What to do if someone is choking

What to do if someone is choking

When I’m teaching and we discuss the management of choking it’s common that someone will know someone who has choked or choked themselves. Sadly it can kill and it kills children. You can read more of Millie’s story and join the campaign here. St John’s Ambulance showed an advert (which has now been banned for using misleading figures) of someone choking at a barbecue. It was designed to be shocking and it was, like so many of their adverts, but it doesn’t take long to learn what to do.

This is the algorithm from the Resuscitation Council which we follow.

When we talk about the management of choking we aren’t talking about people who are coughing and telling you that something is stuck we are talking about someone who has a completely obstructed airway, so it’s important to know what you are looking for.

How do we recognise someone who is choking?

The Resuscitation Council tell us to ‘Assess Severity’ this is how:-
• Unable to cough effectively – encourage them to try and cough, if they can cough that’s great because that is more likely to help dislodge it. If they can’t cough effectively then you need to help.

• Unable to speak – someone who has a complete obstruction can’t speak. They may be able to answer questions with nodding or shaking their head.

• Panic – they will likely look panic stricken. One of my daughters choked when they were 2 and her face changed instantly as she realised she couldn’t breathe. Panic also means that they are not going to sit calmly and it has been known for people to get up and go outside.

• Changing colour – they may initially go red but then you may start to see their lips go blue as they are starved of oxygen.

What do you need to do?

• Start with 5 back blows – use the heel of your dominant hand to deliver the back blow between the shoulder blades, using your other arm to support their chest and lean them forward. Quickly check after each blow if it’s worked, if it has then stop.

• 5 abdominal thrusts – stand behind them and put your arms around them so you make a fist under where the ribs finish and above their belly button, place your other hand over the top. Then pull in and upwards. Quickly check after each thrust if it’s worked, if it has then stop. If you’ve delivered abdominal thrusts and have been successful then they must have someone examine them to check for internal bruising, DO NOT let this put you off using force as their blocked airway is your priority.

• Repeat Cycles – If your first 5 blows and your first 5 thrusts haven’t worked ask someone to call an ambulance and then keep going alternating 5 blows then 5 thrusts until either:-
i. You relieve the obstruction
ii. They become unconscious

• If they become unconscious do CPR, with breaths if you know how and are able. The chest compressions may dislodge the obstruction and some air may squeeze passed the obstruction.  The air may get passed when they are unconscious because their airways may be more relaxed.

Choking and children

The algorithm above is for adults, it’s very similar for children, except for a few small things.

• When delivering the back blows if they’re small enough to go over your lap then do so and if possible have their head hanging down.
• When delivering the abdominal thrusts you can sit them on your lap if they’re small or stand behind them if they’re too big.
• For under 1s we don’t use abdominal thrusts due to the risk of internal damage so we use Chest thrusts instead. To do this lay them across your lap on their back with their head slightly down, then push down and upwards on their chest between the nipples.
• When delivering CPR start with 5 breaths first if you know how and are able.

 

You can see this in action on the Lifesaver app form the Resuscitation Council. This app has 3 games that you can play along with, one of which is choking. I’ve had very positive feedback from my customers about this app and it has also won awards.

Please comment and share your experiences.  Also please share this post so more people know what to to.