Choking

What you do

Flowchart 2.3 Management of Foreign Body Airway Obstruction (Choking) Algorithm

Flowchart 2.4   The choking child

Total obstruction (blockage)

Infant

  • Sit or kneel. Support infant across thigh or lap in head down, face down position — Figure 2.10

Figure 2.10   
  • Give up to 5 sharp blows with an open hand between the scapula (shoulder blades)
  • Check between blows to see if obstruction removed
  • If this doesn’t work — roll infant over to face up position with head in neutral position
  • Give up to 5 chest thrusts — central sternum, sharper than CPR, every 2 seconds — Figure 2.11
  • Check between thrusts to see if obstruction removed

Figure 2.11  
  • If this doesn’t work and infant conscious — alternate between 5 back blows and 5 chest thrusts
  • If consciousness lost or was unconscious when discovered
    • Start CPR for basic life support 30:2 (15:2 if 2 operators) with head in neutral position
    • After 30 compressions, open mouth and check for/remove foreign body. If skilled, use laryngoscope and angled forceps (eg Magills)
    • If unable to clear airway prepare for emergency cricothyroidotomy 

Adult or child

If standing/sitting and conscious

  • Give up to 5 sharp blows with an open hand between scapula (shoulder blades) — Figure 2.12
  • Check between blows to see if obstruction removed
  • If this doesn’t work give up to 5 standing chest thrusts — check between thrusts to see if obstruction removed
    • Stand behind person with their arms raised, your chest pressed into area between shoulder blades.  Place clenched fist on their chest covered by your other hand in same position as CPR in centre of sternum — Figure 2.13
    • 1 thrust per second

Figure 2.12  

Figure 2.13  

   

If on the ground but still conscious — give up to 5 chest thrusts. Compress central sternum as for CPR

If person loses consciousness — lower to ground, face up, start CPR

  • After 30 compressions, open mouth and check for/remove foreign body. If skilled — use laryngoscope and angled forceps (eg Magills)
  • If unsuccessful — continue CPR
  • Prepare for emergency cricothyroidotomy 

Part blockage (obstruction)

Do not

  • Do not give oxygen
  • Do not force the person to lay down
  • Do not finger sweep if you can't see cause of blockage (may push object further down)

Do

  • Call for help
  • Stay calm, be reassuring
  • Leave person in position they find most comfortable
  • Encourage to cough
  • If a foreign body can be seen and easily reached — remove it
    • Take care not to push it further into airway
    • Do no other interventions
  • Observe continuously