Treating an unconscious choking patient

As we learned in my last column the Heimlich Manoeuvre (abdominal thrusts) is very effective when assisting someone who is choking.

The procedure can also be performed on an unconscious patient, however instead of abdominal thrusts we use chest compressions such as the ones used in CPR. Please note that as a rule of thumb we NEVER perform chest compressions on a patient that may have a heartbeat as it can cause serious injury. However, assisting an unconscious choking patient is the one exception to the rule.

Remember the ABCD’s. Assess the scene for possible hazards and activate EMS. Put on your gloves and have a ventilation barrier ready. Inform the patient you can assist them and ask for their consent. If there is no response use the ‘tap and shout’ method to determine their level of consciousness. Firmly tap the shoulder and loudly ask, ‘Are you okay?’ Remember that if a patient doesn’t respond you can assume ‘implied consent’.

Gently roll the patient on their back on a hard surface, keeping their back in a straight line and firmly supporting the head/neck (have a bystander assist you if possible). Open the patient’s mouth with the ‘chin lift’ method by placing your thumb over the tongue and your index finger under the chin, then lifting forward.

If a blockage in the airway is visible and loose, remove it. With your other hand, do a finger sweep from one side of the throat to the other to try and dislodge the blockage. While still holding the mouth open, place your ear to the patient’s lips, then ‘look, listen and feel’ for breathing. Look to see if the chest is rising, listen for breathing and feel for breath on your ear.

Do this for approximately five seconds. If the patient is breathing, finish your primary assessment and place them in the ‘recovery position’. If breathing is absent affix your ventilation barrier, gently tilt the head back, pinch the nose closed and attempt to give two slow rescue breaths. Watch the chest to see if it rises and falls.

If you can’t deliver a rescue breath, re-position the patient’s head to open the airway, and then try again. If you are still unable to deliver breaths begin chest compressions immediately (do not check for signs of circulation).

Position yourself by the patient’s side at chest level. Locate the notch at the base of the sternum (do this by following both sides of the ribcage to the point where they meet). Place your interlocked hands about two finger widths above the notch.

Position yourself over your arms with your elbows straight and push down, compressing the chest about 1-1/2 to 2 inches. Do this 15 times at a fairly fast rate of approximately 100 compressions per minute.

Check the patient’s mouth to see if the object was dislodged, perform a finger sweep and attempt rescue breaths again. Continue this procedure until the object is dislodged or until EMS arrives.

If at any time the airway is cleared and you can give rescue breaths, check for signs of circulation (pulse) and continue CPR as necessary. If the patient begins breathing on their own, finish your primary assessment and place them in the recovery position.

Please remember, it is vital that the patient seeks medical treatment immediately since the trachea (airway) may be damaged and heart complications can arise due to the chest compressions.

This weekly column is only an introduction to emergency care skills and is designed to increase interest in First-Aid/CPR training. For information on courses please contact the Red Cross, a medical professional, or a local dive shop.