CHOKING
I. DEFINITION
· Choking is the mechanical obstruction of the flow of air from the environment into the lungs.
· Choking is a true medical emergency that required fast, appropriate action by anyone available.
· Choking prevents breathing and can be partial or complete, with partial choking allowing some flow of air into the lungs. Prolonged or complete choking results in asphyxia which leads to anoxia and is potentially fatal. Oxygen stored in the blood and lungs keep the
victim alive for several minutes after breathing is
stopped completely.
· Children aged 6months
to 4years
are
at high risk.
II. CAUSES
· Physical obstruction of the airway by a foreign body (food, toys, household objects). In one
study, peanuts were the most common
obstruction.
· Respiratory disease that
involve obstruction of the airways.
· Compression
of the laryngo-pharynx,
larynx or vertebral
trachea in
strangulation.
III. SYMPTOMS
AND CLINICAL SIGNS
If an infant is choking, more attention must be paid to an infant’s behavior. They can’t be
taught the universal sign.
- Difficult breathing.
- Weak cry,
weak cough, or both.
· Sites of obstruction:
- In the upper respiratory
tract:
The diagnosis is established by acute onset of choking along with inability to vocalize or cough
and cyanosis with marked distress (complete obstruction), or with drooling, stridor,
and ability
to vocalize (partial obstruction). Onset is generally abrupt, with a history
of the child running with
food in the mouth or playing with seeds,
small coins, and toys.
Without treatment, progressive cyanosis, loss of
consciousness, seizures, bradycardia and
cardiopulmonary arrest
follow.
- In the lower respiratory
tract:
Respiratory signs vary depending on the site of obstruction and the duration following
the acute
episode. For example, a large or central airway obstruction may cause marked distress. The acute
cough or wheezing caused by foreign body in the lower respiratory
tract may
diminish over time only to recur later and present as chronic cough or persistent wheezing. Long-standing foreign bodies
may lead to bronchiectasis or lung abscess. Hearing asymmetrical breath sounds or localized
wheezing also suggests a foreign body.
IV. TREATMENT
If complete
obstruction is present,
then
one must intervene immediately.
- What to do
if a person starts
to
choke?
- It’s best not to do anything if the person is coughing forcefully and not turning a bluish
color. Ask” are you choking?”, if the person is able to answer you by speaking, it is a partial airway obstruction. Stay with the person and encourage him or her to cough until
the obstruction is cleared.
- Do not give the person any to drink because fluids may take up space needed for the passage of air.
- Someone who can’t answer by speaking and can only nod the head has complete airway
obstruction and need emergency help.
- Do abdominal
thrush
for adults and
children older than 1year
(Heimlich maneuver).
- How to perform back slaps?
It is used for the babies younger than
1year
of age.
· Lay the infant
on your arm or thigh
in a
head down position,
· Give 5 blows to the infant’s back
with heel of Hand,
· If obstruction persists,
turn infant over and give
5 chest thrusts with 2 fingers, one finger breadth below nipple level in midline,
· If obstruction persists,
check infant’s
mouth for any obstruction which can be
removed,
· If necessary, repeat sequence with
back slaps again.
- How to perform abdominal thrush?
·
Lean the person forward slightly and stand behind him or her.
Make a first with one
hand. Put your arms around the
person and grasp your fist with your other hand in the midline just below the ribs. Make a quick, hard movement inward and upward in an attempt to assist the person in coughing
up the object. This maneuver should be
repeated
until the person is
able to breath.
· If the person loses consciousness, gently lay him or her on their back on the floor. To clear the airway, kneel next to the person and put the heel of your hand against the middle of the abdomen, just below the ribs. Place your other hand on top and press
inward and upward five times with both hands. If the airway clears and the person is
still unresponsive,
begin cardiopulmonary resuscitation (CPR).
· CPR involves both chest compression and artificial respiration. These actions are often enough to dislodge the item sufficiently
for air to pass it, allowing gaseous exchange into
the lungs.
At hospital, several tests and procedure may be performed to find out what caused
the choking and make sure no other
objects are blocked
the airway:
· X ray of
the chest
or neck (for radiodense
objects)
· Laryngoscopy with
which the foreign
body
can be directly visualized
· Broncoscopy is indicated if clinical
suspicion
of
foreign body
aspiration
(history of possible aspiration,
focal abnormal lung
exam or abnormal chest
radiography).
· Following the removal
of
the
foreign
body,
beta-adrenergic
nebulization
treatments followed by chest physiotherapy
are recommended to help clear related mucus or treated
bronchospasm.
REFERENCES
1. Chiu CY et al: Factors
predicting early diagnosis of foreign body aspiration in children.
Pediatr Emerg Care 2005;21:161.
[PMID:
15744193]
2. Dunn GR et
al: Management
of
suspected
foreign body
aspiration in children.
Clin
Otolaryngol 2002;27:384.
[PMID: 12383302]
3. Girardi B et al: Two new radiographic findings to improve the diagnosis of bronchial foreign
body
aspiration in children. Pediatr
Pulmonol 2004;38:261. [PMID:
15274108]
4. Rovin JD, Rodgers BM: Pediatric foreign body aspiration. Pediatr Rev 2000;21:86. [PMID:
10702322]
5. Gwendolyn S.Kerby et al, Foreign body aspiration. In: Respiratory Tract and Mediastinum, Current Pediatric
Diagnosis and
Treatment, 18th ed.2007 McGraw-Hill Company;18:504-506.
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