By Scott Whimpey- Medic, TAE and Director of First Aid Accident & Emergency RTO 32508
When I see headlines published like the following from ABC News ‘Inquest into boy’s death examines competency of first-aid training for school staff’.
Warning: This story contains details some readers might find distressing.
The first aid provided to a young boy who choked to death at an Adelaide school was “hampered by panic and communication difficulties”, with an inquest into his death to determine whether South Australian teachers are equipped to respond to first aid emergencies. – see the full story here
After reading such a devastating story, I’ve decided to share the following information on how to manage choking.
This info comes directly from the Australia Resuscitation Council guidelines – Managing an obstructed airway.
Recognition of Upper Airway Obstruction
Airway obstruction may be partial or complete, and present in the conscious or the unconscious person.
Typical causes of airway obstruction may include, but are not limited to:
relaxation of the airway muscles due to unconsciousness
inhaled foreign body
trauma to the airway
The symptoms and signs of obstruction will depend on the cause and severity of the condition. Airway obstruction may occur gradually or suddenly and may lead to complete obstruction within a few seconds. This patient must be observed continually.
In the conscious person who has inhaled a foreign body, there may be extreme anxiety, agitation, gasping sounds, coughing or loss of voice. This may progress to the universal choking sign, namely clutching the neck with the thumb and fingers.
The abdomen will continue to move out but there will be loss of the natural rise of the chest (paradoxical movement), and in-drawing of the spaces between the ribs and above the collar bones during inspiration.
Partial obstruction can be recognised where:
breathing is laboured
breathing may be noisy
some escape of air can be felt from the mouth.
Complete obstruction can be recognised where:
there may be efforts at breathing
there is no sound of breathing
there is no escape of air from nose and/or mouth.
Airway obstruction may not be apparent in the non-breathing unconscious person until rescue breathing is attempted.
Management of Foreign Body Airway Obstruction (Choking)
A Foreign Body Airway Obstruction (FBAO) is a life-threatening emergency.
Chest thrusts or back blows are effective for relieving FBAO in conscious adults and children with a low risk of harm.
Life-threatening complications associated with the use of abdominal thrusts such as the Heimlich Manoeuvre have been reported in 52 observational studies, so we don’t teach this technique anymore, instead back blows and chest thrusts should be used to manage choking.
These techniques should be applied in rapid sequence until the obstruction is relieved. More than one technique may be needed.
The first responder needs to Assess the Severity of the obstruction.
The simplest way to assess the severity of an obstruction is to assess for effective cough.
So what is an effective cough (Mild Airway Obstruction)
This is when the patient can still cough well enough to expel the object- this is really the best way to expel the mild obstruction.
The person with an effective cough should be given reassurance and encouragement to keep coughing to expel the foreign material.
If the obstruction is not relieved the rescuer should call an ambulance.
Ineffective Cough (Severe Airway Obstruction)
This is when the patient can no longer cough or cough well enough to expel the obstruction.
The Conscious patient
If the person is conscious – awake and unable to cough then perform up to five sharp, back blows with the hand in the middle of the back between the shoulder blades and if this does not work, call for an ambulance.
Make sure you 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.
How to manage the choking Infant
An infant may be placed in a head downwards position prior to delivering back blows, i.e. across the rescuer’s lap.
If back blows are unsuccessful the rescuer should perform up to five chest thrusts.
To perform chest thrusts, identify the same compression point as for CPR and give up to five chest thrusts.
These are similar to chest compressions but sharper and delivered at a slower rate.
The infant should be placed in a head downwards and on their back across the rescuer’s thigh, while children and adults may be treated in the sitting or standing position.
With each chest thrust, check to see whether the airway obstruction has been relieved.
If the obstruction cannot be cleared with back blows or chest thrusts, then CPR needs to be started.
If chest thrusts do not work – give 2 breaths
We recommend at this stage that 2 breaths should be administered to see if the obstruction can be moved or cleared. even if the object is blown down into the lungs- then this may be enough to start basic breathing until medical can clear the airway.
If breathing returns, ensure to call an ambulance and manage the patient until medical help arrives.
If breathing does not return, start CPR with 30 Compressions and 2 breaths and continue until breathing stars or medical help arrives.