Management of choking - child & adult

Question 1

What are the general signs of choking?

Answer 1

• Witnessed episode
• Coughing or choking
• Sudden onset
• Recent history of playing with or eating small objects

Question 2

What are the signs of effective coughing?

Answer 2

• Crying or verbal response to questions
• Loud cough
• Able to take a breath before coughing
• Fully responsive

Question 3

What are the signs of ineffective coughing?

Answer 3

• Unable to vocalise
• Quiet or silent cough
• Unable to breathe
• Cyanosis
• Decreasing level of consciousness

Question 4

What technique should be performed on a choking infant/child who is conscious but has ineffective coughing?

Answer 4

Back blows

Question 5

How do you perform back blows on an infant (<1y)?

Answer 5

• Support infant in a head-downwards, prone position, to enable gravity to assist the removal of the foreign body
• A seated or kneeling rescuer should be able to support the infant across their lap
• Support the infant’s head by placing the thumb of one hand at the angle of the lower jaw, and one or two fingers from the same hand on the other side of the jaw
• Deliver up to 5 sharp back blow with the heel of one hand in the middle of the back between the shoulder blades

Question 6

How do you perform back blows on a child (>1y)?

Answer 6

• Back blows are more effective if the child is positioned head down

Question 7

If back blows are insufficient, what is the next manoeuvre that can be performed on infants? How do you perform this manoeuvre?

Answer 7

Chest thrusts:

• turn the infant into a head-downwards supine position
• achieved by placing your free arm along the infants back and encircling the occiput with your hand
• support the infant down your arm, which is placed your thigh
• place the heel of your hand a finger’s breadth above the xiphisternum
• deliver up to 5 chest thrusts - sharper but slower than chest compressions

Question 8

If back blows are insufficient, what is the next manoeuvre that can be performed on children? How do you perform this manoeuvre?

Answer 8

• Stand or kneel behind the child, place your arms under the child’s arms and encircle their torso
• Clench your first and place it between the umbilicus and xiphisternum
• Grasp your first with your other hand and pull sharply inwards and upwards
• Repeat up to 4 more times

Question 9

What do you do if the object has not been expelled after 5 back blows and 5 chest thrusts/abdominal thrusts?

Answer 9

• Continue the sequence of back blows and chest/abdominal thrusts
• Call out, or send, for help if it is still not available

Question 10

What do you do after the object is expelled?

Answer 10

• Assess the child/infant
• It is possible that part of the object may remain in the respiratory tract and complications
• If there is any doubt or if they were treated with abdominal thrusts, urgent medical follow up is mandatory

Question 11

What do you do if the infant/child with foreign body airway obstruction is, or becomes, unconscious?

Answer 11

• Call for help if it is still not available
• Airway opening
• If an object is seen, attempt to remove it with a single finger sweep
• Do not attempt blind or repeated finger sweeps
• 5 rescue breaths
• Chest compressions and CPR