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BLS - Choking

Hi, everyone. You guessed it. In today’s video, we’re talking about choking.

Back in the day, we used to separate choking between a partial and a complete airway obstruction. Today the focus is more on is this a mild or a severe airway obstruction. With a mild airway obstruction, the patient is still able to maintain their own airway. That’s what we’re really looking for. Is the patient able to take air in and out of the body? They may have something in the back of the throat. They may be choking, but they’re able to exchange gas. They can take air in and out of the body. If that’s the case, stay with the patient. Encourage them to cough it up. They may have a little wheezing, but they’re moving air. Stay with them. If need be, call EMS, have professional help come, but stay with the victim. Encourage them to cough it up. With a severe airway obstruction, the patient cannot move air. That’s the difference. There’s no effective air exchange. They may not be able to speak. They can’t produce an effective cough. They may have very high-pitched wheezing. They may start turning blue (cyanosis). These are all signs of a severe airway obstruction, and we have to go to work immediately.

With the adult, we’re going to perform the Heimlich maneuver. Before we talk about relieving choking, let’s talk about breathing. How do people breathe? You breathe mostly through contracture of your diaphragm. The diaphragm is the muscle that separates the chest from the abdomen, and here’s what happens. The diaphragm contracts and drops down. When this happens, you suck air in. When the diaphragm comes back up, you blow air out. That’s how we breathe—the diaphragm going up and down, up and down. The Heimlich maneuver, the whole principle is to move the diaphragm upward so we can move air quickly out of the body. To do this in the adult, you’re going to position yourself behind the adult and you have to get under the diaphragm and move the diaphragm upward. You have to get into the abdomen, which means your thumb has to go into the patient. If you put this part of your hand into the abdomen, you’re not going to get under the diaphragm, so you have to turn and make sure your thumb is in. Wrap your arms around the victim. You’re going to be below the xiphoid, above the belly button, and you’re going to give inward-upward thrusts, sharp thrusts, almost a punch; as opposed to chest compressions during CPR, nice rhythmic compressions, same speed up and down, like a piston. Not so with the Heimlich maneuver. This is a punch—inward, upward, sharply. You’re going to continue those until either the obstruction comes up or the patient becomes unconscious. If they become unconscious, do the best you can without clocking their head on the floor. What you can’t do is this --drops victim--. Once the victim becomes unconscious, your next step: call 9-1-1. If you’re alone, leave the victim and call 9-1-1. If someone else is around, send them to call 9-1-1. You’re going to start CPR immediately. Begin with chest compressions, standard CPR for the adult (30 compressions, 2 ventilations). The difference in the choking victim, unconscious, is that before you provide those ventilations, you open the mouth and see if you can visualize the obstruction. If you see it, pull it out. If you don’t, provide 2 breaths like you normally would in CPR and go back to chest compressions. Really, once they’re unconscious, standard CPR with one additional step of looking into the airway before you provide ventilations.

Let’s talk about choking in the infant for a moment. Same thing applies—is this a mild or a severe airway obstruction? Mild airway obstruction, the kid’s choking, he’s coughing, but he’s moving air in and out of the body. Stay with the infant. Call 9-1-1 if you need to. Stay with them and watch them to see if they develop a severe airway obstruction. In this case, the child can no longer effectively more air in and out of the body. They can’t produce an effective cough. They may start to turn blue. We’re going to go to work immediately. First step, take the baby by the jaw, lay them across your arm, and invert the child. Get the head down. Get the head down so we’re using gravity. You’re going to perform 5 back blows. Put the palm of your hand right between the scapula, and forcefully strike the child 5 times. Then sandwich them. Bring the child back over, keeping the head down. You’re going to provide 5 chest thrust. Again, center of the chest. Our compression depth, the same as CPR, is about a third of the way through the chest. After that, bring the child up. Look in the airway. Since the object of the back blows and chest thrusts was to move that obstruction from the throat into the mouth, take a peek in the mouth and see if you can visualize the obstruction. If you can, take your little finger and try to sweep that out of there. If you can’t, cover the nose and the mouth, provide 2 ventilations, and continue: back blows, chest thrusts, look, breathe. The nice thing about kids is you can take them with you. Let’s say you’re down in the basement and the baby starts to choke, you can perform these maneuvers on your way outside to meet the ambulance.

What if the child is so big that you can’t flip them over and do back blows? In that case, you’re going to do the Heimlich just like in an adult. You’re going to get down on one knee, get behind the child, and perform the Heimlich maneuver just like in an adult. Really, it’s the size of the child. If you can grab this infant, flip them over, and you’re able to effective back blows and chest thrusts, then that’s what you do. If the child is so large that you can’t do that, then you get down on one knee and perform the Heimlich maneuver, same as in an adult.

When providing these back blows, you may need to kneel down. Maybe get your arm against your knee or maybe sit down and have the child on your lap. The idea is that you have the head down and you’re able to do effective back blows. If you can hold the child, if they’re small enough that you can hold them and do effective back blows holding them, fine. If not, you may have to sit down or knee down and place your arm against your leg to provide adequate back blows. What’s important in the infant is that we go to work immediately for a severe airway obstruction. However, you’re going to perform these maneuvers for about 2 minutes, then activate EMS. You’re still going to need professional help coming, call 9-1-1, but go to work first. Work for a couple minutes, then call 9-1-1 or send someone to call 9-1-1.

This has been a quick review of choking in the adult, child, and infant. Thanks for watching. I’ll see you in the next video.