Care of Patients with Choking

EMERGENCY CARE FOR PARTIENT WITH CHOKING

At the end of this presentation student should be able to

• Define choking.
• Explain Types of choking.
• Describe the causes of choking.
• Explain the clinical manifestation of choking.
• Outline the risk factors of choking.
• Explain the emergency management of choking.
• Explain the Complications of choking.
• Describe the Prevention of choking.

OBJECTIVES

Choking refers to impaired or Impeded breathing caused by an obstruction within the air-passages. OR

Choking is a life-threatening medicine emergency characterized by the blockage of air passage into the lungs secondary to the inhalation/ingestion of food or another object.

Food or small objects can cause choking if they get caught in your throat and block the airway.

• This keeps oxygen from getting to the lungs and brain.

INTRODUCTION

Care of Patients with Choking

Complete Obstruction: This is where there is no air going in and out and as a result the casualty is unable to breath and unable to cough.

There may be very high pitched wheezing sounds.

Because the casualty can not cough they will most likely not be able to expel the object without assistance.

Categories of Choking

Partial Obstruction: This is where the airway is not completely blocked.

The casualty is able to cough strongly enough to expel the object on their own.

Because they can get the object out on their own, first aiders should not do abdominal thrusts.

• Instead, just stay with the casualty and encourage them to keep coughing.

Categories of Choking.

If severe enough, airway obstruction leads to oxygen deprivation and death if not rapidly and effectively addressed.

If there is partial obstruction of the airway, a sub-acute process may result in infection, inflammation, and lung injury distal to the lodged object Another mechanism of choking involves the impaction of foreign material in the esophagus, with resultant airway compression.

Choking results from a complex interaction among the individual, the environment, and the object at hand

Care of Patients with Choking

Young children are at highest risk for choking owing to their incompletely developed dentition and oral skills, smaller airways, immature swallowing mechanisms, and lack of experience and cognition.

Also, they tend to explore the world by bringing objects to their mouths.

Children with developmental delay, hypertonia, dysphagia, or anatomic abnormalities retain this increased risk into their later years.

If an adult is choking, you may observe the following behaviors:-

• Coughing or gagging
• Hand signals and panic (sometimes pointing to the throat)

Sudden inability to talk.

Clutching the throat: The natural response to choking is to grab the throat with one or both hands Inability or difficulty breathing. Labored breathing; including gasping or wheezing may be present.

CLINICAL MANIFESTATION

Turning blue (Cyanosis), a blue coloring to the skin, can be seen earliest around the face, lips, and fingernail beds.

The person may become unconscious, if breathing is not restored.

If an infant is choking, more attention must be paid to an infant's behavior.(Difficulty breathing, Weak cry, weak cough, or both) Clinical manifestation cont..

Advanced age.

• Anesthesia or medication administration.
• Delayed gastric emptying.
• Depressed cough or gag reflex.
• Drug or alcohol intoxication.
• Facial, oral, or neck surgery or trauma.
• Impaired (difficulty) swallowing.
• Unsafe eating behavior like eating and drinking very quickly.
• Presence of gastrointestinal tubes.

RISK FACTORS

Presence of tracheotomy and artificial airway (endotracheal tube).

• Reduced level of consciousness.
• Seizure activity.
• Situations hindering elevation of upper body.

Tube feedings. And Wired jaws.

Choking is caused when a piece of food or other object gets stuck in the upper airway.

• In the back of the mouth are two openings.
• One is the esophagus, which leads to the stomach; food goes down this pathway.
• The other is the trachea, which is the opening air must pass through to get to the lungs.

CAUSES CHOKING

When swallowing occurs, the trachea is covered by a flap called the epiglottis, which prevents food from entering the lungs.

• The trachea splits into the left and right main stem bronchae.
• These lead to the left and right lungs.

They branch into increasingly smaller tubes as they spread throughout the lungs.

In adults, choking most often occurs when food is not chewed properly.

Talking or laughing while eating may cause a piece of food to "go down the wrong pipe.“ Normal swallowing mechanisms may be slowed if a person has been drinking alcohol or taking drugs, and if the person has certain illnesses such as Parkinson's disease.

In older adults, risk factors for choking include advancing age, poor fitting dental work, and alcohol consumption.

Care of Patients with Choking

In children, choking is often caused by chewing food incompletely, attempting to eat large pieces of food or too much food at one time, or eating hard candy.

• Children also put small objects in their mouths, which may become lodged in their throat.

Nuts, pins, marbles, or coins, for example, create a choking hazard.

CHOKING (INFANT 1 year)

• 1.Lie infant face down on your forearm with head low.
• 2.Support infant’s head and shoulders on your hand.
• 3.Give four sharp slaps between shoulders.
• 4.Check infant’s mouth and remove any obstruction that may have come loose.
• 5.Check airway and breathing

EMERGENCY MANAGEMENT OF CHOKING

CHOKING CHILD

• Place child face down on the floor or across your lap.
• Give 4 sharp blows between the shoulder blades.
• Remove any loose objects.

Check airway and breathing.

CHOKING ADULT

• For partial blockage;
• 1.Encourage person to relax and breath deeply.
• 2.Ask person to cough and to remove objects.
• For total blockage.
• 1.Lie person on their side on the floor.
• 2.Give 4 sharp blows between the shoulders blades.
• 3.Remove any foreign objects.

4.Check airway and breathing

If still not breathing.

5.Give lateral chest thrusts by placing your hands on the side of person’s chest below the armpit and giving 4 quick downward thrusts.

• 6.Remove any foreign objects

7.Check airway and breathing.

Care of Patients with Choking

Bronchiectasis , foreign material may still be present in the upper or lower airways and cause complications such as bronchiectasis.

(Bronchiectasis is a permanent dilatation and thickening of the airways characterized by chronic cough, excessive sputum production, bacterial colonization, and recurrent acute infections) Hypoxic brain injury and death. Death will usually occur if breathing is not restored in six to eight minutes Complications of choking

Not eating whilst exercising.

• Remembering to chew food properly.
• Not giving peanuts to small children.
• Avoid talking while eating or holding water in the mouth

Prevention of choking

We can also increase public awareness of choking and confidence at initiating first aid.

The abdominal thrust maneuver used in the pre-hospital setting on adults has a good rate of success (86.5%).

These skills should be widely taught and practiced, given the speed with which individuals lose consciousness and die in a complete airway obstruction and the fact that survival often requires obstructions to have been cleared prior to the arrival of paramedics

CONCLUSION

Suzzanne, C. Smeltzer, B. and Suddharth (1990).Medical Surgical Nursing, 8th edition. Lappincott.

• Brunner & Suddarth.(1996).Medical-Surgical nursing(8th ed);Lippincott-riven Publisher:New

York..

Soroudi, A., Shipp, H.E., Stepanski, B.M., Ray, L.U., Murrin, P.A., Chan, T.C. et al. ( 2007) Prehospital Emergence Care , Adult foreign body airway obstruction in the prehospital setting

REFERENCES