People can accidentally choke on many types of objects. Small foods, such as hard candy, peanuts, and grapes can be considered major offenders due to their shape and size. Nonfood items such as balloons, marbles, toys and coins can often become choking hazards for children and infants.
Identifying Airway Obstructions
When an object becomes lodged in the airway it can be considered a mild to severe airway obstruction, depending on the patient's inability to breathe. Good air exchange and the ability to make forceful coughing efforts, is usually present in a mild airway obstruction. If a patient experiences a mild airway obstruction, the patient should be encouraged to continue coughing until the obstruction has been removed.
Signs of a severe airway obstruction include all or one the following:
- Breathing becoming more difficult
- Weak and ineffective cough
- Inability to speak or breathe
- Skin, beds of fingernails, and area in and around mouth may appear bluish gray (indicating cyanosis)
Patients with a severe airway obstruction will have poor air exchange and may need immediate care. Patients with a complete airway obstruction will have little to no air exchange and will need immediate care.
The universal distress signal for choking is grasping the throat. Choking patients may try to speak and grasp their neck in an attempt to alert others. It is important to recognize the signs of choking, as not all patients know or use the universal distress signal. Caring for an airway obstruction for an adult and child are the same while caring for an infant with a severe airway obstruction is different.
Airway Obstruction - Responsive Adult or Child
Check patient for choking. Elicit response to question, “Are you choking?” Observe signs of obstruction (speaking and breathing).
Begin Heimlich Maneuver:
- Move behind the patient
- Reach around the patient’s waist with both arms just above the navel
- Place a fist with the thumb side against the patient's abdomen
- Grasp the fist with other hand
- Press into the abdomen with quick inward and upward thrusts
- Continue administering thrusts until the object is removed or the patient becomes unresponsive
- If unable to move behind the patient, have patient lay on the ground and administer abdominal thrusts using both hands in the same location as if they were standing
- If patient becomes unresponsive, stops breathing and loses consciousness, immediately call or have a bystander call 911 and begin CPR cycle
- Continue CPR cycles until a second rescuer or EMS takes over, you are too tired to continue, or patient begins breathing
- If victim begins breathing, place in recovery position until EMS arrives
***Pregnant women, in the late stages of pregnancy should NOT be given the Heimlich Maneuver from behind. Instead rescuer should administer abdominal thrusts to patient while she is lying on the ground.
Airway Obstruction - Responsive Infant
Check patient for choking. Observe signs of obstruction (speaking and breathing).
- Support the infant’s head, neck, and back with hand and forearm
- Use thigh to support your arm
- Give strong five back blows
- Turn the infant over, supporting the head and neck, using your leg or nearby object
- Check mouth and throat for obstruction
- Give five chest compressions, using two fingers and check airway again
- Repeat these steps until the object is removed
- If the victim becomes unresponsive, stops breathing and loses consciousness, immediately call or have a bystander call 911 and begin CPR cycle
CPR Cycle - Unresponsive Choking Patient
Administer 2 rescue breaths
- If first breath does not make chest rise, re-tilt head and give second breath
- After second breath - begin compressions
- Each time you open the airway to give a breath look for an object in the mouth or throat and if seen, remove it
Continue CPR cycles of 30 compressions, at a rate of 100-120 per minute and then administer 2 rescue breaths
- Adult: At least 2 inches of the chest, but no more than 2.4”
- Child: At least 1/3 depth of the child’s body (or 2”)
- Infant: At least 1/3 depth of the infant’s body (or 1 ½”)
- Adult/Child: On the breastbone (sternum),
- Infant: On the breastbone, just below the nipple line
Continue CPR until:
- AED becomes available
- Patient shows signs of life
- A second rescuer takes over
- EMS arrives and takes over
- You are too tired to continue
Tongue and Airway Obstruction
Airway obstruction in an unresponsive patient lying on his or her back is usually the result of the tongue relaxing in the back of the mouth, restricting air movement. Opening the airway with the head tilt-chin lift method may be all that is needed to correct this problem.