11.3.3: Choking
If a patient is choking and is unable to breathe, cough, or speak, Home Health Aides/Personal Care Aides must take immediate action and call 911. Permanent brain damage could occur in as little as 4-6 minutes if the person is unable to breathe (MedlinePlus, 2015a). Providing first aid quickly can save a person’s life.
- Try to encourage them to cough to remove the object or food.
- Stay with them at all times while you are waiting for help.
- Use your senses of observation to determine the cause and extent of the choking . Did the person swallow an object or did the choking happen while they were eating, drinking, or taking medicine? Are they able to breathe? Are they turning blue ( cyanotic )? Do you hear soft or high pitched sounds when they are trying to breathe?
- Are they unable to make any sound or cry? Are they unable to cough or is the cough weak and ineffective (not working)?
Heimlich Maneuver
If needed, Home Health Aides/Personal Care Aides must be prepared to perform abdominal thrusts to help dislodge the object from the person’s airway. This method is called the Heimlich maneuver . Thrusts are given slightly above the belly button. Each thrust pushes air from the lungs, which can help remove an object that is blocking the airway (American Heart Association, 2011).
Remember to only do this if the person cannot breathe, cough, or speak. A person who is choking might use the choking sign (holding the neck with one or both hands (American Heart Association, 2011). Ask if they need help and if they are choking prior to performing abdominal thrusts.
Performing the Heimlich maneuver for a person who is standing or seated, according to American Heart Association (2011) guidelines:
- Ask, “Are you choking?” If the person nods or indicates yes, tell them you are going to help.
- Stand behind the person and wrap your arms around their waist so your hands are in front.
- Make a fist with one hand, and place your thumb against the person’s abdomen, just above their belly button. Make sure your hand is well below the breast bone.
- With your other hand, grasp the fist that is against their abdomen and quickly thrust upward into the person’s abdomen.
- Give thrusts until the object is forced out and the person can breathe, cough, or talk, or until the person stops responding.
- If the person loses consciousness, lower them to the floor and begin CPR if trained to do so .
- Keep the person in a lying up position so that their head is facing up.
- Ensure their airway is not blocked.
If a person is lying on their back you may also straddle a person facing their head and push your grasped fist inward and upward in a similar manner to performing abdominal thrusts on a person who is standing (MedlinePlus, 2015a).
Performing the Heimlich maneuver for a person who is pregnant or very large and you can’t wrap your arms fully around the waist, according to American Heart Association (2011) guidelines:
- Follow the same steps for performing the Heimlich maneuver except for where you place your hands.
- Ask, “Are you choking ?” If the person nods or indicates yes, tell them you are going to help.
- Put your arms under the person’s armpits and your hands on the lower half of the breastbone.
- Pull straight back to give chest thrusts.
Performing the Heimlich maneuver for a person who has lost consciousness, according to American Heart Association (2011) guidelines:
- If a person stops responding while you are giving abdominal thrusts, lower them gently to the ground. Ensure their airway remains free and they are in a face up position.
- Check to see if the person needs CPR. If you do not know how to give CPR, give hands-only CPR.
- Emergency medical services should be contacted immediately.
- Continue CPR until the person is able to speak, moves, or breathes, or someone with more advanced training takes over.
Performing hands-only CPR:
Your agency may provide training or require you to receive CPR certification. You should only provide CPR if you are trained to do so. For those who are not trained to provide CPR, hands – only CPR can be performed until someone with more advanced training arrives.Hands-only CPR has two easy steps (American Heart Association, 2014). If you see a teen or adult suddenly collapse:
- Call 911 or the emergency medical services phone number in your area.
- Push hard and fast in the center of the chest. You should push at a rate of 100 compressions per minute.
It is helpful to push following the beat to a popular disco song by the Bee Gees called, “Stayin’ Alive”. You can watch a video of Hands-only CPR published by the American Heart Association at: http://cpr.heart.org/AHAECC/CPRAndECC/Programs/HandsOnlyCPR/UCM_473196_Hands–Only–CPR.jsp
Performing abdominal thrusts on an infant is a different process than that used for adults. Choking in infants is usually caused by the infant putting something in their mouth (MedlinePlus, 2015b).
Performing the Heimlich maneuver in an infant according to American Heart Association (2011) guidelines:
- Kneel or sit with the infant in your lap.
- Lay the infant face down on your forearm, across your lap or thigh.
- Provide support to his or her head and neck by placing your one hand under their chin to hold it steady. Be sure to not compress the soft tissues of the infant’s throat.
- The baby’s head should be facing downward, lower than their body. This helps to provide gravity so the object can be removed.
- Using the heel of your hand (bottom part of your hand) provide 5 back slaps to the baby’s back, between the shoulder blades.
- If the object becomes dislodged, you can stop.
- If the object is still stuck, turn the baby face side up. Take care to turn the baby as one unit, supporting the head and neck as you do so.
- Provide support to his or her back with your forearms, resting the baby on your lap or thigh.
- Provide support to the infant’s head and neck with the palm of your hand.
- Provide 5 downward chest thrusts at a rate of 1 per second, by using 2 fingers in the center of their breastbone and quickly press down, compressing their chest about 1 ½ inches (4 cm).
- You can repeat this process until the infant expels the object or until they lose consciousness.
- Remember, 5 back slaps with the baby face down, and then 5 chest thrusts with the baby face up.
Document all instances of choking and steps taken to provide care. The supervisor should always be informed about any instances of choking. A patient who has experienced choking or has had the Heimlich maneuver performed should be assessed by a healthcare provider.
1. Put the steps of performing the Heimlich maneuver on an adult in order:
a). Make a fist with one hand.
b). Thrust inward and upward.
c). Grasp the fist against the abdomen with your free hand.
d). Place your thumb against the person’s abdomen, just above their belly button.
e). Stand behind the person.
True or False
2. When performing the Heimlich maneuver on an infant, you should provide 5 back thrusts with the baby face down and then 5 chest thrusts with the baby face up until the object is dislodged. True or False? _____________
- Answer
-
1. E, A, D, C, B
2. True
FEEDBACK:
1. The order of performing abdominal thrusts, otherwise known as the Heimlich maneuver are as follows: Stand behind the person; make a fist with one hand; place your thumb against the abdomen just above the belly button; grasp the fist with your other hand; and thrust inward and upward until the object is dislodged.
2. Performing abdominal thrusts on an infant is different than an adult. Five back slaps and then 5 chest compressions are performed until the object is dislodged. Care should always be taken to support the head and neck of the infant.