Choking

Choking is sign of poor air exchange and
difficulty breathing
• Mild Airway Obstruction – signs:
 Good air exchange
 Can cough forcefully
 May wheeze between coughs

How can you help the person who has mild airway
obstruction?
• Rescuer Actions:
• Encourage the victim to continue spontaneous
coughing and breathing efforts
• Do not interfere with the residents efforts to cough up
what they are choking on (ie. Do not slap them on the
back, give a drink of water, etc.)
• Stay with the resident and monitor their condition.
• If mild airway obstruction persists, call for help.

Signs of poor air exchange and difficulty
breathing
Severe Airway Obstruction – signs:
• Poor or no air exchange
• High pitched noise while inhaling or no noise at
all
• Increased difficulty breathing
• Weak ineffective cough or ‘silent’ cough
• mouth opening and closing repeatedly as if they
are trying to speak but no sound. Think “guppy”

Signs of poor air exchange and difficulty
breathing
• Severe Airway Obstruction - signs:
 Cyanosis (turning blue)
 Unable to speak
 May show the universal choking sign
(clutch neck with both hands)
• Tell a co-worker to call for help
Clipart: www.medtrng.com

Does the resident with Severe Airway
Obstruction need your help?
• Rescuer Actions:
– Ask the victim if she/he is choking:
 If yes, begin abdominal thrusts.
 If no, stay close and allow them to try to get it out
themselves.
 If they are showing signs of severe airway obstruction but are
unable to confirm or deny that they are choking, begin abdominal
thrusts

How to do abdominal thrusts
 Stand or kneel behind the resident
 Wrap your arms around their waist
 Locate their navel (belly button)
 Make a fist with one hand and place it thumb
side inward between the navel and
breastbone
 Grasp fist with other hand and press into
abdomen with QUICK, FORCEFUL, UPWARD
thrusts
Demonstration of Abdominal Thrust: https://www.youtube.com/watch?v=DE45ks9miIw

Abdominal thrusts
Clipart: www.nursing411.org

How abdominal thrusts work
• “When you choke on something, your body tries to
clear your airway by coughing.
• Abdominal thrusts try to do the same thing with an
artificial cough.
• The illustration on the right shows how an abdominal
thrust creates a cough.
• An abdominal thrust pushes the diaphragm up
towards the lungs very quickly - this forces air from
the lungs up the airway and, hopefully, blows the
object out.
• For the best effect, your fist has to be in the right
place, the forearms off the abdomen and each thrust
a strong and sudden movement.”

Abdominal thrusts for person in a wheelchair
 Push the wheelchair to a wall, lock the brakes,
kneel in front of the victim and give abdominal
thrusts from the front by pushing inward between
the navel and breastbone.
• Note: Abdominal thrusts are not as effective for a person in
a seated position.
• Chest Thrusts are the preferred method.

Abdominal thrusts - alternative method
• Carefully lower the conscious resident to the
floor and give abdominal thrusts
• Straddle the person and put the heel of one hand mid abdomen, just below the
ribcage.
• Place your other hand on top of this hand, interlocking your fingers, then press
in and up in a smooth, forceful movement.
• Do this until object is expelled or the person becomes unconscious.

Chest thrusts
Clipart: www.cc.utah.edu
If victim is obese or rescuer cannot reach around to victim’s abdomen, chest
thrusts can be done either standing or with the victim seated (ie. wheelchair):
 From behind the person wrap your arms around
their chest just under the armpits.
 Make a fist with one hand and place it thumb side
inward in the middle of the victims chest
 Grasp fist with other hand and forcefully press
inward in centre of chest.
Alternatively
 Cross arms over one shoulder and under other arm to reach centre of
chest and give chest thrusts

Chest thrusts for person in a wheelchair
 Push the wheelchair against the wall, lock the
brakes and kneel in front of the victim. Place the
heel of one hand on the breast bone, at the nipple
line, place the other hand on top of it and
interlock the fingers. Forcefully press straight
back.

Chest thrusts - alternative method
• Carefully lower the conscious resident to the
floor and give chest thrusts
•
Chest Thrust on floor clip art from: http://nursing411.org/Courses/MD0532_Cardiopulmonary_Resuscitation/MD0532/images/md0532_img_24.jpg
Kneel at person’s side, place heel of
one hand on chest at the nipple line.
Place your other hand over it and
interlock your fingers. Press straight
down until object is expelled or the
person becomes unconscious.

When to stop:
• Continue abdominal/chest thrusts until:
 Object is expelled (comes out)
 Resident collapses/becomes unresponsive

If resident collapses and becomes unresponsive
 Carefully get them to the floor (if not already there)
 Make sure a co-worker has called Code Blue & 911
 Start CPR (if you’ve had the training)

If there are others nearby, get their attention.
If you are alone do whatever you must do to get
someone's attention. Call 911.
Do not allow anyone to slap you on the back.
If there is no one else to give you abdominal thrusts,
give them to yourself (see illustrations on this slide).
Self-Help Abdominal Thrusts
Source of information & associated illustration  http://www.familyhealthonline.ca/fho/firstaid/FA_choking_FHa06.asp

Important note
• Seek medical attention after abdominal/chest
thrusts are performed. There could be injuries
from this maneuver i.e. bruised/broken ribs;
punctured liver; etc.

References
• American Heart Association (2011). BLS for Healthcare
Providers Student Manual. First Heart and Stroke
Foundation of Canada Printing May 2011.
• Covenant Health Policy VII-C-30:
• Choking Prevention and Management
• http://www.familyhealthonline.ca/fho/firstaid/FA_chokin
g_FHa06.asp
•

• With a partner practice correct land marking
and hand placement. DO NOT DO ACTUAL
PERFORMANCE OF THE MANEUVER as it could
injure your partner.
Time to practice

Cricothyrodotomy|cricothyrotomy
• Refers to the creation of a communication between airway and
skin via the cricothyroid membrane.
• It may be achieved by needle cricothyrotomy or
• by open or percutaneous cricothyroidotomy technique.
• Advantages of cricothyroidotomy compared to tracheostomy
include simplicity, speed, relatively bloodless field, minimal
training required, and avoiding hyperextending the neck in
patients with possible cervical spinal injury

Indications
1. Airway obstruction proximal to the subglottis
2. Respiratory failure
3. Pulmonary toilette in patients unable to clear copious secretions
4. Bronchosopy
• For indications (1) and (2), cricothyroidotomy is generally done as an
emergency temporising procedure when a patient cannot be
intubated, or
• when tracheostomy would be too time consuming or difficult.
• Following cricothyroidotomy the patient should be intubated or a
formal tracheostomy done within 24hrs to avoid complications such
as glottic and subglottic stenosis.

Contraindications
• Inability to identify surface landmarks (thyroid cartilage,
cricoid, cricothyroid membrane) due to e.g. obesity, cervical
trauma
• Airway obstruction distal to subglottis e.g. tracheal stenosis or
transection
• Laryngeal cancer: Other than for an extreme airway
emergency, avoid a cricothyroidotomy so as not to seed the
soft tissue of the neck with cancer cells
• • Coagulopathy (other than emergency situation)

Thyroid prominence
Cricothyroid membrane
Cricoid cartilage

Cricoid artery

Needle cricothyroidotomy
Air bubbles appear in the fluid-filled syringe as the
needle traverses cricothyroid membrane
Fix the larynx and insert intravenous cannula at
450