How to save someone who is choking on a foreign body

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.