Choking
Because recognition of choking (airway obstruction by a foreign body) is the key
to successful outcome, it is important not to confuse this emergency with fainting,
heart attack, seizure, or other conditions that may cause sudden respiratory
distress, cyanosis, or loss of consciousness.
Foreign bodies may cause either mild or severe airway obstruction. The signs
and symptoms enabling differentiation between mild and severe airway
obstruction are summarised in the table below. It is important to ask the
conscious victim ‘Are you choking?’
General signs of choking
• Attack occurs while eating
• Victim may clutch his neck
Signs of mild airway obstruction Signs of severe airway obstruction
Response to question ‘Are you
choking?’
• Victim speaks and answers yes
Other signs
• Victim is able to speak, cough,
and breathe
Response to question ‘Are you
choking?’
• Victim unable to speak
• Victim may respond by nodding
Other signs
• Victim unable to breathe
• Breathing sounds wheezy
• Attempts at coughing are silent
• Victim may be unconscious
Adult choking sequence
(This sequence is also suitable for use in children over the age of 1 year)
1 If the victim shows signs of mild airway obstruction:
• Encourage him to continue coughing, but do nothing else.
2 If the victim shows signs of severe airway obstruction and is
conscious:
• Give up to five back blows.
o Stand to the side and slightly behind the victim.
o Support the chest with one hand and lean the victim well
forwards so that when the obstructing object is dislodged it
comes out of the mouth rather than goes further down the
airway.
o Give up to five sharp blows between the shoulder blades with
the heel of your other 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
necessarily to give all five.
• If five back blows fail to relieve the airway obstruction give up to five
abdominal thrusts.
o Stand behind the victim and put both arms round the upper
part of his abdomen.
o Lean the victim forwards.
o Clench your fist and place it between the umbilicus (navel) and
the bottom end of the sternum (breastbone).
o Grasp this hand with your other hand and pull sharply inwards
and upwards.
o Repeat up to five times.
• If the obstruction is still not relieved, continue alternating five back
blows with five abdominal thrusts.
3 If the victim becomes unconscious:
• Support the victim carefully to the ground.
• Immediately call an ambulance.
• Begin CPR (from 5B of the Adult BLS Sequence). Healthcare
providers, trained and experienced in feeling for a carotid pulse,
should initiate chest compressions even if a pulse is present in the
unconscious choking victim.
Explanatory notes
Following successful treatment for choking, foreign material may nevertheless
remain in the upper or lower respiratory tract and cause complications later.
Victims with a persistent cough, difficulty swallowing, or with the sensation of an
object being still stuck in the throat should therefore be referred for a medical
opinion.
Abdominal thrusts can cause serious internal injuries and all victims receiving
abdominal thrusts should be examined for injury by a doctor.
CHOCKING ALGORITM
ADULT CHOCKING VIDEO
INFANT CHOCKING VIDEO
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