Choking in adults, infants and children Flashcards
Q: What is choking, and how prevalent is it?
A: Choking, or foreign body airway obstruction (FBAO), is a preventable cause of accidental death.
The exact prevalence is unknown, but it is common, with ambulances in London attending an average of five choking incidents per day in 2016.
Q: What are the common causes of choking in adults?
A: Most choking incidents occur during eating, with food being the most common cause. Other culprits include dentures, hat pins, scarf pins, and pen lids.
Q: Who is at the greatest risk for choking?
A: Elderly individuals, those with impaired swallowing or coughing reflexes (e.g., after a stroke), reduced consciousness, respiratory diseases, poor dentition, or dementia are at higher risk.
Q: How can you distinguish between mild and severe airway obstruction?
A:
Mild obstruction: Strong cough, ability to speak and breathe.
Severe obstruction: Weak or ineffective cough, inability to speak, and difficulty breathing.
Q: What are the signs of choking?
A: Persistent coughing, distress, breathlessness, clutching at the neck, red face, or waving hands to attract attention.
Q: How should you manage mild airway obstruction?
A: Encourage the person to keep coughing, monitor their condition, and be prepared to act if their condition deteriorates.
Q: What is the first physical intervention for severe airway obstruction?
A: Deliver up to five back blows, checking after each to see if the obstruction is cleared.
Q: What steps should you take if back blows fail to clear the obstruction?
A: Move to abdominal thrusts unless the individual is pregnant or obese, in which case chest thrusts should be used.
Q: How are abdominal thrusts performed?
A:
- Stand behind the person and wrap your arms around their upper abdomen.
- Place a clenched fist between the umbilicus and the rib cage.
- Grasp your fist with your other hand and pull sharply inwards and upwards.
- Repeat up to five times, alternating with back blows if necessary.
Q: What should you do if the person loses consciousness during choking?
A:
- Lower them to the floor and turn them onto their back.
- Call for emergency help.
- Open the mouth and remove any visible obstruction.
- Open the airway using a head-tilt/ chin-tilt technique
- Start CPR with chest compressions (x30) and rescue breaths (x2) if required.
Q: What post-choking care should be provided?
A: Assess for foreign material in the airway, monitor for complications like pneumonia due to blockages, and arrange medical assessment for injuries caused by abdominal or chest thrusts.
Q: What should be documented following a choking incident?
A: Record the details of the incident, treatment provided, and any observations. Inform the medical team and complete an incident form if required.
Q: Why is a formal assessment needed after choking?
A: To evaluate for medical factors contributing to the incident (e.g., swallowing difficulties) and to make necessary referrals to specialists like speech and language therapists.
Q: What investigations might be required after successful choking treatment?
A: Chest X-rays, bronchoscopy, or CT scans to check for residual material or complications such as endobronchial scarring.
Q: What should be avoided when trying to clear an obstruction manually?
A: Do not insert fingers blindly into the mouth, as this may push the obstruction further back.
Q: What is the recommended action if residual airway obstruction is suspected after choking?
A: Arrange urgent medical assessment, either in the hospital setting or at the emergency department.
Q: What is the guidance for seeking support during a choking emergency in a hospital setting?
A: Call the cardiac arrest team by dialing 2222 if the person loses consciousness.
Q: What are the potential complications of choking-related interventions like abdominal and chest thrusts?
A: These interventions can cause internal injuries, requiring examination and possible imaging studies such as CT scans.
Q: Why is early recognition and intervention critical in choking incidents?
A: Early action can prevent severe hypoxia, loss of consciousness, and cardiac arrest.
Q: Why are a combination of techniques often necessary in severe choking cases?
A: Studies show that in 50% of cases, a combination of back blows and abdominal or chest thrusts is needed to relieve the obstruction.
Q: What are the main differences in managing choking in pregnant or obese individuals?
A: Abdominal thrusts are replaced with chest thrusts to avoid harm to the fetus or because of difficulty encircling the abdomen
Q: What should you do if physical interventions fail to clear the obstruction and the person becomes unconscious?
A: Start CPR, attempt to clear visible obstructions, and continue until the person breathes normally or professional help arrives.
Q: How can clinicians prepare for dealing with choking incidents?
A: Recognise their limitations, seek senior support early, and refer to clinical guidelines like those for CPR in adults.
Q: What should healthcare providers consider regarding medical factors contributing to choking?
A: Conditions like swallowing difficulties or neurological impairments may require dietary changes or specialist referrals, such as to a speech and language therapist.
Q: What is choking, and why is it a concern in infants and children?
A: Choking, or foreign body airway obstruction (FBAO), is a preventable cause of accidental death. Infants and children under 3 years are at the highest risk due to immature chewing coordination, exploring objects with their mouths, and higher respiratory rates.
Q: What are the most common causes of choking in infants and children?
A: Choking often occurs during eating or play. Common causes include food, small objects, and toys.
Q: What are some key risk factors for choking in children?
A:
Immature oropharyngeal coordination.
Absence of molar chewing.
Reflex inhalation during laughing or crying.
Physical activity during eating.
Q: How can you differentiate between mild and severe choking in children?
A:
Mild choking: Loud or effective cough, ability to cry, breathe, or speak.
Severe choking: Quiet or ineffective cough, inability to vocalise, cyanosis, or loss of consciousness.
Q: What are common signs of choking in children?
A: Persistent coughing, distress, breathlessness, red face, clutching the neck, or trying to attract attention.
Q: How should you manage mild choking in children?
A: Encourage the child to keep coughing and monitor them closely without physical intervention.
Q: What is the initial step for managing severe choking in an infant?
A: Deliver up to five back blows while supporting the infant’s head and ensuring their airway is not compressed.
Q: How are chest thrusts performed in infants?
A:
- Lay the infant on their back, head down, supported by your arm.
- Place two fingers on the lower half of the sternum.
- Press down sharply to a depth of one-third the chest’s depth.
- Deliver up to five thrusts, alternating with back blows if needed.
Q: When should abdominal thrusts be used in children?
A: For severe choking in children over one year old, unless they are very small or it is unsafe. Deliver up to five thrusts, alternating with back blows.
Q: What should you avoid in infants during choking management?
A: Avoid abdominal thrusts, as they carry a high risk of internal injury.
Q: What steps should you take if a child becomes unresponsive during choking?
A:
- Call emergency services.
- Lay them flat and perform CPR.
- Attempt to remove visible obstructions but avoid blind finger sweeps.
- Alternate chest compressions and rescue breaths.
Q: What complications can arise from untreated residual airway obstructions?
A: Complications include pneumonia, atelectasis, and endobronchial scarring.
Q: Why must children treated with abdominal or chest thrusts undergo medical assessment?
A: These interventions can cause internal injuries requiring further investigation, such as imaging studies.
Q: What should be documented following a choking incident in healthcare settings?
A:
- Details of the incident and interventions.
- Observations and outcomes.
- Communication with the medical team or general practitioner.
- Incident forms if required.
Q: How is CPR for infants different from CPR for children?
A:
Infants: Use two fingers for compressions; compress one-third of chest depth.
Children: Use one hand (or two for larger children); compress one-third of chest depth, but not more than 6 cm.
Q: What is the correct compression-to-breath ratio for CPR in infants and children?
A:
15:2 for those trained in pediatric CPR.
30:2 if trained only in adult CPR.
Q: What is the next step after the obstruction is cleared but the child is still unconscious?
A: Place them in the recovery position, monitor breathing, and resume CPR if needed.
Q: Why is early recognition and intervention critical in choking incidents?
A: Early recognition and intervention prevent complications such as severe hypoxia, loss of consciousness, or cardiac arrest.
Q: What is the recommended head position during rescue breaths for infants and children?
A:
Infants: A neutral head position.
Children: A “sniffing” position.
Q: How should you provide rescue breaths to an infant or child?
A: Deliver five rescue breaths using a bag-valve-mask attached to oxygen if available, or a face shield/pocket mask. Adjust head position if the chest does not rise.
Q: What should be done if a choking incident occurs at home or in a healthcare setting?
A:
- Document the incident in the child’s notes or electronic patient record.
- Notify the medical team or general practitioner.
- Complete an incident form if required by local policy.
Q: Why are blind finger sweeps discouraged during choking management?
A: Blind finger sweeps can push the obstruction further into the airway, worsening the situation.
Q: What should be done if no help has arrived and you are alone with a choking child?
A: Perform CPR for one minute before calling emergency services, using the speaker function on a mobile phone if available.
Q: What type of injuries might occur from abdominal or chest thrusts, and how are they managed?
A: Internal injuries such as organ damage may occur. A qualified healthcare practitioner should examine the child, and further imaging (e.g., CT scan) may be necessary.
