassured and encouraged to keep coughing to expel the foreign material. Continue to monitor. If the obstruction is not relieved, the first aider should call an ambulance (000).

Severe Airway Obstruction or choking

Occurs when the foreign body is firmly lodged in the casualty’s throat and they are unable to cough effectively or make any sound. The person’s airway is blocked by a foreign object, most commonly a piece of food or a small object. Choking prevents air from reaching the lungs and can be a life-threatening medical emergency if not promptly addressed.

The Danger Signs of Severe Airway Obstruction (Choking) are:

• Inability to cry or make any sound
• Unable to cough, or weak, ineffective coughing
• Soft or high-pitched sounds while inhaling
• Difficulty breathing – ribs and chest retract
• Bluish skin colour or lips
• Loss of consciousness if the blockage is not cleared
• The casualty may be clutching or pointing at their throat

 

What is Choking First Aid?

Choking first aid involves immediate and vital actions to aid a choking person experiencing airway obstruction due to a foreign object. In Australia, the equivalent technique to the Heimlich manoeuvre used in the USA is referred to as the “abdominal thrusts” or “chest thrusts”. These maneuvers entail delivering quick and upward thrusts to the abdomen to dislodge the obstructing item and restore proper airflow. Cautionary Note: Avoid using abdominal thrusts (Heimlich maneuver) in choking management due to reported life-threatening complications. Instead, consider employing back blows, a safer alternative recommended by experts. It is crucial to respond promptly and effectively to a choking adult or child, as airway blockage can lead to severe consequences, including unconsciousness or fatality. If abdominal thrusts prove unsuccessful and the individual becomes unresponsive, chest compressions may be employed as a last resort.

First aid Steps for Severe Airway Obstruction (choking):

• First, ask “Are you choking?” If the casualty can speak – do not interfere. Encourage them to cough and reassure them. Continue to monitor.
• If they cannot speak and it appears they have Severe Airway Obstruction, bend the casualty forward and support the upper front of their chest while using the heel of your hand to give back blows between the shoulder blades. Check to see if each back blow has relieved the airway obstruction. If the blockage hasn’t cleared after 5 blows, try chest thrusts
• Place one hand in the middle of the casualty’s back and the other arm across their chest. Using your hand on the chest, perform 5 chest thrusts like CPR compressions but slower and sharper. Check to see if the blockage has cleared between each chest thrust
• If the casualty is still choking, call 000 / 112 and alternate 5 sharp blows and 5 chest thrusts until emergency help arrives. If at any point the casualty becomes unconscious, follow DRS ABCD

Choking Infants

Full blockage choking occurs when food or other small objects are lodged in a child’s throat or windpipe (trachea), which prevents oxygen from getting to the lungs and brain. Children who begin to choke typically, cannot breathe, cry or make crowing noises. As choking persists, a child’s face may become initially red, gagging, then turn blue as the body runs out of oxygen. DO NOT perform the following steps if the infant has a Mild Airway Obstruction and is coughing forcefully and effectively or is crying strongly – either of which can dislodge the object on its own.

For a Severe Airway Obstruction (Choking):

• Lay the infant face down, along your forearm
• Hold the infant’s chest in your hand and support the jaw with your fingers
• Point the infant’s head downward, lower than the body
• Give up to 5 sharp, forceful blows between the infant’s shoulder blades
• Use the heel of your free hand
• Check to see if each back blow has relieved the airway obstruction
• The aim is to relieve the obstruction with each blow rather than to give all five blows

 

If the object isn’t free after 5 blows:

• Turn the infant face up. Use your thigh or lap for support. Support the head.
• Place 2 fingers on the middle of the infant’s breastbone
• Give up to 5 sharp thrusts down, compressing the chest 1/3 the depth of the chest
• Check to see if each chest thrust has relieved the airway obstruction
• The aim is to relieve the obstruction with each chest thrust rather than to give all five thrusts
• Continue this series of 5 back blows and 5 chest thrusts until the object is dislodged or the infant loses consciousness, in which case you commence CPR

If the infant loses consciousness, becomes unresponsive, stops breathing, or turns blue:

• Send for medical help. Call triple zero (000) or the nearest children’s hospital.
• Give infant cardiopulmonary resuscitation or CPR.
• Try to remove an object blocking the airway ONLY if you can see it.
• DO NOT interfere if the infant is coughing forcefully, crying strongly, or breathing adequately. However, be ready to act if the symptoms worsen
• DO NOT perform these steps if the infant stops breathing for other reasons, such as asthma, infection, swelling or a blow to the head

Choking Video

Please watch the video on how to manage airway obstruction and choking, as you will be asked to demonstrate this for your assessment.

Vital Choking Fact Sheet

The Australian choking fact sheet serves as a concise and informative resource on dealing with choking incidents. It offers essential health information on:

• recognising the signs of choking
• understanding potential risk factors
• immediate steps to take in such emergencies

However, it is crucial to bear in mind that the fact sheet is not a substitute for professional medical advice. A disclaimer accompanies the sheet, reminding readers that while it provides valuable guidance, seeking qualified medical assistance is always recommended for any serious or life-threatening situations.

Conclusion

Understanding and implementing proper choking first aid techniques are of paramount importance in saving lives during critical situations. Through comprehensive first aid courses, individuals can equip themselves with the knowledge and skills necessary to respond effectively to choking incidents at home or in the workplace. CPR First Aid Australia stands as a reputable source for acquiring the necessary expertise in handling choking emergencies and other life-saving procedures. By promoting widespread first aid training, we can create a safer and more prepared community, ready to act swiftly and confidently during choking emergencies and other medical crises.