Choking is a blockage of the upper airway by food or other objects, which prevents a person from breathing effectively. Choking is a true medical emergency that requires fast, appropriate action by anyone available. Emergency medical teams may not arrive in time to save a choking person’s life.
Oxygen is an absolute necessity for life. When a person is choking with a completely blocked airway, oxygen cannot enter the lungs. The brain is extremely sensitive to this lack of oxygen and begins to die within four to six minutes. It is during this time that first aid must take place. Irreversible brain death occurs in as little as 10 minutes.

Causes of Choking
Choking is caused when a piece of food or other object gets stuck in the airway.
There are 2 openings at the back of the mouth – the esophagus and the trachea. While food passes through the esophagus to get into the stomach; the trachea is the access way to air going into the lungs. For swallowing to occur, the trachea is covered by a flap called the epiglottis, which prevents food from entering the lungs.
1. Talking or Laughing: We should careful not to communicate while eating such that it may cause a piece of food to “go down the wrong pipe.”
2. Alcohol and Drug intake: Alcohol and some hard drugs have been implicated in of the causes of choking.
3. Some Disease Conditions: Diseases such as Parkinson’s disease may alter normal swallowing mechanisms.

Risk Factors Associated with Choking
Risk factors for choking include advancing age, poor fitting dental work, and alcohol consumption. 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.

Symptoms of Choking
If something gets stuck, several symptoms may occur such as:
• Clutching the throat: The natural response to choking is to grab the throat with one or both hands. This is also the universal choking sign and a way of telling people around you that you are choking.
• Hand signals and panic (sometimes pointing to the throat)
• Coughing or gagging
• Sudden inability to talk
• Wheezing
• Passing out
• Turning blue
• Difficulty breathing
• Weak cry, weak cough, or both

What to do when Someone is Choking
Choking is an emergency. It can quickly result in death if not treated promptly. Do not hesitate to call for emergency help if you believe a person is choking. Do not attempt to drive a choking person to a hospital emergency department. As you prepare to help the choking victim always shout for help. Have other bystanders call the emergency medical service.
While waiting for the ambulance, follow the steps below:
• It is best not to do anything if the person is coughing forcefully and not turning a bluish color.
• Ask, “Are you choking?” If the person is able to answer you by speaking, it is a partial airway obstruction. Stay with the person and encourage him or her to cough
until the obstruction is cleared.
• Do not give the person anything to drink because fluids may take up space needed for the passage of air.
• Someone who cannot answer by speaking and can only nod the head has a complete airway obstruction and needs emergency help.
If the choking episode is successfully treated at home and there is no fear that other objects may still be in the airway, a visit to the hospital may not be necessary.
If you are alone and no one responds to your calls for help, do not leave the choking person to call emergency help lines. Begin first aid immediately. Do not attempt to drive a choking person to a hospital emergency department.

The American Heart Association’s Recommendations for Choking
The treatment for a choking person who begins to turn blue or stops breathing varies according to the person’s age.
In adults and children older than one year of age, abdominal thrusts (also known as “Heimlich maneuver”) should be attempted. These thrusts create an artificial cough and it may be forceful enough to clear the airway. The quick, upward abdominal thrusts force the diaphragm upward very suddenly, making the chest cavity smaller. This has the effect of rapidly compressing the lungs and forcing air out. The rush of air will force out whatever is causing the person to choke.

How to perform abdominal thrusts

Lean the person forward slightly and stand behind him or her. Make a fist with one hand. Put your arms around the person and grasp your fist with your other hand in the midline just below the ribs. Make a quick, hard movement inward and upward in an attempt to assist the person in coughing up the object. This maneuver should be repeated until the person is able to breathe or loses consciousness.
If the person loses consciousness gently lay him or her flat on their back on the floor. To clear the airway, kneel next to the person and put the heel of your hand against the middle of the abdomen, just below the ribs. Place your other hand on top and press inward and upward five times with both hands. If the airway clears and the person is still unresponsive, begin CPR.
For babies (younger than one year of age), the child will be too small for abdominal thrusts to be successful. Instead, the infant should be picked up and five back blows should be given, followed by five chest thrusts. Be careful to hold the infant with the head angled down to let gravity assist with clearing the airway. Also be careful to support the infant’s head. If the infant turns blue or becomes unresponsive, CPR should be started.
References: Mayo Clinic, Wikipedia

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