A month back, we had discussed about the basic life saving measures when you come across an unresponsive child. Today, we'll deal with something you and I have seen many a time on the big screen in slapstick comedies but is, in fact, no laughing matter.

Choking.

Choking is defined as the inability to breathe due to obstruction of the trachea. It is a medical emergency as the obstruction prevents air from entering the lungs. If this obstruction cannot be relieved, the lack of oxygen will eventually lead to death.
While choking may also occur due to allergic reactions, infections or sleep apneoa, here we're going to be discussing the most common cause which you, as the public, can treat - choking after swallowing an object.
Every year, nearly 1,00,000 people die due to accidental suffocation of food or a foreign body. Unfortunately, choking is more commonly seen in children. The usual suspects which the child maybe playing with and accidentally ingest are :

  1. Peanuts - the most common culprit.
  2. Coins
  3. Bones
  4. Buttons
  5. Pins
  6. Hair clips
  7. Marbles
  8. Seeds or nuts
Signs and Symptoms of a blocked airway :


Choking is usually a sudden event.

  • The child may desperately grab at his throat. 
  • He maybe unable to cough or have a weak cough.
  • He won't be able to speak or cry out.
  • As oxygen-lack sets in, his face will turn blue and he may lose consciousness.






What should you do if you find a person choking on a swallowed object :

A one word answer which I guess most of you will confidently yell is - The Heimlich maneuver (HM, from here on). 
Good. But how do you perform the HM ?
For the sake of clarity, we'll discuss this under five separate categories :
  1. Adults
  2. Children more than 1 year of age.
  3. Infants ( less than 1 year of age. )
  4. Pregnant women / Obese people.
  5. If you start to choke when you are alone.
In all cases, if the person is able to speak or cough forcefully, do not forcefully attempt the HM on the person. But do keep a strict eye on him as unsuccessful attempts could lead to rapid deterioration and require your active assistance.


1. Adults :
This wonderful illustration does all my work for me : giving a visual idea as well as directions.




2. Children greater than 1 year 
The same steps apply as in the case of adults with the single change that you may need to kneel to get your hands at the same level of the child's abdomen.



3. Infants ( less than 1 year )
This is slightly more tricky. It involves a bit of tricky maneuvering of the infant and two separate actions.

a) Back slaps.

Kneel or sit and place the infant in your lap.Look at the picture clearly.


Note how we've turned the infant's face downwards while also giving support to the head. Be careful not to inadvertently apply pressure on the neck while doing this.
Also note how you can support both your hand and the infant with your lap by sitting down.
Give up to 5 back slaps between the infant's shoulder blades with enough force to dislodge the foreign body. 
If it hasn't dislodged, you move to Step B.


  • Turning the child over is gonna be tricky. I still need to focus intently while 'turning' patients over following surgeries on their backs so I can imagine how tense it can be when you're trying to save a choking child. Remember that hand you gave the back slaps with ? Place that hand over the child's back, supporting even the head. The child is now sandwiched between both your hands and with one palm supporting the face and the other supporting the back of the head, turn him over. 


  • Sadly, there isn't time to congratulate yourself for safely turning the infant over. Again, support the child with your arm and thigh and place the head lower than the trunk. Give 5 quick downward thrusts ( 1 per second ) over the lower part of the breastbone. Repeat until the infant spits out the object or becomes unresponsive.



4. Pregnant women /Obese people
Instead of abdominal thrusts as seen in HM, deliver chest thrusts.


5. What if you are alone and accidentally start choking on a chicken bone ?

Remember the steps of the HM ? You may need to perform it on yourself if you are alone. Find a surface you can lean forward on ( eg : a chair ) and after positioning your hands as mentioned earlier, give rhythmic forceful thrusts. 

What happens if your attempts have been unsuccessful and the child becomes unconscious ?
Remember the C-A-B of saving a life. This is one scenario where you have to apply it. Call for help and start compressions. When you open the airway to deliver breaths, check if you can visualise the foreign body. If yes, remove it. Otherwise continue till help arrives or the child regains consciousness.


I'd be more than happy to answer any doubts you have on the topic. Till then, stay safe.



41 Comments

poonam said…
amazing info Roshan, thanks for sharing!!
Rachna said…
Really useful info. I knew the basics, but this is detailed and practical. I will try and practice it.
Roshan R said…
Thanks Poonam
Roshan R said…
Actually, you can practise the basics on just a sofa cushion ... be it how to administer HM or how to turn an infant
broca's area said…
thks....as CMO nw this wil help me :)
Shilpa Garg said…
This is a wonderful series. The pictures and simple explanation makes it easy to understand. Thks for sharing!
Roshan R said…
Perfect person to ask then - what other basic topics can you think of that you think the general public should be educated on which could be life-saving before an ambulance can arrive ?
Roshan R said…
Thanks.. am aiming for that. This is all life saving stuff that the general public can do - you dont need a medical degree for this. It's important to share it with the public, I feel. We docs cant be everywhere.
Zephyr said…
This is very useful and should be made part of school curriculum so that children can be prepared in an emergency too.

Sometimes the person just passes out without a warning as has happened a couple of times with my husband. What does one do then? Of course, it is momentary and he comes to, even before one realises what happened.
Roshan R said…
off the back of my head, the first things that come to my mind are :
1.hypoglycemia ( is he diabetic - if so, oral sugar is enough. dont give too much because there is the serious risk of him choking on any fluids/food u give. )
2. absence seizures ( if he recovers instantly, not a problem. just ensure he is breathing well till he awakens. )
3. Low Blood pressure. ( generalised weakness/overdose of hypertension medication. )
4.Heart or nervous system condition - would need a more detailed evaluation.

And yes, I do wish more schools/colleges/work places would take interest in teaching how to save lives instead of just byhearting books.
Zephyr said…
He is not diabetic, no BP, either low or high, but this happens when he is eating. So it is choking. That's why I asked you. But he does not choke as people normally do, but keels over abruptly. And then recovers too within a few seconds.
Lazy Pineapple said…
a really informative post. You have told us in such a simple and easy way how to help someone who is choking. I have seen this in many movies but thankfully never had to use it on anyone.
Roshan R said…
the primary cause isnt choking, but the loss of consciousness can put him at great risk for choking if the food goes down the trachea instead of the oesophagus.

I really would like to request you to go for a consult to a general physician to identify the cause.
Roshan R said…
Heaven forbid you ever find yourself needing to use the info... but still, its always better to have knowledge like this...
Dil se said…
Very useful information. Always knew about the terms but never knew or learnt the basic process and details.
With 2 kids in the house, i never know when i may need this info.
Am printing this and putting on my refrigerator.
Thanks so much
Binu Thomas said…
Very informative Roshan. It seems scary for infants though. Maybe only a doctor or someone from the medical background can handle such situations.
Roshan R said…
You're welcome..stay safe
Roshan R said…
But thats just it Binu...thats why I'm writing all this. Because there may not be enough time to get to a doctor... an infant shouldnt die because of a traffic jam or distance getting to a hospital
Seena said…
Very useful and timely information for me, with a toddler at home and his habit of picking up and eating something on the floor the second we don't notice.Just yesterday,he took large bite of the baby biscuit I had given him to munch and he choked. He was trying to cough and his eyes started watering. I put him over my shoulder with his head facing down and slapped 3-4 on his back just below the neck and the biscuit piece came out and he became alright. I have done it 2 -3 times earlier also when he had choked. It helped but I wasn't sure whether I was doing it right. Thanks to your write up now I know the right way of doing it.
Roshan R said…
am so glad to hear that this will be helpful in real life.. it is exactly for these kind of situations that I'm writing this. There should be an idea of what is the right thing to do in case of an emergency...
Nisha said…
We've seen this happen so many times on English T.V. series. Yet we never made an attempt to learn this technique. I always thought they push from behind. Now I know it's just a strong backward jerk of your fist.
Thanks.
Roshan R said…
thats the point.. we've seen it in many movies till now.. but its always important to know the basic steps... seeing it in a movie and doing it in real life are entirely different
~nm said…
This is a very useful information that you have provided. Although I've read it many times earlier also, I really wonder if I will be able to remember this at the time of need.
Roshan R said…
it may be necessary.. even if you get part of the basics rt, u can save a life. Cant wait for the child to reach a hospital.
Ritika said…
This is such a great article Roshan.
Everybody should have a basic knowledge about it. Though its somewhat satisfying to know the main culprits are peanuts and bones. I am a vegetarian and allergic to peanuts :D :D :D
Roshan R said…
haha.. good for u in some ways :) but yes, this is something I wanted to share because i sincerely believe that everyone would benefit by such basic knowledge... u should have it in you to say- i can do this. I can save a life, if need be.
Harman said…
thanks for sharing very useful tips!
Roshan R said…
glad if it helps any one person also, Harman.
broca's area said…
regarding epilepsy....would help..:)
Good info, beyond time... i came across this article today n still its so important :) thanks for sharing. Another common seen for us in our movies is someone drowning in water {heroine drowning, n the hero coming n taking her out n ...... ;) } Can you please tell us what needs to be done if someone has drowned n finding it difficult to breath?
Good question Sindhu.
Once you have got the person out of water and lying down on dry land, assess if he is conscious and breathing. Some amount of water may have entered his lungs, which can lead to what is called 'dry drowning' later on which can be fatal.
Unlike in the movies, a few pushes across the chest will rarely be enough to get the water out...if there is any visible water in theri mouth, you may attempt to turn them on their sides (assuming no neck injury) and let the water drain out. But dont waste too much time on this if it isnt happening. Because after that comes the hard part - the C-A-B of resuscitation.

To give you a good idea of the same, I have written it in detail here.
http://www.godyears.net/2012/10/the-c-b-of-saving-child.html

While I sincerely hope you never have to use it, I also hope that should the need arise, you will be able to save a person with what you have read here.
Nabanita said…
Thanks for this....I hope no one ever has to come across such situations but then it's always better to be prepared...The one of an infant is really tricky ...
Pixie said…
Very useful info Roshan! thanks for resharing this post :)
Beloo Mehra said…
Very helpful info, Doc. The inclusion of drawings helps a lot in understanding the steps. Thanks for this.
An important post Roshan: thanks for sharing! Today I actually couldn't breathe properly for a bit due to an orange hot house pepper that got caught in my throat. I was wondering how do I make the choking sign and couldn't remember! And I didn't know what to do, that is, I forgot that I could bend over a chair for example. Luckily I thought to swallow some water and it eased down my throat. Thank goodness. However, I had an even scarier episode due to almonds when I popped them into my mouth -
http://xpressyouressence.blogspot.ca/2012/03/close-call-death-almost-befalls-me.html
Shailaja V said…
I remember my sister doing this for my niece when she was a year old. It was terrifying to watch but very grateful that she managed to get it dislodged. Very useful post, Roshan. Thanks for sharing this.
it is definitely not easy.. which is why i recommend practising on a regular sized doll.. always better to be aware than to struggle during an emergency...
I've tried to keep it as simple as possible. Pictorials always help
wow.. u really have had some close shaves with death.. me more careful. During an event, we all tend to panic and may not think logically
Thanks Shailaja... its something I wish more families knew about.. it can save lives and you don't need to be a doctor for that...