In first aid, choking is defined as mechanical obstruction of the airways by a foreign object such as food. 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, 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.
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.
Severe Airway Obstruction choking occurs when the object is firmly lodged in the casualty’s throat and they are unable to cough effectively or make any sound.
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
Do Not use abdominal thrusts (Heimlich manoeuvre) in the management of choking as there have been reported cases of life-threatening complications associated with the use of abdominal thrusts.
First aid 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 your other 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 back blows and 5 chest thrusts until emergency help arrives. If at any point the casualty becomes unconscious, follow DRS ABCD
Full blockage choking occurs when food or other small objects are lodged in a child’s throat or airway (trachea), which prevents oxygen from getting to the lungs and brain. Food is among the objects most likely to cause choking in a child. Children who begin to choke with a Severe Airway Obstruction typically cannot breathe, cry or make noise. As choking persists, a child’s face may become initially red, 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 help. Call ‘000’
- Give infant 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
Please watch the video on how to manage an airway obstruction and choke, as you will be asked to demonstrate this for your assessment.