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 Emergency & First Aid

June 2012
No Choking On This Emergency
Dr Supreet Bakshi & Dr Shahbaz Ahmed
Choking is a fairly common situation in which a small object or food gets stuck in a person’s throat or windpipe leading to breathing inability. It’s an emergency presenting especially with children as patients or victims. It leads to considerable anxiety to the victim and his/her parents. Most of the time, the victim is able to cough out the objectand relieve the choking by self.

However, in some cases, coughing may be ineffective. The object may Dr Supreet Bakshi & Dr Shahbaz Ahmed be too deep inside or the victim may not have sufficient air inside his/her lungs to cough it out. The related anxiety will cause a panic reaction and the inability to inhale air will lead to loss of consciousness. This is due to lack oxygen supply to the brain. The resultant hypoxia (lack of oxygen in the blood) in turn leads to respiratory and cardiac arrest, which puts the person at risk of death.

The brain cells can survive without oxygen for approximately four to eight minutes. Consequently, the window period to relieve choking is short. One may not succeed in taking a choking victim to the hospital in time. Therefore, it becomes crucial that all of us know how to attend to a victim of choking.

Symptoms Of Choking
Adults: A typical victim starts gasping for air and may clutch at the throat. S/he will not be able to speak or communicate verbally. The victim may only point to the throat with his/her finger. In adults, most victims choke while eating. Instances of accidentally getting foreign objects stuck in the throat are few.
Children: A typical child victim may choke on small toys, objects or foods, especially hard candies. The child may suddenly stop talking and appear in distress. The child may also develop noisy breathing (if the object partially obstructs the passage) and the skin may turn blue.

Situations That Predispose To Choking
  • Talking and laughing while chewing food.
  • Gulping food without chewing.
  • In children, while playing with small objects, pellets, marbles and similar small toys.
  • In children, while eating hard candy and round chocolates
What To Do When You See A Person Choking?
Victim Is An Adult Victim Is An Infant
Position yourself behind the victim. Form a fist with your right hand and place it just below the breastbone and on the upper abdomen. Support this fist with your left hand. Now give a forceful thrust in upward and backward direction. Repeat the thrust till object/ food falls out from the mouth and the victim is able to breathe again. Never put your finger in the mouth to search for the obstructing object – you will push it deeper inside! Sit down on a chair and place the infant with face down over your forearm. Give five forceful backslaps between the shoulder blades with the palm of your other hand. Turn the child over and press forcefully on the upper abdomen five times. Keep repeating this procedure till the object comes out. If the object is visible in the mouth, remove it. Do not put your finger inside if you can’t see the object.

What To Do If Choking Is Not Relieved?
If the victim becomes unconscious and stops breathing, call an ambulance and start cardio-pulmonary resuscitation (CPR). Or start CPR and transport the victim immediately to the closest hospital’s emergency room. The emergency physician can provide oxygen directly into the windpipe using various tubes or may perform an emergency surgical cut directly on the windpipe for this.

Tips To Prevent Choking
  • Keep a watch on children when they are eating.
  • Do not allow small children to playwith marbles and pellets, which they can swallow.
  • Do not talk while chewing food.
Train Yourself
Enroll yourself for a Basic Life Support or Life Saver’s Course. This one-day programme will teach you the life saving skills necessary to manage choking, as well as cardiac arrest in adults, children and infants. If you are a parent with high school/college going children, encourage them to undergo this training. School teachers, baby sitters, lifeguards, sports and gym instructors and others are also encouraged. Contact the emergency medical section in your local hospital and find out where these courses are held in your locality.

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