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One situation you may have to deal with is dealing with someone who's choking. Now, choking is divided into two main groups. There is mild choking and severe choking. Now, mild choking is where you have a blockage in a throat, however, air can still pass through. So this person is going to be coughing, they are going to be breathing heavily, they are going to be in a lot of distress, but the air can pass through. So you will hear them making noise, you will hear them coughing, they may be able to talk. An example of a mild obstruction could be a fishbone that's caught in the throat. The procedures are to try and calm them down the best you can, allow them to cough and hopefully, they'll expel the object. If they don't, then you are going to need to get them to medical help and call the EMS, because you are not going to be able to take that obstruction out of their throat.The next group are the severe airway obstructions. Severe airway obstruction is a complete blockage in the throat. It could be they are in a restaurant and you have eaten a very large lump of steak, just swallowed it, which often happens where people are laughing or talking and eating at the same time. That can cause an obstruction or rush their food. If the lump of steak got stuck into the throat, there is no air passing. So, with this person, they are not going to be able to cough. They are going to be very, very distressed. They are going to be passing out in a very short space of time, just in a minute or just over a minute and this person is going to need help immediately. So with this person, we are going to need to approach them, get their consent. Now, one of the things you can say to someone is, "Are you choking?" It might seem a bit of an odd thing to say, but the reason you say, "Are you choking?" is we want them to get a reaction from it. If they say, "Yes," it means that they are not choking in the sense of the procedure we are going to be talking about next.If they can not answer you, then you are going to have to look for other signs. Now one of the universal signs of choking is hands to the throat. If you say, "Are you choking?" They might not, or they might indicate you to come over. Anything like this, this is all concerns and we go through within first aid. You still have to go through your first aid cycle, your consent side. But, in order to gain that consent and know they are choking, it's not only verbal, they are not going to be able to talk to you, it can be other signs that you look for. What we are going to do is do two key procedures. The first one will be five back slaps and the second one will be five abdominal thrusts and then we repeat that. With the demonstration of how to deal with choking, the first things you are looking for are signs. So, if Matt was choking, he would be having his hands to the throat and then I would ask, "Are you choking?" Now, he can not answer me, so he's going to nod. You will see it in his face, you will see him turning red, he's trying to breathe, he's going to be very distressed.So what you can then do is move through to the back blows. The first thing you do is take one arm and just lay it forward, to just lean in forward slightly. And we are going to deliver five back blows as individual blows between the shoulder blades and it will literally be one, two, three, four, five. Between each one, I'm looking down to see if the object has been expelled. If it has, I will then stop and allow him to cough. What I then do if that hasn't worked, I then need to do abdominal thrusts. So, I need to get the thumb side of my fist in against... Just above his belly button, in here. So you are not pushing on the rib cage, you are doing below the rib cage. The other hand is going right the way around and then we are giving an inward and upward motion. It would be literally in like this. Now, I won't do this fully because it would cause... Could cause him injury. So it would be literally inward one, two, three, four and five. And if that hasn't worked, I leave my arm there and go back to one, check, two, check, three, check, four, check, five. So, it's five back slaps, five abdominal thrusts and then you repeat that until the object comes out or he becomes unconscious.One advantage of having your arm around here is if he did become unconscious, you can lower him into the ground. And once you lower him to the ground, you would then start CPR at the chest compression stage. You know he's not breathing; he's been choking. So, you would start CPR chest compression stage, because the trapped air in his lungs, as you push down on the chest, the hope is, is that trapped air in the lungs will force against the object and expel it out the body. Finally, if you had to do the abdominal thrust on a pregnant lady, then you can not do it down into the stomachs, you do what's called chest thrusts. This would be exactly where we do the CPR compressions. It's fist-size straight in, in the middle of the breastbone. And you would pull through onto the chest in the same manner as you would down on the stomach, but you will push in on the chest. This is the only option you have really got because there's no other way round of doing it. If you couldn't get your arms around someone's waist, then again, you can move up here and do chest thrusts if you needed to.
Dealing with Choking: Recognizing and Responding
1. Understanding Choking
Choking can be categorized as mild or severe, depending on the extent of airway obstruction.
1.1 Mild Choking
In cases of mild choking, there's partial blockage in the throat, and the person can still cough, breathe heavily, and may even talk. Common examples include throat blockage due to a fishbone. Initial steps involve calming the person and allowing them to cough, but if the obstruction persists, seek medical help as you can't remove the object yourself.
1.2 Severe Choking
Severe choking results from a complete throat blockage, often caused by large food items. The person won't be able to cough and will rapidly deteriorate, necessitating immediate intervention.
2. Recognizing Severe Choking
To identify severe choking:
- Ask, "Are you choking?" and observe for signs.
- Signs include hands clutching the throat and difficulty breathing.
- If the person can't respond verbally, look for non-verbal cues of distress.
3. Performing Life-Saving Procedures
For severe choking, take these critical actions:
3.1 Back Blows
Deliver five back blows between the shoulder blades while ensuring the person leans forward slightly. Watch for the expelled object after each blow.
3.2 Abdominal Thrusts
Perform five abdominal thrusts by placing your thumb side just above the belly button and giving inward and upward thrusts. Alternate with back blows until the obstruction clears or the person loses consciousness.
4. Emergency CPR
If the person loses consciousness, gently lower them to the ground and initiate CPR chest compressions. The trapped air in the lungs may help expel the obstruction as you compress the chest.
5. Special Consideration for Pregnant Individuals
If dealing with choking in a pregnant person, use chest thrusts instead of abdominal thrusts, placing your fists on the middle of the breastbone and performing inward thrusts.