Choking and the Heimlich Maneuver

Last updated: December 26, 2020

Choking is a life threatening situation that occurs whenever a foreign object lodges in the throat or windpipe. This can cause blockage to the oxygen flow to the brain. Choking a real medical emergency that requires fast and appropriate action by the closest available person. Choking can cause potential death if not acted upon immediately.

Causes of choking

While choking occurs most often among infants and children, choking among adults is not uncommon. ^[1] According to Injury Facts 2017, choking is the fourth leading cause of unintentional injury death. Of the 5,051 people who died from choking in 2015, 2,848 were older than 74.

These are the common reasons for choking:

When a foreign matter ends up in the trachea and becomes stuck as the airway narrows, choking occurs. Food or other foreign matter is supposed to go on another path when swallowed. As swallowing occurs, the epiglottis covers the trachea to prevent the swallowed object from entering the airway. However, when swallowing happens while talking or laughing, the object may go down the wrong pipe hence getting stuck in the airway.
Normal swallowing may be deterred by alcohol consumption or drug intake.
When food is not chewed properly or when swallowing too much food, large chunks of food may become lodged in the throat.
Certain illnesses may cause choking such as Parkinson’s disease may also cause some difficulty in swallowing and this can be a potential cause for choking.

Choking hazards for infants and toddlers

Infants and toddlers are still learning how to chew and swallow properly. This means that they are more prone to choking. Parents must supervise closely when an infant or toddler is eating. They also tend to put anything they touch in their mouth so they must be watched at all times. According to the CDC, the following food are potential hazards to infants and children^[2]:

Cooked or raw whole corn kernels
Uncut cherry or grape tomatoes
Pieces of hard raw fruit or vegetables
Whole pieces of canned fruit
Uncut grapes, berries, cherries, or melon balls
Uncooked dry fruit such as raisins
Whole or chopped nuts and nut butters such as peanut butter
Tough or large chunks of meat
Hot dogs, meat sticks, or sausages
Fish with bones
Large chunks of cheese, especially string cheese
Cookies or granola bars
Potato or corn chips, pretzels, or similar snack foods
Crackers or breads with seeds, nut pieces, or whole grain kernels
Whole kernels of cooked rice, barley, wheat, or other grains
Hard candy, jelly beans, caramels, gum drops, or gummy candies
Chewing gum
Marshmallows

Choking symptoms

Most of the time, choking victims will have difficulty in speaking so it is important to know the symptoms of potential choking just in case one is around someone who might be a victim. The following are the known symptoms of choking:

Coughing hard
Gagging
Throat clutching
Panicking signals while unable to speak
Chest beating
Inability to speak
Turning pale or blue
Losing consciousness

Prevention

It is difficult to know when choking will occur however, certain practices can be put in place to prevent this from happening.

Eat and chew with enough pacing.
Avoid talking or laughing while eating.
Avoid alcohol before eating.
For infants and toddlers, always supervise them while eating.
Make sure that a child’s area is free from objects that can be easily fit in the child's mouth.
When an infant is just beginning solid food intake, cut up the infant’s food into smaller pieces.
For someone with choking prone illness, meals should always be facilitated.

The heimlich maneuver

Named after the American surgeon Henry Heimlich, the Heimlich maneuver is a well known emergency procedure that is recommended for someone who is choking. This can be learned even by a non-medical professional. Most of the time, choking needs immediate intervention and waiting for a medical professional for help may endanger the life of the victim. The Heimlich maneuver is a series of under-the-diaphragm abdominal thrusts. These thrusts are intended to lift the diaphragm, forcing air from the lungs to produce an artificial cough. The cough will force air through the trachea, pushing the object blocking the airway out to the mouth. Abdominal thrusts must be strong enough to force air from the lungs but not too strong as to damage any internal organs or the victim’s ribs.

Before performing the procedure, make sure to call emergency medical help if you are alone with the victim or have someone else call otherwise. To perform the Heimlich maneuver ^[3]:

Reach around the person's waist.
Position one clenched fist above the navel and below the rib cage.
Grasp your fist with your other hand. Pull the clenched fist sharply and directly backward and upward under the rib cage 6 to 10 times quickly.
If the person is obese or in late pregnancy, give chest compressions.
Continue uninterrupted until the obstruction is relieved or advanced life support is available. In either case, the person should be examined by a healthcare provider as soon as possible.

When helping an infant or toddler, extra precaution is needed. Before performing thrusts, try doing at least five firm blows on the child’s back. If the child responds with a cry or cough, this is a good sign. Continue giving back blows until the child coughs out the cause of the choking. If the child is still unresponsive, place the child facing upwards on your lap with the head in a lower position than the whole body. Perform chest thrusts using two fingers on the center of the breastbone just below the nipples. The thrust must be enough to compress the child’s chest a third to a half of its depth.

Continue doing the Heimlich maneuver until the obstruction is cleared or medical assistance arrives.