# Choking Infant

## Overview

This module describes the management of a choking infant.

## Indications

1. Choking infant

## Contraindications

1. None

## Patient information & consent

This procedure is done during an emergency, 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 infant should be positioned prone on your arm, with their face held in your hand, and their legs straddling your bicep. As you progress from back blows to chest thrusts, place your free arm on top of the infant and flip them over onto your top arm so that they are supine, with the back of their head held in your hand.

The infant’s head should always be lower than their feet so that gravity assists with expelling the obstructing object.

## Procedure

Follow medical asepsis without gloves.

Infant is awake:

1. Back blows: hit their back between the shoulder blades with your palm five times.
2. Chest thrusts: place your index and middle fingers on the centre of the infant’s chest and give up to five thrusts.
3. Repeat 1 & 2 until the blockage is cleared or the infant becomes unconscious. Perform finger sweeps to check and sweep away visible objects.

Infant is unconscious:

- If 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.
- If 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.

## 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.