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Primary care emergencies - the choking adult

Dr Chantal Simon, Dr Karen O’Reilly, Dr Robin Proctor and Dr John Buckmaster on how to handle this situation

Dr Chantal Simon, Dr Karen O'Reilly, Dr Robin Proctor and Dr John Buckmaster on how to handle this situation

If blockage of the airway is only partial the victim will usually be able to dislodge the foreign body by coughing. If obstruction is complete, urgent intervention is required to prevent asphyxia.

Is foreign body airways obstruction likely?

• Sudden onset of respiratory distress while eating
• Is the victim clutching his neck?
•Is the patient coughing effectively?
• Signs of an effective cough include:
– in response to the question ‘are you choking?', the victim answers and says ‘yes'
– fully responsive: able to speak, cough and breathe.

Encourage victim to cough and monitor.

• Signs of an ineffective cough include:
– in response to the question ‘are you choking?' the victim either responds by nodding or is unable to respond
– breathing sounds wheezy
– unable to breathe
– attempts at coughing are silent
– unconscious.

Call 999 and assess conscious level. If victim is conscious but has ineffective or no coughing:

• Give up to five back blows (see box below)
• If back blows don't relieve the obstruction, give up to five abdominal thrusts as needed (see box below).
• Following back blows, or abdominal thrusts, reassess – if the object has not been expelled and the victim is still conscious, continue the sequence of back blows and abdominal thrusts.
• If the object is expelled successfully, assess clinical condition (including abdominal examination if abdominal thrusts used); if there is any suspicion part of the object is still in the respiratory tract or there are any intra-abdominal injuries as a result of abdominal thrusts, refer to A&E

If the victim becomes unconscious:

• Lower the victim carefully to the ground
• Immediately call an ambulance
• Begin CPR with 30 chest compressions at 100/min, even if carotid pulse is present.

Foreign body in the throat after eating

• Fish bones or food bolus are most common; can cause severe discomfort, distress and inability to swallow saliva
• Refer immediately to A&E or ENT for investigation (lateral neck X-ray ± laryngoscopy); most fish bones have passed and discomfort is from mucosal trauma; food boluses often pass (especially if the patient is given a smooth muscle relaxant) but occasionally need removal under anaesthetic.

This is an extract from Emergencies in Primary Care published by Oxford University Press, edited by Dr Chantal Simon, Dr Karen O'Reilly, Dr Robin Proctor and Dr John Buckmaster. www.oup.co.uk ISBN 978-0-19-857068-4

Blows and thrusts

Back blows
• Stand to the side and slightly behind the victim
• Support the chest with one hand and lean the victim well forwards so that when the obstructing object is dislodged it comes out of the mouth
• Give up to five sharp blows between the shoulder blades with the heel of the other hand

Abdominal thrusts
• Stand behind the victim and put both arms around the upper part of the abdomen
• Lean the victim forwards
• Clench your fist and place it between the umbilicus and bottom end of the sternum
• Grasp this hand with your other hand and pull sharply inwards and upwards – repeat up to five times

If blockage of the airway is only partial, your patient will usually be able to dislodge the obstruction by coughing. If blockage of the airway is only partial the victim will usually be able to dislodge the foreign body by coughing.

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