Providing first aid to a client who is choking

In clients who are choking it is essential to remove the obstruction and clear the airway to prevent asphyxia.

Adult:

If blockage of the airway is only partial, the client will usually be able to clear it by coughing so should be instructed to do so; but if obstruction is complete, urgent intervention is required to prevent asphyxia. Therefore if the client is conscious and breathing, despite evidence of obstruction:

Encourage them to continue coughing, but do nothing else.

If obstruction is complete, or the client shows signs of exhaustion or becomes cyanosed but is still conscious, carry out back blows as explained below.

Procedure	Rationale
Remove any obvious debris or loose teeth from the mouth	To clear airway of observable blockages and prevent inhalation of debris/teeth
Stand to the side and slightly behind client, support their chest with one hand and lean them well forward	To ensure that when obstructing object is dislodged it comes out of the mouth rather than going further down the airway
Give up to five sharp blows between the scapulae (shoulder blades) with the heel of your other hand; each blow should be aimed at relieving the obstruction, so all five need not necessarily be given	To dislodge the obstruction
If back blows fail, carry out abdominal thrusts: Stand behind the client and put your arms around the upper part of the abdomen	Correct position to administer abdominal thrusts
Make sure the client is bending well forwards	To ensure that when the obstructing object is dislodged it comes out of the mouth rather than goes further down the airway
Clench your fist and place it between the umbilicus (navel) and xiphisternum (bottom tip of the sternum) and grasp it with your other hand	To ensure correct hand position
Pull sharply inwards and upwards	To dislodge the obstructing object
If the obstruction is not relieved, recheck the mouth for any obstruction that can be reached with a finger, and continue alternating five back blows with five abdominal thrusts	To dislodge the obstructing object
If the client at any time becomes unconscious, carry out the following sequence of life support (see Chapter 1): Open the client’s airway and remove any visible obstruction from the mouth.	To facilitate respirations
Check for breathing by looking, listening and feeling	To establish whether respiration has ceased. If not breathing, attempt to give two rescue breaths. Expelled air will enter client’s lung fields, providing some oxygen
If effective breaths can be achieved within five attempts check for signs of a circulation and start chest compressions as given in Chapter 4 and/or rescue breaths as appropriate	See Chapter 4
If effective breaths cannot be achieved within five attempts: Start chest compressions immediately and do not check for signs of circulation.	To relieve obstruction and continue resuscitation
After 15 compressions check the mouth for any obstruction then attempt further rescue breaths.	Obstruction may have been dislodged by chest compressions
Continue to give cycles of 15 compressions followed by attempts at rescue breathing	To sustain circulation of blood during cardiac arrest – see Chapter 4
If at any time effective breaths can be achieved: • Check for signs of a circulation • Continue chest compressions and/or rescue breaths as appropriate	If obstruction is dislodged quickly a spontaneous circulation may return

Child and infant

If a child is breathing spontaneously, his/her own efforts to clear the obstruction should be encouraged. Intervention is necessary only if these attempts are clearly ineffective and breathing is inadequate.

• Do not perform blind finger sweeps of the mouth or upper airway as these may further impact a foreign body or cause soft tissue damage.

• Use measures intended to create a sharp increase in pressure within the chest cavity (an artificial cough), such as those procedures outlined below.

Procedure	Rationale
Perform up to five back blows: • Hold the child in a prone position and try to position the head lower than the shoulders with the airway • Deliver up to five smart blows to the middle of the back between the shoulder blades • If this fails to dislodge the foreign body proceed to chest thrusts	To dislodge the obstruction by creating a sharp increase in pressure within the chest cavity – an artificial cough
Perform up to five chest thrusts: • Turn the child into a supine position, again with the head lower than the shoulders and the airway in an open position • Give up to five chest thrusts to the sternum: The technique for chest thrusts is similar to that for chest compressions (see Chapter 4) Chest thrusts should be sharper and more vigorous than compressions and be carried out at a rate of about 20 per minute	As above
Check mouth: • After five back blows and five chest thrusts check the mouth • Carefully remove any visible foreign bodies	Foreign object may have been dislodged
Open airway: • Reposition the airway by the head tilt and chin lift manoeuvre • Reassess breathing (refer to Chapter 1)	To facilitate respiration or to establish whether spontaneous respirations have ceased
If the child is breathing: • Turn the child into the recovery position • Check for continued breathing	To maintain airway and monitor respirations
If the child is not breathing: • Attempt up to five rescue breaths (refer to Chapter 1) to achieve two effective breaths, each of which make the chest rise and fall. The child may be apnoeic or the airway partially cleared; in either case the rescuer may be able to achieve effective ventilation at this stage • If the airway is still obstructed repeat the sequence as follows:
For a child: • Repeat the cycle previously outlined but substitute five abdominal thrusts for five chest thrusts: Use the upright position if the child is conscious; kneel behind a small child Unconscious children should be laid supine and the heel of one hand placed in the middle of the upper abdomen • Alternate chest thrusts and abdominal thrusts in subsequent cycles • Repeat the cycles until the airway is cleared or the infant breathes spontaneously For an infant: • Abdominal thrusts are not recommended in infants as they may rupture the abdominal viscera • Perform cycles of five back blows and five chest thrusts only Repeat the cycles until the airway is cleared or the infant breathes spontaneously	To dislodge obstruction

If the infant or child stops breathing follow the BLS algorithm as outlined in Chapter 4.

It is important to stay with the client following any successful first aid measures, to provide reassurance and to address any further concerns or worries they may have; always ensure that the client is safe from further danger before leaving.