Choking – Physiology, Symptoms and Preventions
Choking is the medical emergency which occur everyday. Each year, more than 17,000 infants and children are treated in hospital emergency departments for choking-related incidents, and more than 80 percent of these occur in children aged four years and younger. The data of Nepal is unavailable but we think the numbers are similar in proportion. Choking is defined as a condition caused by inhalation of a foreign object that partially or fully blocks the airway. It is a serious medical emergency condition if not managed in few minutes then person may die with minutes.
To understand choking, you first have to understand the physiology of swallowing and breathing. All the food we eat and the air we breathe passes through common opening, the throat to get into our body.
But there are two different opening, one for food and liquid which goes to one pipe, the esophagus to our stomach and another for air which goes down another pipe, the trachea, or windpipe to our lungs. Though they share same opening but our body has mechanism to control this puzzle. A little flap of cartilage called the epiglottis sits near trachea, and every time when we swallow, it comes into action. Acting like a little door, it closes off the entrance to trachea so that food is sent down to esophagus into stomach instead of into the lungs.
Epiglottis is our life saver but some times when we are laughing while eating, the epiglottis doesn’t close in time. A piece of food can slip down into the trachea. Most of the time, it’s no big deal, because our body makes us cough and forces it back up to its right pipe or out into mouth.
That’s because coughing is the body’s natural defense against stuff that doesn’t belong in the trachea. A good cough often can clear out a piece of food — or even an object — that heads down the trachea. If a person can still breathe and talk, coughing often does the trick.
But when someone is truly choking it means the person is really in trouble. The food or object is completely blocking the airway and air cannot flow into and out of the lungs. The person cannot cough the object out and cannot breathe, talk, or even make noise. The person might grab at his or her throat or wave his or her arms. If the trachea remains blocked, the person’s face may turn from bright red to blue. The body needs oxygen to stay alive. When oxygen can’t reach the lungs and the brain, a person can become unconscious, sustain brain damage, and even die within minutes. That’s what makes choking such a serious emergency.
Choking is diagnosed by observation of the choking victim. Following are the symptoms but patient may present in any way with history of eating something.
- inability to cough, cry, or speak
- blue or purple face color from lack of oxygen
- grabbing at throat
- weak cough and labored breathing that produces a high-pitched noise
- all of the above, followed by loss of consciousness
It is better to prevent this emergency condition than managing. Choking is easily preventable by taking the following steps and might be different for children and adults:
- supervising infants and children while they eat and play
- childproofing play areas by removing small objects
- cutting foods into very small pieces
- avoiding serving foods which are prone to cause as choking hazards to children
- monitoring older children to make sure they do not give younger children hazardous objects and food
- following age and safety guidelines on toys
- not letting children and infants play with coins
Be extra careful when eating certain foods that are easy to choke on
Sit down, take small bites, and don’t talk or laugh with your mouth full
Because most choking incidents occur in the home, all parents and infant/child caregivers should be trained in the Heimlich maneuver. Who knows? You could be a lifesaver someday!
The likelihood of choking incidents can be reduced by closely supervising infants and children while they eat and play. Most choking incidents are associated with food items, especially candies, grapes, nuts, popcorn, and carrots. Common non-food items that present choking hazards include deflated balloons, buttons, coins, small balls, small toys, and toy parts. All toys should be examined to make sure they are age-appropriate and do not have loose parts. Young adults should be focusing on chewing the food properly before swallowing.
The Heimlich maneuver
The Heimlich maneuver is a way to help someone who is choking. It’s usually performed by another person, but there’s even a way to do it on yourself, if necessary.
The traditional Heimlich maneuver is to be used on adults and children over 1 year old. A helper gets behind the choking person and gives a certain kind of quick squeeze in the middle of the abdomen. This squeeze sends a quick, powerful burst of air from the person’s lungs upward, dislodging the problem food or object and often sending it flying out of the person’s mouth.
To do it properly and safely, it’s best to learn it from a health care professional who can show you how it’s done.
American Medical Association (2009-05-05). American Medical Association Handbook of First Aid and Emergency Care. Random House. ISBN. 978-1-4000-0712-7.
Yadav SP, Singh J, Aggarwal N, Goel A (September 2007). “Airway foreign bodies in children: experience of 132 cases”. Singapore Med J. 48 (9): 850–3.
Luczak (2016.02.015). “Head-down self-treatment of choking”. Resuscitation.doi:10.1016/j.resuscitation.2016.02.015.
Posted by Dr. Sandesh Karki