Monday, April 16, 2012

Foreign-Body Airway Obstruction (choking)

 For conscious adult victim:

·   Assess for responsiveness. Ask “Are you choking?” “Can you speak?”
·   Check for signs of airway obstruction.
·   Watch out for universal distress signal: victim clutches his/her neck with the thumb and index fingers, difficulty speaking, high-pitched sounds while inhaling, poor ineffective coughs, bluish skin color/ cyanosis.
·   Call for help; activate EMS immediately.
·   Relieve the obstruction by performing the Heimlich maneuver, in adult) until the object is dislodged or the victim becomes unconscious.
o    Stand behind the victim. Wrap your arms around the waist. Tip the person forward slightly.
o    Make a fist with one hand. Position it slightly above the person's navel.
o    Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust — as if trying to lift the person up.
o     Perform a total of five abdominal thrusts, if needed. If the blockage still isn't dislodged, repeat the "five-and-five" cycle.

For adult victim who becomes unconscious:

·   Position the victim and assess consciousness. Turn on back as a unit, supporting the head and neck, face up, and arms by sides.
·   Call for help; activate EMS immediately.
·   Open the airway, check for foreign body.
·   Repeat the rescue breaths and maintain open airway until obstruction is relieved.
·   Attempt breath, reposition then attempt 2nd breath begin CPR compressions.
·   Note: Use finger sweep only if able to visualize object.

For unconscious adult victim:

·   Determine unresponsiveness by tapping or gently shaking the shoulder of the victim.
·   Call for help; activate EMS and position the victim. Turn on back as a unit, supporting the head and neck, face up, and arms by sides.
·   Attempt breath; if no chest rise reposition attempt 2nd breath. If 2nd breath still no chest rise, begin 30 CPR compressions; repeat.

For conscious choking child:

·         Assess the victim if the child can cough or speak. Allow the child to continue coughing if the cough is forceful.
·         If the cough is ineffective or develops increased respiratory distress accompanied by a high-pitched noise during inspiration, an immediate action must be done.
·         Perform abdominal thrusts/ Heimlich maneuver:
o    Stand behind the victim; wrap your arms around his/her waist, making a fist with one hand.
o    Place the thumb side of the fist against the child’s abdomen, between the umbilicus and xiphoid process.
o    Place your other hand over the fist & give quick upward thrusts.
o    Provide continuous thrusts until the obstruction is dislodged or becomes unconscious.

 For unconscious child:

·         Assess consciousness.
·         Open the airway by the tongue-jaw lift; check for breathing & obstruction.
·         Position the child down onto his/her back.
·         Maintain open airway with a head-tilt and a chin-lift; give 2 rescue breaths.
·         Attempt breath; if no chest rise reposition attempt 2nd breath. If 2nd breath still no chest rise, begin 30 CPR compressions; repeat.

For choking infant:

·         Assess for obstruction and note breathing condition.
·         Ease the obstruction by performing 5 back blows & 5 chest thrusts.
o    Straddle the infant over the arm, place the infant’s head lower than the trunk, supporting the head firmly, and holding the jaw with your thumb and fingers to stabilize the head of the infant.
o    Use the heel of your hand to give 5 back blows between the shoulder blades.
o    Turn the infant over; making sure the infant’s head is lower than his/her chest.
o    Give 5 chest thrusts; imagine a line across the infant’s chest between the nipples, placing your ring finger on the infant’s breastbone just below the imaginary line, then place the pads of  the next 2 fingers just under the line. Lift your ring finger, and feel the notch, moving your fingers up compressing the infant’s breastbone at a depth 1/3 – 1/2 inch. of the chest. Give 5 compressions.
o    Check for the object in the mouth and remove if seen. Blind finger sweeps are avoided in infants and small children, since the object may be pushed back farther into the airway, resulting to further obstruction.
o    Continue giving back blows & chest thrusts until the infant can cough, or the object is removed.

For unconscious infant:

·         Determine consciousness by gently tapping the infant.
·         Open the airway by the tongue-jaw lift
·         Check for breathing and assess for obstruction.
·         Attempt ventilation.
·         Position the infant down on its back; perform 30 chest compressions
·         Finger sweep the mouth only if the object is seen.
·         Provide 2 rescue breaths and continue performing 30 chest compressions. Repeat the sequence until object is dislodged.
·         If unsuccessful, activate EMS and perform CPR if the infant is breathless & pulseless.

For pregnant or obese victim:

·   Do the preliminary assessment for airway, breathing &
·   Activate the EMS.
·   Perform Heimlich maneuver:
o    Place arms under the victim’s axilla and across the chest.
o    Put the thumb side of a clenched fist against the middle sternum, and place the other hand over the fist.
o    Perform backward thrusts until the foreign object is dislodged or until the woman becomes unconscious.
o    Open the airway with a head-tilt and a chin-lift, and give 2 rescue breaths.
o    If the victim becomes unconscious, place her on her back; and a wedge such as pillow or rolled blanket placed under the right abdominal flank & hip to displace the uterus to the left side of the abdomen.
o    Continue 30 compressions to 2 breaths, with repositioning between breaths.

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