Choking


Choking
Choking
Classification and external resources
ICD-10 F41.0, R06.8, T17, W78-W80
ICD-9 784.9, 933.1
MeSH D000402

Choking is the mechanical obstruction of the flow of air from the environment into the lungs. Choking prevents breathing, and can be partial or complete, with partial choking allowing some, although inadequate, flow of air into the lungs. Prolonged or complete choking results in asphyxia which leads to anoxia and is potentially fatal. Oxygen stored in the blood and lungs keep the victim alive for several minutes after breathing is stopped completely.[1]

Choking can be caused by:

Contents

Foreign objects

The type of choking most commonly recognized as such by the public is the lodging of foreign objects (also known as foreign bodies, but consisting of any object which comes from outside the body itself, including food, toys or household objects) in the airway.[2]

This type of choking is often suffered by small children, who are unable to appreciate the hazard inherent in putting small objects in their mouth.[3] In adults, it mostly occurs whilst the patient is eating. In one study, peanuts were the most common obstruction.[4]

Symptoms and clinical signs

  • The person cannot speak or cry out, or has great difficulty and limited ability to do so.
  • Breathing, if possible, is labored, producing gasping or wheezing.
  • The person has a violent and largely involuntary cough, gurgle, or vomiting noise, though more serious choking victims will have a limited (if any) ability to produce these symptoms since they require at least some air movement.
  • The person desperately clutches his or her throat or mouth, or attempts to induce vomiting by putting their fingers down their throat.
  • If breathing is not restored, the person's face turns blue (cyanosis) from lack of oxygen.
  • The person does any or all of the above, and if breathing is not restored, then becomes unconscious.

Treatment

Choking can be treated with a number of different procedures, with both basic techniques available for first aiders and more advanced techniques available for health professionals.

Many members of the public associate abdominal thrusts, also known as the Heimlich Maneuver with the correct procedure for choking, which is partly due to the widespread use of this technique in movies, which in turn was based on the widespread adoption of this technique in the United States at the time.

Most modern protocols, including those of the American Heart Association and the American Red Cross, who changed policy in 2006[5] from recommending only abdominal thrusts) involve several stages, designed to apply increasingly more pressure.

The key stages in most modern protocols include:

Encouraging the victim to cough

This stage was introduced in many protocols as it was found that many people were too quick to undertake potentially dangerous interventions, such as abdominal thrusts, for items which could have been dislodged without intervention. Also, if the choking is caused by an irritating substance rather than an obstructing one, and if conscious, the patient should be allowed to drink water on their own to try to clear the throat. Since the airway is already closed, there is very little danger of water entering the lungs. Coughing is normal after most of the irritant has cleared, and at this point the patient will probably refuse any additional water for a short time.

Back slaps

The majority of protocols now advocate the use of hard blows with the heel of the hand on the upper back of the victim. The number to be used varies by training organization, but is usually between five and twenty.

The back slap is designed to use percussion to create pressure behind the blockage, assisting the patient in dislodging the article. In some cases the physical vibration of the action may also be enough to cause movement of the article sufficient to allow clearance of the airway.

Almost all protocols give back slaps as a technique to be used before to the consideration of potentially damaging interventions such as abdominal thrusts,[6][7] but Henry Heimlich, noted for promulgating abdominal thrusts, wrote in a letter to the New York Times that back slaps were proven to cause death by lodging foreign objects in to the windpipe.[8]

The findings of a 1982 Yale study by Day, DuBois, and Crelin that "persuaded the American Heart Association to stop recommending back blows for dealing with choking...was partially funded by Heimlich's own foundation."[9] According to Roger White MD of the Mayo Clinic and American Heart Association (AHA), "There was never any science here. Heimlich overpowered science all along the way with his slick tactics and intimidation, and everyone, including us at the AHA, caved in."[10]

Abdominal thrusts

A demonstration of abdominal thrusts

Abdominal thrusts, also known by the proprietary name the Heimlich Maneuver (after Henry Heimlich, who first described the procedure in a June 1974 informal article entitled "Pop Goes the Cafe Coronary", published in the journal Emergency Medicine). Edward A. Patrick, MD, PhD, an associate of Heimlich, has claimed to be the uncredited co-developer of the procedure.[11] Heimlich has objected to the name "abdominal thrusts" on the grounds that the vagueness of the term "abdomen" could cause the rescuer to exert force at the wrong site.[12]

Performing abdominal thrusts involves a rescuer standing behind a patient and using their hands to exert pressure on the bottom of the diaphragm. This compresses the lungs and exerts pressure on any object lodged in the trachea, hopefully expelling it. This amounts to an artificial cough.

Due to the forceful nature of the procedure, even when done correctly it can injure the person on whom it is performed. Bruising to the abdomen is highly likely and more serious injuries can occur, including fracture of the xiphoid process or ribs.[13]

In some areas, such as Australia, authorities believe that there is not enough scientific evidence to support the use of Abdominal thrusts and their use is not recommended in first aid.[14]

Self treatment with abdominal thrusts

A person may also perform abdominal thrusts on themselves by using a fixed object such as a railing or the back of a chair to apply pressure where a rescuer's hands would normally do so. As with other forms of the procedure, it is possible that internal injuries may result.

Modified chest thrusts

A modified version of the technique is sometimes taught for use with pregnant and/or obese patients. The rescuer places their hand in the center of the chest to compress, rather than in the abdomen.

Finger sweeping

The American Medical Association advocates sweeping the fingers across the back of the throat to attempt to dislodge airway obstructions, once the choking victim becomes unconscious.[15]

Some protocols advocate the use of the rescuer's finger to 'sweep' foreign objects away once they have reached the mouth.[citation needed] However, many modern protocols recommend against the use of the finger sweep as if the patient is conscious, they will be able to remove the foreign object themselves, or if they are unconscious, the rescuer should simply place them in the recovery position (where the object should fall out due to gravity). There is also a risk of causing further damage (for instance inducing vomiting) by using a finger sweep technique.

Direct vision removal

The advanced medical procedure to remove such objects is inspection of the airway with a laryngoscope or bronchoscope, and removal of the object under direct vision, followed by CPR if the patient does not start breathing on their own. Severe cases where there is an inability to remove the object may require cricothyrotomy.

CPR

In most protocols, once the patient has become unconscious, the emphasis switches to performing CPR, involving both chest compressions and artificial respiration. These actions are often enough to dislodge the item sufficiently for air to pass it, allowing gaseous exchange in the lungs.

Notable victims

  • United States President George W. Bush survived choking on a pretzel on January 13, 2002, receiving major media coverage.[16]
  • Jimmie Foxx, a famous Major League Baseball player, died by choking on a bone.[17]
  • Tennessee Williams, the playwright, died after choking on a bottle cap.[18]
  • An urban legend states that obese singer Mama Cass choked to death on a ham sandwich. This was borne out of a quickly discarded speculation by the coroner, who noted a partly eaten ham sandwich and figured she may have choked to death. In fact, she died of a heart condition, often wrongly referred to in the media as heart failure.[19]
  • The Queen Mother was admitted to a UK Hospital for an operation in May 1993 after choking on a fish bone.[20]

Other uses of abdominal thrusts

Dr. Heimlich also advocates the use of the technique as a treatment for drowning[21] and asthma[22] attacks, but Heimlich's promotion to use the maneuver to treat these conditions resulted in marginal acceptance. Criticism of these uses has been the subject of numerous print and television reports which resulted from an internet and media campaign by his son, Peter M. Heimlich, who alleges that in August 1974 his father published the first of a series of fraudulent case reports in order to promote the use of abdominal thrusts for near-drowning rescue.[23]

References

  1. ^ Ross, Darrell Lee; Chan, Theodore C (2006). Sudden Deaths in Custody. ISBN 9781597450157. http://books.google.com/?id=BFl6GGZsqp4C&pg=PA49&dq=Asphyxiation+and+Ventilatory+Requirements#v=onepage&q=Asphyxiation%20and%20Ventilatory%20Requirements&f=false. 
  2. ^ "Foreign Body Aspiration: Overview - eMedicine". http://emedicine.medscape.com/article/298940-overview. Retrieved 2008-12-16. 
  3. ^ "Choking Prevention". American Academy of Pediatrics (healthychildren.org). 2010-06-14. http://www.healthychildren.org/english/health-issues/injuries-emergencies/pages/choking-prevention.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token. 
  4. ^ Yadav SP, Singh J, Aggarwal N, Goel A (September 2007). "Airway foreign bodies in children: experience of 132 cases". Singapore Med J 48 (9): 850–3. PMID 17728968. http://smj.sma.org.sg/4809/4809a10.pdf. 
  5. ^ Red Cross press release on the move from abdominal thrusts only to an integrated protocol
  6. ^ Guildner CW, Williams D, Subitch T (September 1976). "Airway obstructed by foreign material: the Heimlich maneuver". JACEP 5 (9): 675–7. PMID 1018395. 
  7. ^ Langhelle A, Sunde K, Wik L, Steen PA (April 2000). "Airway pressure with chest compressions versus Heimlich manoeuvre in recently dead adults with complete airway obstruction". Resuscitation 44 (2): 105–8. doi:10.1016/S0300-9572(00)00161-1. PMID 10767497. http://linkinghub.elsevier.com/retrieve/pii/S0300-9572(00)00161-1. 
  8. ^ "Heimlich, on the maneuver". New York Times. 2009-02-06. http://www.nytimes.com/2009/02/06/opinion/l06heimlich.html?_r=1&scp=1&sq=heimlich&st=cse. Retrieved 2009-02-07. 
  9. ^ "Lifejackets on Ice (August 2005)". University of Pittsburgh Medical School. http://pittmed.health.pitt.edu/AUG_2005/life_jackets.pdf?_r=1&scp=1&sq=heimlich&st=cse. Retrieved 2009-05-24. 
  10. ^ Pamela Mills-Senn. "A New Maneuver (August 2005)". Cincinnati Magazine. http://www.cincinnatimagazine.com/archives/article.aspx?id=34600?_r=1&scp=1&sq=heimlich&st=cse. Retrieved 2009-05-24. 
  11. ^ "Patrick Institute". http://patrickinstitute.org/press_release.htm. Retrieved 2008-09-08. 
  12. ^ John R. Fletemeyer, Sports Aid Intl Inc, Samuel James Freas (1998). Drowning: new perspectives on intervention and prevention. Informa Health Care. ISBN 9781574442236. http://books.google.com/?id=Xcnwm8zE24QC&pg=PA206&dq=Heimlich+lethal#v=onepage&q=Heimlich%20lethal&f=false. 
  13. ^ Broomfield, James (2007-01-01). "Heimlich maneuver on self". Discovery Channel. http://www.health.discovery.com/encyclopedias/illnesses.html?article=671. Retrieved 2007-06-15. 
  14. ^ Swan, Norman (27 July 2009). "The Heimlich manoeuvre". The Health Report. Australian Broadcasting Corporation. http://www.abc.net.au/rn/healthreport/stories/2009/2634253.htm. Retrieved 2009-07-27. "...the reason it's not taught is the simple fact that research conducted here in Australia and also overseas has proven that it can be dangerous..." 
  15. ^ American Medical Association (2009-05-05). American Medical Association Handbook of First Aid and Emergency Care. Random House. ISBN 9781400007127. http://books.google.com/?id=WuvXnhwU8nQC&pg=PR8&dq=AMA+Emergency#v=onepage&q=dislodge%20the%20object&f=false. 
  16. ^ "Bush makes light of pretzel scare". BBC News. 2002-01-14. http://news.bbc.co.uk/1/hi/world/americas/1758848.stm. Retrieved 2007-06-15. 
  17. ^ "Jimmie Foxx Obituary". http://www.armchairgm.com/index.php?title=Jimmie_Foxx. Retrieved 2007-06-15. 
  18. ^ "Biography of Tennessee Williams". IMDB. http://www.imdb.com/name/nm0931783/bio. Retrieved 2007-06-15. 
  19. ^ "Urban Legend of Mama Cass choking". Snopes Urban Legend Reference. http://www.snopes.com/music/artists/mamacass.asp. Retrieved 2007-06-15. 
  20. ^ "Queen Mother recovers after operation". BBC News. 1999-01-25. http://news.bbc.co.uk/1/hi/uk/262249.stm. Retrieved 2009-08-22. 
  21. ^ "Heimlich Institute on rescuing drowning victims". http://www.heimlichinstitute.org/drowning.php. Retrieved 2007-06-05. 
  22. ^ "Heimlich Institute on rescuing asthma victims". http://www.heimlichinstitute.org/asthma.php. Retrieved 2007-06-05. 
  23. ^ Heimlich, Peter M. "'Outmaneuvered - How We Busted the Heimlich Medical Frauds'". http://www.medfraud.info. Retrieved 2007-06-22. 

External links


Wikimedia Foundation. 2010.

Look at other dictionaries:

  • Choking — Chok ing, a. 1. That chokes; producing the feeling of strangulation. [1913 Webster] 2. Indistinct in utterance, as the voice of a person affected with strong emotion …   The Collaborative International Dictionary of English

  • choking — adjective Date: 1556 1. producing the feeling of strangulation < a choking cloud of smog > 2. indistinct in utterance used especially of a person s voice < a low choking laugh > • chokingly adverb …   New Collegiate Dictionary

  • choking — adj British desperate for relief, typically in the form of alcohol or sex. The widespread term, popular, e.g., among university students since the late 1990s, is a shortening of the colloquial phrase choking for (the specified item) . The phrase… …   Contemporary slang

  • Choking — Choke Choke (ch[=o]k), v. t. [imp. & p. p. {Choked}; p. pr. & vb. n. {Choking}.] [OE. cheken, choken; cf. AS. [=a]ceocian to suffocate, Icel. koka to gulp, E. chincough, cough.] 1. To render unable to breathe by filling, pressing upon, or… …   The Collaborative International Dictionary of English

  • choking — chokingly, adv. /choh king/, adj. 1. (of the voice) husky and strained, esp. because of emotion. 2. causing the feeling of being choked: a choking cloud of smoke. [CHOKE + ING2] * * * …   Universalium

  • choking — adj. Choking is used with these nouns: ↑sensation, ↑smoke, ↑sob …   Collocations dictionary

  • choking — Synonyms and related words: abolishment, abolition, annihilation, annulment, asphyxia, asphyxiation, bar, barrier, blank wall, blind alley, blind gut, block, blockade, blockage, blurred, bottleneck, breathy, burking, burning out, burnout, cecum,… …   Moby Thesaurus

  • choking — tʃəʊk n. act of choking; throttle (in a car) v. strangle, block the windpipe; be strangled; block, obstruct; fill full …   English contemporary dictionary

  • choking — chok•ing [[t]ˈtʃoʊ kɪŋ[/t]] adj. 1) (of the voice) husky and strained, esp. because of emotion 2) causing the feeling of being choked: choking gas fumes[/ex] • Etymology: 1560–70 chok′ing•ly, adv …   From formal English to slang

  • choking — /ˈtʃoʊkɪŋ/ (say chohking) adjective 1. so full of emotion one almost chokes: to speak in a choking voice. 2. that causes the sensation of being choked. –chokingly, adverb …   Australian English dictionary


Share the article and excerpts

Direct link
Do a right-click on the link above
and select “Copy Link”

We are using cookies for the best presentation of our site. Continuing to use this site, you agree with this.