Understanding the Choking Condition

Introduction

Choking is a medical emergency that occurs when an object blocks the airway, preventing normal breathing. It can be life-threatening if not addressed promptly. Choking typically involves the obstruction of the windpipe (trachea) by food, foreign objects, or even liquids, leading to reduced airflow and oxygen supply to the lungs and body.

Causes of Choking

Choking can happen to anyone, but certain groups such as young children and elderly individuals are more vulnerable. The main causes include:

• Food Obstruction: Swallowing large pieces of food, eating too quickly, or not chewing properly can lead to food getting stuck in the throat.
• Foreign Objects: Small objects such as toys, coins, or buttons, especially in children, can accidentally enter the airway.
• Medical Conditions: Conditions like dysphagia (difficulty swallowing), neurological disorders, or stroke can increase the risk of choking.
• Alcohol or Sedatives: These substances may impair swallowing reflexes and increase choking risk.

Symptoms of Choking

Recognising the signs of choking is crucial for timely intervention. Common symptoms include:

• Inability to Speak or Cry: The person may not be able to talk, cough, or make sounds.
• Difficulty Breathing: Laboured or noisy breathing, or complete inability to breathe.
• Clutching the Throat: A universal sign of choking is when a person grabs their throat with one or both hands.
• Coughing: Sometimes, the person may have a weak or ineffective cough.
• Change in Skin Colour: Bluish skin (cyanosis) due to lack of oxygen.
• Panic or Distress: Visible anxiety or distress, sometimes accompanied by loss of consciousness if the obstruction is not cleared.

Types of Choking

Choking can be classified into two types:

1. Partial Obstruction: Some air is able to pass through. The person may be able to cough forcefully and speak, but breathing is still difficult.
2. Complete Obstruction: No air passes through. The person cannot speak, cough, or breathe, and this is a critical medical emergency.

Immediate Management and First Aid

Quick action is essential to prevent serious outcomes. The recommended first-aid steps include:

1. Encourage Coughing: If the person can cough, encourage them to continue, as this may dislodge the object.
2. Back Blows: Deliver up to five firm blows between the shoulder blades with the heel of your hand.
3. Abdominal Thrusts (Heimlich Manoeuvre): Stand behind the person, make a fist, place it above the navel, and thrust inward and upward sharply.
4. Call Emergency Services: If the obstruction is not cleared, seek medical help immediately.
5. CPR: If the person becomes unconscious, begin CPR and continue until help arrives.

Prevention

• Educate caregivers and family members about choking hazards and first-aid responses.
• Chew food thoroughly and avoid talking or laughing while eating.
• Keep small objects out of reach of children.
• Be cautious with medications or substances that may affect swallowing.

Nursing Care of Patients with Choking

Nurses, as frontline healthcare professionals, play a vital role in the early recognition, immediate intervention, and ongoing care of patients experiencing choking episodes.

Assessment of Choking

Recognition of Choking

Timely and accurate assessment is crucial to prevent fatal complications. Signs and symptoms may vary depending on the severity of the obstruction.

• Signs of Partial Airway Obstruction:
• Coughing or gagging
• Wheezing or noisy breathing
• Panic or distress
• Clutching the throat (universal choking sign)

Signs of Complete Airway Obstruction:

• Inability to speak, cough, or breathe
• Cyanosis (bluish skin, lips, or nail beds)
• Loss of consciousness, if not relieved
• Silent attempts to cough

Initial Assessment Steps

1. Assess airway, breathing, and responsiveness.
2. Determine if the obstruction is partial or complete.
3. Look for the universal choking sign and observe patient’s color and level of consciousness.
4. Listen for abnormal breathing sounds such as stridor or silence.
5. Check for the presence of a visible foreign body in the mouth or throat.

Immediate Nursing Interventions

For Partial Obstruction

• Encourage the patient to continue coughing to attempt to clear the obstruction.
• Stay with the patient and monitor for worsening symptoms.
• Do not attempt to interfere if the patient is coughing effectively.

For Complete Obstruction

1. Call for emergency assistance immediately (activate emergency code or call 911).
2. Perform abdominal thrusts (Heimlich maneuver) in adults and children over one year of age.
3. Stand behind the patient, make a fist, place it above the navel, grasp with the other hand, and deliver quick upward thrusts.
4. For infants under one year, use back slaps and chest thrusts:
5. Place the infant face down along your forearm, deliver five back slaps between the shoulder blades, then turn the infant over and deliver five chest thrusts.
6. If the patient becomes unconscious:
7. Begin CPR (cardiopulmonary resuscitation) and check the airway for visible obstructions before giving breaths.
8. Continue until help arrives or the obstruction is relieved.
9. Do not perform blind finger sweeps, as this may push the object further down.

Other Emergency Measures

• If trained, use suction equipment to remove secretions or debris from the mouth.
• Administer oxygen via face mask if the airway is partially open and the patient is hypoxic.
• Prepare emergency airway equipment (e.g., laryngoscope, Magill forceps, airway adjuncts, or tracheostomy kit) if obstruction is not relieved.

Post-Resuscitation Care

Once the airway is cleared and the patient stabilizes, ongoing monitoring and care are essential.

Monitoring

• Observe for respiratory distress, recurrent coughing, or stridor.
• Monitor vital signs, including oxygen saturation (SpO2), heart rate, and respiratory rate.
• Assess for complications such as aspiration pneumonia or laryngeal trauma.

Documentation

• Document the event in detail: time, nature of the obstruction, interventions performed, and patient’s response.
• Record vital signs and any follow-up treatment or referrals.

Psychosocial Support

Choking episodes can be frightening for patients and their families. Providing reassurance, clear explanations, and emotional support is a key aspect of nursing care.

• Offer comfort and explain all interventions.
• Educate the patient and family about warning signs and prevention strategies.
• Encourage the patient to express their feelings and anxieties related to the incident.

Prevention Strategies

Nurses are instrumental in educating patients, caregivers, and the public about choking prevention.

Patient and Family Education

• Instruct on the importance of chewing food thoroughly and eating slowly.
• Advise against talking, laughing, or being distracted while eating.
• Keep small objects and foods that are choking hazards away from young children.
• Educate caregivers of high-risk individuals (elderly, those with dysphagia) about safe swallowing techniques and food modifications.

Special Considerations for At-Risk Groups

• Suggest texture-modified diets (pureed, minced, or thickened fluids) for patients with swallowing difficulties.
• Ensure dentures fit properly and oral hygiene is maintained.
• Promote regular swallowing assessments for those with neurological disorders or after strokes.
• Recommend supervision during meals for children and vulnerable adults.

Role of the Nurse in Multidisciplinary Care

Collaboration with doctors, speech therapists, respiratory therapists, and dietitians enhances patient safety and recovery.

• Refer patients with persistent dysphagia to speech and language therapists for assessment and therapy.
• Work with dietitians to develop suitable meal plans for patients at risk.
• Coordinate with respiratory therapists in cases of severe airway compromise.
• Participate in community health programs focusing on choking prevention and first aid training.

REFERENCES

1. American Academy of Pediatrics. Choking Prevention for Babies & Children. https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/Choking-Prevention.aspx. Last updated 8/23/2024
2. Ghasemi N, Razavi S, Nikzad E. Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy. Cell J. 2017;19(1):1–10. doi:10.22074/cellj.2016.4867
3. American Red Cross. Adult/Child Choking. https://www.redcross.org/take-a-class/resources/learn-first-aid/adult-child-choking.
4. Bhanderi BG, Palmer Hill S. Evaluation of DeChoker, an Airway Clearance Device (ACD) Used in Adult Choking Emergencies Within the Adult Care Home Sector: A Mixed Methods Case Study. https://pubmed.ncbi.nlm.nih.gov/33425826/. Front Public Health. 2020 Dec;8:541885.
5. National Health Service (U.K.). Choking and gagging on food. https://www.nhs.uk/start-for-life/baby/weaning/safe-weaning/choking-and-gagging-on-food/.
6. National Safety Council (U.S.). Choking Prevention and Rescue Tips. https://www.nsc.org/community-safety/safety-topics/choking.
7. Resuscitation Council U.K. Adult basic life support guidelines. https://www.resus.org.uk/library/2021-resuscitation-guidelines/adult-basic-life-support-guidelines. Published 5/2021.
8. Saccomanno S, Saran S, Coceani Paskay L, et al. Risk factors and prevention of choking. https://pubmed.ncbi.nlm.nih.gov/37905785/. Eur J Transl Myol. 2023 Oct;33(4):11471.
9. Simpson E. How to manage a choking adult. https://pubmed.ncbi.nlm.nih.gov/27745052/. Nurs Stand. 2016 Sep;31(3):42-46. 
10. Shochat G, Nemer J. Relief of Choking and Acute Upper Airway Foreign Body Removal. In: Reichman EF, eds. Reichman’s Emergency Medicine Procedures. 3rd ed. McGraw-Hill Education; 2018.
11. Sidell DR, Kim IA, Coker TR, Moreno C, Shapiro NL. Food choking hazards in children. Int J Pediatr Otorhinolaryngol. 2013;77(12):1940-6. doi:10.1016/j.ijporl.2013.09.005

Stories are the threads that bind us; through them, we understand each other, grow, and heal.

JOHN NOORD

Connect with “Nurses Lab Editorial Team”

I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.