Choking

Choking occurs when a foreign body (eg. a mouthful of food) partly or completely blocks a person's airway making breathing difficult. Choking is a medical emergency. If the object causing the blockage cannot be easily removed call 000 immediately.

What is Choking?

The respiratory tract begins at the nose, nasal passages and mouth, joining at the throat to form an air pipe (called the trachea) which is held open by C-shaped pieces of cartilage. When a foreign body partly or completely blocks a person's airway, the passage of air into and out of the lungs may be compromised. Depending on how much the airway is blocked will determine how severe this compromise may be. In extreme cases, no air at all may be able to pass into the lungs, signalling a medical emergency as the brain can only be deprived of oxygen for a few minutes before damage begins. In less severe cases, air entry may not be reduced, although discomfort or pain may be experienced.

Choking is more common in infants and the elderly. The Australian Institute of Health and Welfare estimated that between 1999-2003 suffocation or choking accounted for 11% of injury related deaths in infants. Young children are particularly at risk of choking due to their smaller airways, reduced ability to bite and chew their food and their tendency to explore their surroundings by placing objects in their mouth.

Common Causes of Choking

• eating or drinking too quickly
• swallowing food before it has been sufficiently chewed
• swallowing small bones or objects
• inhaling small objects

Signs and Symptoms

The signs and symptoms of choking may vary according to the severity of the obstruction and the object itself:

• clutching at the throat
• neck or throat pain
• inability to speak, breathe or swallow
• coughing
• wheezing or other unususal breathing sounds
• gagging
• a change in colour (eg. blue lips or red face)
• chest pain
• collapse

Management

The following information is not a substitute for first aid training. It is recommended that everybody undertake a first aid course, such that in the event of an emergency, you have been trained to manage the situation.

If the patient is over one year of age the following management is recommended:

• ask them to cough to remove the object
• encourage them to relax and breathe deeply
• if this does not remove the blockage call 000

While waiting for the Ambulance:

• bend the patient forward and give them a sharp hit in the middle of their back between the shoulder blades with the heel of your open hand
• check to see if this has dislodged the object
• if the objected is still lodged, repeat this procedure up to five times
• it is important to bend the patient forward before delivering the blow to the back, if a patient is in the upright position dislodging the object may cause it to move further down the respiratory tract

If the blockage has still not cleared:

• place one hand over the middle of the patient's back and the other hand over the breast bone (in the CPR position)
• give one chest thrust
• check to see if the obstruction has cleared
• repeat up to five times
• if this fails to clear the object, repeat the five back hits with the heel of your open hand and alternate with five chest thrusts
• continue this until the ambulance has arrived
• if the patient collapses or loses consciousness at any point, begin cardio pulmonary resuscitation (CPR)

In a child under one year of age, the management is slightly different:

• call 000 immediately
• position the child with head downwards and stomach along your forearm
• support the child's head with your hand
• hold the infant's mouth open with your fingers
• deliver a sharp blow to the back and check to see if the object has become dislodged
• repeat up to five times.if this fails to dislodge the object, turn the child onto their back and remove any loose material from the infant's mouth
• if the blockage is still present, perform up to five chest thrusts with two fingers in the CPR position on the breast bone
• alternate between chest thrust and back blows until the obstruction is removed or the ambulance arrives
• if the child loses consciousness at any point, begin CPR

If YOU are choking:

• stay calm
• attempt to call for assistance
• forcefully cough to expel the object
• do not allow anyone to hit your back whilst you are in the upright position, in case this lodges the object further down the airways

Depending on how serious the choking event is, you make be required to spend some time in hospital until your health care professional is satisfied that no injuries were obtained.