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Now let's cover the highly effect and very important skill called conscious adult choking. Now in this scenario we have someone who is eating at a table, they begin to choke, we know they were choking because they could not cough, they could not breathe, they could not speak. This is a full obstruction if and it needs help if it's gonna come out in most cases. If it's easy to activate the emergency response team or call 911, great, but if not, we can wait until the patient goes unresponsive before we actually take the time to call 911 or activate a code. But in this case we're gonna come up to the person, we're gonna look them in the eyes, "Are you choking?" They nod "Yes." "I know how to help you. May I help you." They give me permission to help them. They're still conscious and so we wanna get that permission from the patient if at all possible. Now I'm gonna elevate their elbows, I'm gonna find the belly button. The belly button is my landmark so that I can tuck my thumb in and put the fist just above the belly button on their abdomen. I wanna stay below the xiphoid process which is approximately right here, I wanna stay just above the belly button because this is where I find the diaphragmatic region. This is exactly what I want so that I can bring that diaphragm up and in while I compress the lower lobes of the lung, shoot the air up the trachea, popping that object out, and it's effective the majority of the time. So I'm gonna take that hand, keep my elbows out so I'm not on their ribs anymore than I have to be, and I'm gonna start with my inward and upward thrust. And I'm gonna do these thrusts, until either the object comes out or the person goes unresponsive. In this case the object did come out. He began breathing, coughing, clearing his own airways. I simply re-encourage him that he's doing fine. If he feels like sitting down you can have him sit down. And if we had not already called 911, now would be the time to call 911 or call a code "if" they go unresponsive. If we've already called 911 keep 'em coming, it's fine. Even though the object already came out, it's always a good idea to have EMS stay on the way, so that if this person opts not to go in, they can be checked out by the EMS professionals. They're gonna check airway, they're gonna check some lung sounds to make sure there's no partial obstruction, and they're probably gonna do a quick assessment to make sure there is no internal bleeding from the abdominal thrust. So if the individual does not opt to have that done to him, or the EMS providers do not come, I always like to encourage them to go to their own practitioner and just be looked over and made sure that everything is okay. Keep in mind, that if this person were not to have this successful removal of the obstruction, they would probably go unresponsive in a short amount of time. And it's then that we would assist them to the ground carefully and begin the skill of unconscious adult choking. Now we're gonna talk about special considerations as it relates to a pregnant woman. You know when we're doing this lifesaving skill of trying to remove the obstruction from the airway, and the person is pregnant, we need to understand that we're dealing with two patients, save mom, save baby. So it's important that we're aggressive in our treatment, but there's a special way to do it so that we don't injure the baby in the process. Let's take a look at how we do that right now. When we have the person in front of us, we know the baby is here in the normal location where we would do abdominal thrust. So we're gonna avoid the area altogether by forming the fist and going under the breast with that fist on the sternum. We're then gonna take that opposite hand, go under the breast and onto that fist that's on the sternum. We're now gonna do inward thrusts, inward deep thrusts. And we're gonna continue to do those compressions until the object comes out and the person begins to breathe normally again. If the object doesn't come out, they're gonna go unconscious. When they go unconscious, we're gonna activate 911, and then we're gonna start doing our unconscious choking victim compressions as we learned in the other segment.
This conscious adult choking lesson is for situations where you can see that an adult is choking and he or she is conscious. The choking victim will usually be exhibiting some unmistakable signs, including:
- They cannot cough
- They cannot breathe
- They cannot speak
Another sign to look for is the universal sign for choking – when the victim places both of their hands around their throat.
The good news is that, even when dealing with a full obstruction, in most situations the obstruction will come out if you perform the abdominal thrusts correctly.
Pro Tip #1: Only worry about calling 911 and activating EMS if doing so is quick and easy, or there is another person nearby that can call. Otherwise, don't waste time calling 911 and go right into assessing the victim.
How to Provide Care
The first thing you want to do is face the person and look them in the eyes. You want confirmation that the victim is choking, and you want to receive permission to help the person.
"Are you choking?"
The person will probably nod yes.
"May I help you?"
You'll likely get another nod. If the victim is conscious, it's always a good idea to get permission and it only takes a second.
Abdominal Thrust Technique for Adults
- Elevate the victim's arms and elbows so you have clear access to the abdominal area.
- Locate the belly button using the index finger on your dominant hand and hold it there. This is the landmark you'll use to find the correct abdominal point.
- On your non-dominant hand, tuck in your thumb and place your fist thumb-first above the finger that's on the belly button, essentially stacking one on top of the other vertically.
Pro Tip #2: Make sure you stay below the xyphoid process and above the belly button. This is the diaphragmatic region where you'll be performing the abdominal thrusts.
- Take your index finger off the belly button and wrap that dominant hand over your other hand that's positioned on the victim's diaphragm.
- Keep your elbows out so they're resting on the victim's ribs as little as possible.
- Thrust up and in and turn your hands upward as you perform each thrust.
- Perform the abdominal thrusts until the object comes out or the person becomes unresponsive.
Pro Tip #3: It's important to turn your hands upward as you perform each thrust, as this will bring the diaphragm up and in and compress the lower lobes of the lungs, forcing air to shoot up the trachea and pop the obstruction out. This works in the majority of choking situations.
- Once the object comes out, the victim will begin coughing to help clear the airway and should begin breathing normally again in a matter of seconds.
- Encourage the victim and let the person know that he or she is OK now and have them sit down if necessary.
If you called 911, let them come anyway, so the person can be examined. EMS responders can check the choking victim's airway and listen to their lungs to make certain that there are no partial obstructions remaining. And they can do a quick assessment for internal bleeding or other damage.
If you did not call 911, it's always a good idea to encourage the choking victim to see his or her own doctor to make sure everything is OK.
If you weren't able to remove the obstruction using the abdominal thrust technique, the victim will go unconscious pretty quickly. Help lower them to the ground, so they don't fall and injure themselves. Call 911 immediately and activate EMS or call in a code if in a healthcare setting. Then begin performing the unconscious adult choking procedure.
Special Consideration for Pregnant Women
It's important to remember that when treating a pregnant woman, regardless of the situation, you're actually treating two patients. Saving mom is always the priority, as saving mom will also save the baby. So, be just as aggressive in your treatment.
However, you don't want to injure the baby while performing the abdominal thrusts. Which is why you'll be using a different area for the thrusts – directly under the breasts and on top of the sternum.
Pro Tip #4: Besides the point of thrusting, there is only one other difference when dealing with an adult choking victim who's pregnant. The thrusts will be inward only; not up and in.
A Word About Types of Airway Obstruction
There are two types of airway obstructions – anatomical and mechanical, also referred to as Foreign Body Airway Obstruction (FBAO).
Anatomical obstructions occur when a part of the victim's anatomy is causing the blocked airway. It could be due to the tongue, swollen mouth tissues, or a swollen throat.
The tongue is the most common type of anatomical obstruction, as it relaxes in unconscious victims when their bodies are deprived of oxygen. Because the tongue tends to relax on the back of the throat in these situations, it can block airflow to the lungs.
Mechanical or FBAO obstructions include food, toys, and liquids. Poorly chewed food is the biggest culprit – eating too fast and/or laughing, talking, or running while eating can contribute to choking. And with small children, it's no surprise that toys are also a common choking obstruction.