Clinical Notes : Resuscitation
97. Choking - Adult and Child over 1 year old
Some countries have a survival rate following out of hospital cardiac arrest of 5% while other countries have a survival rate
as high as 30%.
Countries with the best outcome have raised national cardiac arrest awareness and have embedded Chain of Survival in their emergency response protocols, so that more bystanders and first responders are able to deliver effective CPR.
In out-of-hospital cardiac arrest, ALS care (Advanced Life Support) is associated with increased ROSC (Return of Spontaneous Circulation), but is not associated with greater functional outcome than BLS care alone .
BLS choking adult and child over 1 year old
Universal signal for choking:
patient has both hands wrapped around the base of their throat.
ASSESSMENT
Get the adult/child’s attention and ask them if they are choking.
Assess for signs and symptoms of airway obstruction.
-
Partial airway obstruction
-
may result in stridor or a high-pitched audible noise during respiration
-
may allow for a productive cough or allow the patient to speak
-
-
Complete airway obstruction
-
the adult/child is unable to speak, cry, or provide any sounds of respiration
-
the adult/child may be confused, weak, obtunded, or cyanotic
-
01:15
If partial airway obstruction:
-
Do not attempt Heimlich maneuver
-
Encourage cough
-
watch closely for progression to complete airway obstruction
If complete airway obstruction, and conscious adult/child:
-
Send someone to call the emergency response team
-
If alone:
-
immediately call the emergency response team.
-
Attempt Heimlich maneuver:
-
Stand directly behind the child/adult
-
Place both of your arms around the child/adult’s waist
-
Make a fist with one hand and grab the fist with opposite hand
-
Position the thumb end of the fisted hand immediately above the patient’s navel (ample distance away from the xiphoid process)
-
Perform fast upward and inward diaphragmatic abdominal thrusts
-
Continue abdominal thrusts until the obstruction is removed
-
-
If adult/child becomes unconscious:
-
Carefully support the adult/child to the ground
-
Immediately activate (or send someone to activate) EMS
-
Initiate CPR
-
After 2 minutes, if someone has not already done so, the healthcare provider should activate the emergency response system
-
Before attempting rescue breaths during normal CPR, assess the airway, removing any visually present obstruction
-
Simply looking into the mouth should not significantly increase the time needed to attempt the ventilations and proceed to the 30 chest compressions.
-
Do not use a blind finger sweep in an attempt to remove an obstruction
02:31
If abdominal thrusts are not effective, the rescuer may consider chest thrusts
Chest thrusts should be used for obese patients if the rescuer is unable to encircle the victim’s abdomen.
If the choking victim is in the late stages of pregnancy, the rescuer should use chest thrusts instead of abdominal thrusts.
2015 to 2020
Chest thrust
Abdominal thrust
Guidelines for CPR & Emergency Cardiovascular Care
American Heart Association
Updated November 2017
Highlights of the 2015 American Heart Association Guidelines Updates for CPR and ECC
AHA
Resuscitation Council; UK
Adult basic life support and automated external defibrillation
ERC Guidelines 2015
European Resuscitation Council
Advanced vs. Basic Life Support in the Treatment of Out-of-Hospital Cardiopulmonary Arrest in the Resuscitation Outcomes Consortium.
Kurz et al
Resuscitation. 2018 Jul;128:132-137
CPD Quiz and Certificate
This activity attracts 1,0 CPD point
Scroll down the box above to view its entire content
All users who successfully complete the quiz are e-mailed a copy of their personalised CPD certificate.
