Choking (FBAO)

1. Choking (FBAO) Unit: CPR/AED and 1st Aid

2. A dome-shaped muscle separating the thoracic and abdominal cavities which helps control breathing • Inhalation – the diaphragm presses the abdominal organs forward and downward, thus increasing the space in the thoracic cavity • Air rushes into the lungs • Exhalation – the diaphragm rises and recoils to the resting position, decreasing the amount of space in the thoracic cavity • Air is pushed out of the lungs • Responsible for performing the major work of bringing atmospheric air into the lungs Key Points-Diaphragm

3. Good air exchange • The victim can respond and cough forcefully • The victim may wheeze between coughs • Rescuer’s Action • If the victim is able to cough forcefully, the rescuer does nothing but encourage the victim to continue coughing • Stay with the victim and monitor their condition • If the mild airway obstruction persists, call 911. Key Points-Mild Airway Obstruction

4. May be unable to speak – air cannot get in or out of the lungs • Weak, ineffective cough, or the inability to cough • High pitched noise while inhaling or no noise at all • Cyanosis – it is a sign of lack of 02 in the body • Universal choking sign – clutching the neck with thumbs and fingers, visibly panicking Key Points-Severe Airway Obstruction

5. Ask the victim if he/she is choking • If they nod yes and cannot talk, activate the emergency response system – CALL 9-1-1 Rescuer’s Action – Severe Airway Obstruction

6. Heimlich maneuver • Stand or kneel and wrap your arms around the victim’s waist • Make a fist with one hand • Place the thumb side of your fisted hand just above the umbilicus • Put your other hand over your fisted hand • Using the strength of both hands, press your fist into the victim’s abdomen with a quick upward thrust • This pushes the diaphragm upward • Creates an artificial cough • Repeat thrusts until obstruction is expelled • Victim may become unresponsive Child or Adult Over Age 1

7. If your choking victim becomes unresponsive: • Let the victim slide down your body to the floor • Try to prevent the victim’s head from hitting the floor • You should have already called 9-1-1 • Now you have an unconscious victim whom you know is unconscious because he/she was choking • Open the airway, if you see the object, remove it • If the victim does not start breathing, give 2 rescue breaths and check for a pulse • If they have a pulse, continue rescue breathing until EMS arrives • If thy do not have a pulse, begin the steps of CPR Unresponsive adult or child

8. Unable to see the obstruction • Begin the steps of CPR • Look for the object every time you open the airway to give breaths • Don’t put your fingers in their mouth unless you see the object • Continue CPR until EMS arrives Unresponsive adult or child

9. Recovery Position: • Laying on their left side – allows for vomit to fall out of their mouth and not back down their throat • Medical Attention: • Encourage the victim to seek medical attention • Possible damage to internal organs • Possible cracked ribs Post Heimlich Maneuver

10. If you cannot get your arms around the victim, you may perform chest thrusts instead of abdominal thrusts • Stand or kneel and wrap your arms around the victim’s chest • Make a fist with one hand • Place the thumb side of your fisted hand in the middle of the chest, between the nipples • Put your other hand over your fisted hand • Using the strength of both hands, press your fist into the victim’s chest with a quick upward thrust. • Repeat until the obstruction is expelled from their airway Obese or Pregnant Choking Victims

11. Sit with the infant on your lap • Resting the baby on your forearm, hold the infant prone with the head lower than the chest • Support the baby’s head and jaw with your hand • Rest your forearm on your lap or thigh to support the baby • Deliver 5 back slaps to the infant • Slaps must be delivered forcefully in the middle of the back, between the baby’s shoulder blades • Use the heel of your hand to deliver the slaps (glancing blows) • Each slap should have sufficient force to attempt to dislodge the foreign body Responsive Choking Infant

12. 6. Place your free hand on the infant’s back, supporting the baby’s head with the palm of your hand. 7. Carefully cradle the infant between your forearms, with the head supported, and turn the baby on his/her back. 8. Keep the infant’s head lower than his/her trunk 9. Give 5 downward chest thrusts in the same location as chest compressions 10. Repeat the sequence until the object is removed, or the infant becomes unresponsive Responsive Choking Infant

13. Stop giving back slaps once the infant become unresponsive • Begin the steps of CPR • Look for the object each time you give breaths – if you see it, remove it. DO NOT perform a blind finger sweep • After about 2 minutes of CPR (5 cycles), activate the EMS system if you have not already done so. • Continue CPR until EMS arrives to take over • Infant is revived: • Continue to monitor until EMS arrives • The recovery positions is NOT recommended for infants and small children Unresponsive Choking Infant