# Choking Adult & Child

## Overview

This module describes the management of a choking adult or child.

## Indications

1. Choking adult or child

## Contraindications

1. None

## Patient information and consent

This procedure is an emergency done when a patient is unable to speak, so consent is generally implied.

## Preparation

Choking management is an emergency procedure. In hospital, always:

- Know where defibrillators, transcutaneous pads, and red trolleys are kept. Know the relevant staff and keep your seniors’ contact details close at hand.
- Familiarise yourself with the defibrillators in your work area. Check that they are maintained regularly and have pads and the correct connections.
- Keep unstable patients in resuscitation bays with continuous monitoring.

In out of hospital situations:

- Carry gloves and a CPR protective device.
- In public places such as airports and malls, look out for AEDs and first aid stations attached to walls.
- Memorise emergency phone numbers, or keep them on your cell phone, to call for help.

## Site & Positioning

The patient should be standing during abdominal thrusts, and should be bent forward for back blows.

## Procedure

Follow medical asepsis without gloves.

1. Ask the patient “Are you choking?” and “Can you cough?”. Evaluate whether the patient is able to speak and cough.
2. If the patient is able to cough, encourage the patient to do so until the blockage is cleared. If unable to cough, continue:
3. Back blows: bend the patient forward and hit their back between the shoulder blades with an open hand five times.
4. Abdominal thrusts: stand behind the patient with one foot between theirs and the other behind you. Wrap your arms around them just below the ribcage. Place one fist with the thumb side against the patient. Grasp that fist with your other hand and give up to 5 fast thrusts, pressing inwards and upwards.
5. Repeat 3 & 4 until the blockage is cleared or the patient becomes unconscious.
6. If unconscious:

- Out of hospital: call an ambulance. Place the patient on their back and start CPR. Before each set of rescue breaths, look inside the mouth and sweep away any visible foreign material.
- In hospital: Call for urgent ENT or anaesthesia support. Proceed with CPR until the emergency trolley arrives. Before each set of rescue breaths, look inside the mouth and sweep away any visible foreign material. While continuing CPR, attempt to visualise and remove the foreign body using a laryngoscope and Magill’s forceps. If all else fails, an emergency surgical airway may be necessary.

## Troubleshooting

My patient is pregnant or obese.

Place your hands somewhat higher than for other patients, on the base of the sternum instead of just below it.

My patient is a child under 1 year of age.

Follow the Choking Infant module.

## Risks

1. Unsuccessful attempt—cardiac arrest and death
2. Bruising
3. Rib/sternal fractures
4. Pneumothorax
5. Airway injuries

## References

1. Resuscitation Council of Southern Africa. Choking Algorithm. 2021.