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Choking is a life-threatening medical emergency which needs quick action for survival.

Choking occurs when an object blocks the airway, making it impossible to breathe. Choking can occur at any stage of life and can be fatal. The oesophagus (food pipe) and trachea (windpipe) share an opening at the back of the throat. When a person swallows food, the food travels down to the stomach via the oesophagus. When a person swallows food, a small flap of cartilage (called the epiglottis) covers the opening of the trachea, so the food goes right into the oesophagus.

Sometimes, as we laugh, talk or run while eating, the epiglottis fails to close the trachea fast enough and food slips down the trachea. Most of the time, our body fixes this problem by coughing up the blockage. But when the food gets lodged way down the trachea, it may block the airflow, thus choking the person. 

  1. What are the causes of choking?
  2. What are the signs of choking?
  3. What to do if someone is choking?
  4. How to perform the Heimlich manoeuvre?
  5. How can one prevent choking?

Choking is most commonly seen in infants and young children. The choking hazards for children are:

  • Latex balloons
  • Hard candies
  • Large pieces of raw vegetables 
  • Uncut grapes, berries or cherries
  • Coins
  • Pieces of nuts
  • Marbles
  • Toys with small detachable parts
  • Pen caps
  • Beads
  • Buttons 

Choking in adults is usually caused by an improper way of eating. Some people have an unusual habit of grabbing a handful of food (like popcorn or nuts) and shovelling it into their mouth. This makes the food go closer to the windpipe, thus the chances of choking increase.

Some chewy and dry food items like peanut butter or overcooked chicken can also cause choking in adults. Some people may also choke on small bones of chicken or fish which they might not have noticed before ingesting.

A choking person would obviously show some signs of distress. The common signs of choking are:

  • Severe coughing and gagging
  • Pointing at the throat with hands
  • Clutching the throat with both hands
  • Inability to speak
  • Gasping for breath or wheezing
  • The nails, lips and face turning blue (cyanosis: lack of oxygen in the body)
  • Loss of consciousness

A child wouldn’t point at or grasp their throat to get your attention while choking. A choking infant or child would find it difficult to even cry or cough. The child’s face could be red and puffy. The child may struggle to remove the choking object with their hand.

If you see the signs of choking in an infant (under 1-year-olds), you can follow these steps:

  • Open the baby’s mouth and look for any visible object.
  • If you cannot find anything in the baby’s mouth, lay the baby face down, along your thighs with the head towards your knees. 
  • Support the baby’s head with one hand and give at least five sharp back blows (between the shoulder blades) with the other hand.
  • Turn the baby over on your thighs to check their mouth again. Carefully pick out any visible obstructive material from the mouth.
  • Do not use a sweeping motion to remove the object or else you might end up pushing the object further down.
  • If the baby is still choking, turn the infant face up, supporting the back of the infant's head with your hand. 
  • Now put two fingers at the centre of their chest just below their nipple line and give five sharp chest thrusts about 1.5 inches deep.
  • Check the baby’s mouth again for any dislodged object. If still there is no success, call for medical help as soon as possible.
  • If at any point the baby becomes unresponsive or loses consciousness then you must start cardiopulmonary resuscitation (CPR) immediately.

If you notice signs of choking in a child (1-12 years old) or adult, these are the steps you can follow:

  • Look for any visible choking object in their throat and encourage them to cough the obstruction out.
  • If coughing doesn’t benefit, help them lean forward and hold their upper body with one hand. Now with the heel of your other hand, give them at least five back blows between their shoulder blades.
  • After the blows, check their mouth and remove any visible object with caution.
  • Do not use a sweeping motion to remove the object or else you might end up pushing the object further down.
  • If they are still choking, then you may need to perform the Heimlich manoeuvre.
  • Check the mouth again for any dislodged object. If there is still no success, call for medical help as soon as possible.
  • If at any point the child or adult becomes unresponsive or loses consciousness then you must start cardiopulmonary resuscitation (CPR) immediately.

For your own self

If you are all by yourself and end up choking on something, then you can try and give the Heimlich manoeuvre to yourself.

  • Make a fist and place it above the belly button, just where the rib cage ends.
  • With your other hand grasp the fist and push in and then up, making a J-shaped motion.
  • If the object does not dislodge, find a stable object like a chair that is at least waist-high.
  • Bend over, brace your fist between the chair and your abdomen and drive your body against it.
  • Repeat this motion to dislodge the object.

For children and adults

  • It must only be given when the child or adult is conscious. One must be 100% sure of choking before performing the manoeuvre.
  • Stand behind the child or adult and put your arms around their waist.
  • Clench the fist of one hand and place it above the belly button, just where the rib cage ends.
  • With your other hand, grasp the fist and pull sharply inwards and upwards.
  • Repeat this movement up to five times and check their mouth each time.

For pregnant woman

You need to be cautious while performing Heimlich manoeuvre because you cannot put pressure at the end of the rib cage as the foetus is occupying that space. The steps for the manoeuvre in pregnant women are:

  • Stand behind the pregnant woman and put your arms around the rib cage, below the breasts.
  • Clench the fist of one hand and place it around the lower half of the sternum (middle bone of the rib cage).
  • With your other hand, grasp the fist and pull sharply inwards like you would do while doing chest compressions.
  • The pull should be at least 2 inches deep while simultaneously squeezing the whole rib cage to create pressure so that the obstruction comes out on its own.
  • Repeat the compressions five times and check for the choking object in their mouth after each time.

Choking can be fatal for both children and adults.

It can be prevented easily in infants and children by keeping some minor precautionary measures in mind: 

  • You should not let your children walk, run, play or laugh while they have food in their mouth.
  • Keep beads, coins, latex balloons, marbles, and small detachable toys away from infants and young children, especially from children below 4 years of age.
  • Parents should not feed food items like hot dogs, nuts, chunks of meat, uncut grapes, hard candies, popcorn, chunks of peanut butter, or raw carrots to their kids below the age of 4 years.
  • Parents should oversee their young children’s mealtimes and must not feed their children while they’re lying down.

Choking on food in adults can be prevented by following these guidelines:

  • Take small bites at a time.
  • Chew the food slowly and thoroughly.
  • Do not laugh or talk while chewing or swallowing.
  • Eat food items like fish with caution, as you may choke on a bone.
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References

  1. National Health Service [Internet]. UK; What should I do if someone is choking?
  2. Stanford Children's Health: Lucile Packard Children's Hospital [Internet], Stanford. USA; How to Help a Choking Child
  3. National Health Service [Internet]. UK; How to help a choking child
  4. National Safety Council [Internet]. Itasca. Illinois. USA; Choking Prevention and Rescue Tips
  5. St John Ambulance [Internet]. Order of Saint John. London. UK; Choking
  6. Johns Hopkins Medicine [Internet]. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System; Choking and the Heimlich Maneuver
  7. MSDmannual consumer version [internet].How To Do the Heimlich Maneuver in the Conscious Adult or Child. Merck Sharp & Dohme Corp. Merck & Co., Inc., Kenilworth, NJ, USA
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