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Have you ever seen someone choking and you are confused on the next action to take? In our previous article, we did a general introduction to choking. This article explains some helpful tips when you meet someone choking.

The American Red Cross’ Recommendations for First Aid in Choking
• Have someone call 9-1-1
• Obtain consent from the victim.
• Lean the person forward and give 5 back blows with the heel of your hand.
• Give 5 quick, upward abdominal thrusts.
• Continue alternating back blows and abdominal thrusts until – the obstructing object is forced out; or the person can breathe or cough forcefully; or the person becomes unconscious.
• If the victim becomes unconscious, call 9-1-1, if not already done, and follow the steps for an unconscious choking adult below.
The American Red Cross recommends the following for the unconscious choking adult:
• Try 2 rescue breaths. To give a rescue breathe – tilt the head and lift the chin, then pinch the nose shut; take a breath and make a complete seal over the person’s mouth; blow in to make the chest clearly rise. Each rescue breath should last about 1 second.
• If breaths do not go in, tilt the head farther back. Try 2 rescue breaths again.
• If the chest does not rise – give 30 chest compressions. To give a chest compression – place two hands in center of the chest (on lower half of sternum); compress 1.5 to 2 inches; compress 30 times in about 18 seconds (100 compressions per minute)
• Look for an object in the airway. Remove if one is seen.
• Try 2 rescue breaths.
Repeat until emergency medical services (EMS) responders arrive or the obstruction is removed and the patient begins to breathe on his or her own.
The American Red Cross guidelines for treating choking in infants or babies one year or younger are similar to the guidelines mentioned above for the American Heart Association.

What do emergency personnel do to treat choking?
Treatment begins when local EMS responders arrive on the scene. They have several ways to treat a choking person. In addition to being skilled in the choking treatment and CPR, they also may have several tools to assist them in clearing the airway. Some of the ways they can assist the choking victim include:
1. Intubation: a breathing tube is passed into a person’s windpipe (trachea). This may push the object that is obstructing the airway out of the way enough for air to enter the lungs. To intubate, a metal scope is inserted into the back of the throat to aid in seeing the vocal cords, which mark the opening of the trachea. If, while using this scope, the object causing the obstruction can be seen, it may then be removed with a long instrument called a Magill forceps.
2. If attempts to intubate a person with a complete airway obstruction are unsuccessful, EMS personnel may have to perform a surgical procedure called a cricothyrotomy. This involves cutting the neck and making a hole in the trachea just below the Adam’s apple, through which a breathing tube is inserted. This tube should enter the trachea below the spot that is blocked by the foreign body.
3. Once at the hospital, a doctor may use a bronchoscope to remove the object. Bronchoscopy involves inserting a flexible scope into the airway. If something is found, this scope also has attachments that the doctor can use to remove the object.
4. If all of these maneuvers fail, the choking person will be taken to the operating room to have the foreign body removed and a clear airway established surgically.
Follow-up care
Follow-up care is rarely needed if the object blocking the airway is removed quickly. Choking victims who require surgery or who suffer brain damage from lack of oxygen will require more extensive follow-up care.
Choking Prevention tips for children
1. Don’t give young children foods or small objects that are likely to become lodged in their airways. This includes nuts, seeds, gum, hard candy, peas, and tough meats. It is recommended that these foods be not given to any child younger than four years of age.
2. Cut foods such as hot dogs, sausages, and grapes into small pieces before serving them to young children.
3. Look over toys to find small pieces (eyes and noses on stuffed animals, for example) that the child might be tempted to place in his or her mouth.
4. Choking on a rubber balloon is the leading cause of choking death in children who choke on objects other than food. Clean up right after parties. Toddlers are prone to stick anything they find on the floor into their mouths, including dangerous objects.
5. Store small objects, such as buttons and batteries, out of a child’s reach.
6. Do not allow children to play sports with food or gum in their mouths.
7. Tell babysitters and older brothers and sisters what foods and objects should not be given to young children.
8. Instruct children to chew their food thoroughly before swallowing.
Choking Prevention tips for adults
1. Avoid placing objects such as nails or pins in your mouth for quick access.
2. Take small bites and chew food thoroughly.
3. Be aware that alcohol may impair your ability to chew and swallow and increase your risk of choking.

Choking Prognosis
The lack of oxygen caused by choking can result in brain damage or death in four to six minutes. Unless immediate action is taken to open a completely obstructed airway, the chances for survival and complete recovery decrease rapidly. If the object can be removed quickly and breathing returns to normal, recovery should be complete.
References: Mayo Clinic, Wikipedia

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