Choking and what to do about it

Thomas Bliss Emergency Preparedness, First Aid Training For Teachers and Daycare Workers, Pediatric First Aid and CPR Training For Parents Leave a Comment

Choking:  The Fourth Leading Cause of Unintentional Injury Death

It seems that every week we read a story of some poor child or adult dying as a result of choking.  Just recently, I read a story of a two year old toddler Jacob Jenkins who was with his parents in a Pizza Hut restaurant branch in Hartlepool Marina, UK on Friday 9 October 2015.  A grape became lodged in his throat, and after unsuccessful attempts by the restaurant staff to clear the obstruction; Jacob’s heart stopped.

jacobHis heart stopped for around thirty minutes before paramedics were able to arrive and restart it.  Little Jacob was airlifted to Hospital, but sadly died two days later.

I have read many media stories about this horrible tragedy, but only one states that anyone did anything to try and dislodge the “grape.”  I have no reason not to believe that everything that could be done was done to save Jacob, but as a first responder, I have to ask myself was everything that could have been done at least attempted?

I have been in EMS for a very long time, and my first choking rescue was back in 1985.  While watching a movie with friends, one of the guests had a piece of popcorn stuck in her airway.  After she communicated to me that she was indeed choking, I quickly applied what we all know as the Heimlich maneuver.  Out came the popcorn, and we went back to watching the movie.

For more than thirty years, the Heimlich maneuver was considered the gold standard for rescuing conscious choking victims.  The method, invented by Dr. Henry Heimlich in 1974, involves applying upward pressure under the choke point to force whatever is stuck to pop out.  It’s more accurately described as an abdominal thrust.

In 2006, the American Red Cross, which undergoes a review of first-aid protocols every five years, decided to downgrade the importance of the Heimlich maneuver.  I do not agree with this decision.

The organization instead recommended forcefully slapping the victim’s back five times with the heel of the hand (which is the original way a person was treated before the Heimlich maneuver came along); abdominal thrusts should only be tried if the first method doesn’t work.

The Red Cross made the switch because there was no evidence that abdominal thrusts worked better than back blows.  As a first responder I have plenty of evidence that abdominal thrust’s work.  Of course Back Blows and The Abdominal Thrusts will work together but….

Dr. Heimlich, now 92, stands by his method.  He’s speaking out against the American Red Cross’ decision to use the Heimlich maneuver as a last resort.

Speaking to Cliff Radel of The Cincinnati Enquirer, Dr. Heimlich called the recommendation “Horrifying! There has never been any research saying the back slap saves lives,” he told the paper. “We know the Heimlich maneuver works.  So it comes down to a matter of life or death.”

Although some evidence has suggested that slapping causes the blockage to drop deeper into the throat, making the problem worse, there doesn’t seem to be any conclusive evidence as to which method works better, but doing nothing will not aid the choking victim.

After combing through 40 years of research, William Terry Ray, director of the University of Cincinnati College of Nursing’s Nurse Anesthesia program, said that “there is no one definitive treatment to relieve an obstructed airway on a conscious person.”

Choking and suffocation is the third leading cause of death in American homes, according the National Safety Council.

So how do we respond to a choking victim?  Follow these simple steps, and practice them; especially if you have or are around small children, the elderly, and certainly before Thanksgiving dinner.

What Should You Do?choking 2

  • If you suspect that a person is choking call 911 immediately.

If you encounter a conscious, choking individual that is coughing, encourage continued coughing.  If the victim is unable to cough, speak, or breathe; complete the following:

  • Send someone to call 9-1-1
  • Lean person forward and give 5 sharp back blows with heel of your hand between the shoulder blades.
  • If the object is still blocking the airway, give 5 quick abdominal thrusts.
    • by placing the thumbside of your fist against the middle of the victim’s abdomen, grasp your fist with your other hand and thrust inward and upward into the victim’s abdomen with quick jerks
    • Continue abdominal thrusts until the victim expels the oject or becomes unresponsive
  • If the victim becomes unresponsive, begin CPR and try rescue breaths.  In-between the 30 chest compressions; look inside the mouth each time you give breaths, and remove any objects you may see.  Continue CPR with rescue breaths until help arrives.

Repeat until the object the person is choking on is forced out, and the person breathes or coughs on his or her own.

  • A person who can’t cough, speak or breathe needs immediate help!  Ask if they are choking?   Then let them know you will use abdominal thrusts (the Heimlich maneuver).

For a responsive pregnant victim, or any victim you cannot get your arms around or for whom abdominal thrusts are not effective; give chest thrusts from behind; avoid squeezing the ribs with your arms.

Even after choking stops, it’s important to seek medical attention.

What should I do if my baby chokes?

If your baby is choking, don’t use a finger sweep, which could lodge the particle further down in the airway.  Instead, hold your baby facedown on one of your forearms.  The baby’s head should be lower than his or her body.  Then thump your baby firmly on the middle of the back using the heel of your other hand.  The combination of gravity, and the force from your hand will help dislodge the object that’s blocking your baby’s airway.  If you’re concerned about your baby’s breathing, call 911 or your local emergency services provider.

To be prepared in case of an emergency, take a class on cardiopulmonary resuscitation (CPR) and choking first aid for children.  Encourage everyone who cares for your child to do the same.

Here are a two really good videos to give you an idea of what to do before you take a class.

Infant Choking:

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Adult Choking

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The Heimlich Maneuver or abdominal thrust procedure is not recommended for children younger than 1, but it is generally considered safe for children older than 1, according to the National Library of Medicine.

 

 

 

 

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