Choking is not a common cause of death and is treatable. People are most likely to choke when they are eating and where they are often in company. As victims are initially conscious and responsive, early intervention can save a life.
Recognising that someone is choking is the key to a successful outcome, so do not confuse this emergency with fainting, heart attack, seizure or other conditions that may cause sudden respiratory distress, cyanosis or loss of consciousness.
Choking usually occurs while the victim is eating or drinking. People at increased risk of choking include those with reduced consciousness, drug/or alcohol intoxication, neurological impairment with reduced swallowing and cough reflexes like Stroke or Parkinson’s disease, respiratory disease, mental impairment, dementia, dental problems and older age.
Foreign bodies may cause either mild or severe airway obstruction. It is important to ask the conscious victim “Are you choking?” The victim that is able to speak, cough and breathe has mild obstruction. The victim that is unable to speak, has a weakening cough, is struggling or unable to breathe, has severe airway obstruction.
We will look at the treatment of choking in other videos but it's worth looking at the difference in mild and severe choking briefly first.
Someone with a mild airway obstruction is encouraged to cough. Coughing generates high and sustained airway pressures and may expel the foreign body. Aggressive treatment with back blows, abdominal thrusts and chest compressions at this stage may cause harm and can worsen the airway obstruction. These treatments are reserved for victims who have signs of severe airway obstruction. Victims with mild airway obstruction should remain under continuous observation until they improve, as severe airway obstruction may subsequently develop.
The clinical data on choking are largely retrospective and anecdotal. For conscious adults and children over one year of age with complete airway obstruction, case reports show the effectiveness of back blows or ‘slaps’, abdominal thrusts and chest thrusts. Approximately half of cases of airway obstruction are not relieved by a single technique. The likelihood of success is increased when combinations of back blows or slaps, and abdominal and chest thrusts are used.
Higher airway pressures can be generated using chest thrusts compared with abdominal thrusts. Bystander initiation of chest compressions for unresponsive or unconscious victims of choking is associated with improved outcomes.
Following successful treatment of choking, foreign material may nevertheless remain in the upper or lower airways and cause complications later. Victims with a persistent cough, difficulty swallowing or the sensation of an object being still stuck in the throat should, therefore, seek medical advice. Abdominal thrusts and chest compressions can potentially cause serious internal injuries and all victims successfully treated with these measures should be examined afterwards for injury.