Signs and Symptoms of Choking

Choking

• A person who is choking cannot breathe and will exhibit a universal signal for choking, signaling for help.
• The hand grasping the throat is the universal sign for choking.

Types of Upper Airway Obstruction

• Complete obstruction
• Partial obstruction

Chain of Survival

• Early recognition: Recognize the problem and call for help.
• Early CPR: Start CPR as soon as possible.
• Early Defibrillation: Get an AED and start defibrillation as soon as possible.
• Post Resuscitation Care: Focus on restoring the victim's quality of life.

CPR

• Check the scene for safety.
• Shake the victim and shout their name or "Are you okay?".
• Call for nearby help.
• Check for breathing and signs of cardiac arrest for no more than 10 seconds.
• Position the fingers over the carotid artery to assess pulse activity.
• Activate EMS and get an AED as soon as possible.
• Place the victim supine on a firm surface.
• If there is a pulse but the victim is not breathing, perform rescue breathing at a rate of 1 breath every 5-6 seconds.
• If there is no pulse and no breathing, place the heel of one hand on the lower half of the sternum and the heel of the other hand on top of the first hand, keeping the fingers off the chest.
• Depress at least 2 inches but no more than 2.4 inches, with equal time for compression and release.
• Give 30 compressions at a rate of 100-120/min and minimize interruptions.

Cardiopulmonary Resuscitation (CPR)

• CPR must be started whenever someone is found in respiratory or cardiac arrest (without breathing or without a heartbeat).
• CPR can prevent damage to vital organs (brain and heart).

Automated External Defibrillator (AED)

• A device that can deliver a controlled electric shock to the heart to reverse ventricular fibrillation and restore heart function.

Important Points when Using AED

• Dry the chest if it is wet.
• Shave chest hair to obtain adequate contact.
• If the patient has a pacemaker, ensure AED pads are not placed on it.
• Remove any metal jewelry.
• Remove any plaster or other material attached to the victim's skin.

Safety Issues when Using AED

• Do not touch the victim during analysis, charging, or the delivery of a shock.
• Make sure the environment is safe.

Assessing a Collapsed Victim

• Approach safely.
• Check response.
• Shout for help.

For the Unconscious Infant

• Call for help and/or activate EMS.
• Turn the infant onto her back and place on a firm, hard surface, preferably above the ground.
• Begin CPR starting with 30 compressions.
• Perform the head tilt-chin lift to open the airway.
• If you can see an object, carefully perform a finger sweep to remove it.

For the Conscious Infant

• Place the infant face down straddling your arm, keeping the head lower than the trunk.
• Place your hand under the chest and around the jaw for support.

Abdominal Thrusts

• For a conscious person, ask if they can speak.
• If the person is unable to talk or coughing is proving ineffective, position them to deliver abdominal thrusts.

Abdominal Thrusts Procedure (Heimlich maneuver)

• Stand behind the person.
• Encircle your arms around the upper part of their abdomen just below their rib cages.
• Give sharp forceful squeezes, forcing the diaphragm sharply into the thorax, to expel sufficient air from the lungs to force the foreign body out of the trachea.
• Repeat the thrusts until the foreign body is expelled or the person becomes unconscious.

Nursing Assessment

Inspection

• Is the patient conscious?
• Is there any inspiratory effort?
• Does the chest rise symmetrically?
• Is there use or retraction of accessory muscles?
• What is the skin color?
• Are there any obvious signs of deformity or obstruction (trauma, food, teeth, vomitus)?
• Is the trachea midline?

Palpation

• Do both sides of the chest rise equally with inspiration?
• Are there any specific areas of tenderness, fracture, or subcutaneous emphysema (crepitus)?

Auscultation

• Is there any audible air movement, stridor (inspiratory sound), or wheezing (expiratory sound)?
• Are breath sounds present over the lower trachea and all lobes?