Foreign-body airway obstruction (choking) is an uncommon but potentially treatable cause of accidental death. The common most cause of choking in adults is airway obstruction caused by food such as fish, meat, or poultry.
Foreign bodies may cause either mild or severe airway obstruction. The signs and symptoms enabling differentiation between mild and severe airway obstruction are summarized in the picture below.
It is important to ask the conscious victim “Are you choking?”
General signs of FBAO: attack occurs while eating, victim may clutch at neck.
As most choking events are associated with eating, they are commonly witnessed. Thus, there is often the opportunity for early intervention while the victim is still responsive.
FBAO with Severe Airway Obstruction
For conscious adults and children over 1 year with a complete FBAO, case reports demonstrate the effectiveness of back blows or ‘slaps’, abdominal thrusts, and chest thrusts. Approximately 50% of episodes 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 pressure can be generated using chest thrusts compared with abdominal thrusts. Since chest thrusts are virtually identical to chest compressions, rescuers should be taught to start CPR if a victim of known or suspected FBAO becomes unconscious.
Adult FBAO Treatment
This sequence is also suitable for use in children over the age of 1 year.
Mild Airway Obstruction
Encourage him/her to continue coughing but do nothing else.
Victims with mild airway obstruction should remain under continuous observation until they improve, as severe airway obstruction may develop.
Severe Airway Obstruction – Conscious
Apply up to five back blows as follows:
- Stand to the side and slightly behind the victim.
- Support the chest with one hand and lean the victim well forwards.
- Give up to five sharp blows between the shoulder blades with the heel of your hand.
- Check to see if each back blow has relieved the airway obstruction.
- The aim is to relieve the obstruction with each slap rather than necessarily to give all five.
If five back blows fail to relieve the airway obstruction, give up to five abdominal thrusts as follows:
- Stand behind the victim and put both arms around the upper part of his/her abdomen.
- Lean the victim forwards.
- Clench your fist and place it between the navel and xiphoid (lower part of the sternum).
- Grasp this hand with your other hand and pull sharply inwards and upwards.
- Repeat up to five times.
If the obstruction is not relieved, continue alternating five back blows with five abdominal thrusts.
If the victim at any time becomes unconscious
- Support the victim carefully to the ground.
- Immediately activate EMS.
- Begin CPR (start with chest compressions)
- During CPR, each time the airway is opened the victim’s mouth should be checked for any foreign body that has been partially expelled. The incidence of unsuspected choking as a cause of unconsciousness or cardiac arrest is low, therefore, during CPR routinely checking the mouth for foreign bodies is not necessary.
The Finger Sweep
Avoid use of a blind finger sweep and manually remove solid material in the airway only if it can be seen.
Use your baby finger for the sweep.
Pregnant or Obese Victims
Abdominal thrusts should NOT be used on these victims. Chest thrusts should be used instead.
Abdominal thrusts are dangerous on infants (below 1 year) because they may damage the liver. Instead 5 chest thrusts should be alternated with 5 back blows. Chest thrusts for infants are performed as follows:
- Turn the infant into a head-downwards supine (on the back) position. This is achieved safely by placing the free arm along the infant’s back and encircling the base of the head with the hand.
- Support the infant down your arm., which is placed down (or across) your thigh.
- Identify the position for chest compressions (middle of lower sternum).
- Give five chest thrusts; these are similar to chest compressions but sharper and delivered at a slower rate.
Aftercare and Referral for Medical Review
Following successful treatment for FBAO, foreign material may nevertheless remain in the upper or lower respiratory tract 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 be referred for a medical opinion.
Abdominal thrusts can cause serious internal injuries, and all victims treated with abdominal thrusts should be examined for injury by a doctor.