Choking - Prevention and Managament

Introduction:

Choking refers to the blockage or obstruction of the upper airways either by food or foreign objects resulting in the breathing process being more difficult. It can range from simple coughing to airway obstruction leading to death. Breathing is the most important and essential process of life. When a person inhales, oxygen with a mixture of other gasses is carried into the lungs, and when a person exhales, carbon dioxide is released. During choking, due to the complete blockage of the airway, no level of oxygen is carried into the lungs. The brain is so sensitive, and the response to the lack of oxygen results in brain death within a duration of ten minutes. In order to prevent this, the first aid measure should be given as early as possible.

How Is Choking Caused?

• The primary cause of choking is when a piece of food material or other foreign material gets blocked in the upper airway.

• At the posterior part or back of the mouth, there are two openings, one opens into the esophagus, which enters into the stomach, and the other opening is called the trachea, through which the air passes into the lungs.

• During swallowing, the opening of the trachea is covered with a flap called epiglottis to prevent the entry of food particles into the air passage. If food particles enter the epiglottis, it results in choking.

• Most of the foreign objects get stuck in the trachea at the level of vocal cords as it is narrower in this region.

• In adults, it is caused mainly due to improper chewing of food. While eating, talking, or laughing can cause the food to enter into the wrong passage and cause choking.

• This can occur in persons with slow swallowing mechanisms, in the case of taking drugs, consuming alcohol, or in patients affected with Parkinson's disease.

• In children, choking is commonly caused by improper chewing of food, attempting to consume large pieces of food, or when eating big and hard candies.

• While playing, there are more chances of putting harmful things such as nuts, pins, coins, tiny toy materials, and marbles inside the mouth which can result in choking hazards.

What Are the Signs and Symptoms of Choking?

In adults, choking causes following signs and symptoms and these include-

• Gagging or coughing.

• Inability to talk suddenly.

• Panic reactions with hand signals pointing to the throat.

• Clutching the throat is the typical sign of choking. It can be shown by grabbing the throat with one or both hands.

• Difficulty in breathing.

• Squeaky sounds while breathing.

• Wheezing.

• Passing out or lack of consciousness suddenly.

• Cyanosis occurs due to the lack of oxygen. A bluish discoloration of the skin around the face, lips, and nail beds can be seen.

• In the case of infants, weak cough, weak cry, or both can occur, and difficulty in breathing is noticed as they cannot show the universal sign of clutching the throat.

What Are the Possible Objects That Cause Choking?

In children, certain objects can commonly cause the incidence of choking frequently, and these include-

• Hard candies.

• Popcorn.

• Pencil erasers.

• Carrots.

• Peanuts.

• Chewing gum.

• Cherry tomatoes.

• Large pieces of vegetables and fruits.

• Whole grapes.

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How to Rule Out the Cause of Choking?

In the hospital, various investigations are carried out to rule out the cause, nature, and position of the foreign material. These include-

• X-ray: Through chest X-ray, it can be helpful in finding the position of foreign objects. The object can be shown as radiopaque. These radiopaque objects (for example, nails and coins) which get blocked in the airway are easily identified on the neck or chest X-rays.

• Bronchoscopy: Bronchoscopy is performed by inserting a flexible fiberoptic scope into the trachea or airway so that it provides a clear view of any foreign objects. In the case of the presence of any objects, the scope has an attachment that helps to remove the object.

How to Prevent Choking?

In Children:

• Cut foods such as sausages, hot dogs, and grapes into small pieces before serving them to children.

• Avoid giving hard foods or objects that can be blocked in the smaller airways. Certain small-sized foods such as nuts, peas, chewing gum, tough meats, and seeds are not recommended to give to children younger than four years of age.

• As kids are tempted to place everything in their mouth, check for small pieces of toys (for example, eyes or noses of small animal toys, tiny broken pieces of toys).

• Store small batteries or buttons away from the children.

• Instruct children well to chew the food properly before swallowing.

• One of the leading causes of death is due to choking on a rubber balloon. Keep balloons after parties immediately out of the child's reach.

For Adults:

• Chew food thoroughly before swallowing.

• Avoid talking or laughing while eating.

• Consumption of alcohol can diminish chewing and swallowing ability, which can increase the risk of choking.

• Keeping pins or nails in the mouth should be avoided.

How to Manage Choking?

The treatment for choking generally varies with age. In adults and children more than one year of age, abdominal thrusts or the Heimlich maneuver are attempted. Through this procedure, pressure or thrusts are given to create an artificial cough. These thrusts are given with enough force to clear the airway.

Quick abdominal upward thrusts are given to force the diaphragm upward suddenly to make the chest cavity smaller, which in turn compresses the lungs by forcing air out. The rapid force of air moving out forces out the lodged object in the airways.

How to Perform Abdominal Thrusts?

• The initial step is to lean the person forward slightly and stand behind the person.

• Make a fist using one hand and surround both arms around the person by grasping the fist with the other hand in the midline just below the ribs.

• In an attempt to cough up the blocked object, make quick and hard inward and outward movements.

• This procedure can be repeated till the person is able to breathe clearly or loses consciousness.

With Loss of Consciousness:

• If a person is not in a conscious state, lay the person on their back on the floor.

• Kneel down next to the person and place the heel of the hand against the middle of the abdomen, just below the ribs.

• Later, place the other hand on the top and press inward and upward up to five times using both hands.

• If the airway clears but the person is not responding, start with cardiopulmonary resuscitation.

Conclusion:

Choking with a lack of oxygen can result in brain damage or death in four to six minutes. Hence, immediate first-aid measures should be taken to avoid any serious complications. The chance of survival and recovery is faster when necessary actions are taken immediately. Quick response and immediate action save the life of the affected persons.