Overview of Choking
Choking or foreign body airway obstruction is when something, such as food, coins, or toys, gets stuck in the air passage from the mouth and nose to the windpipe or trachea. This can block the flow of air, either partially or fully. Choking usually happens to very young children or elderly people. In most cases, young children choke on food or toys, while elderly people mostly choke on food.
This kind of incident primarily affects two age groups – children between 1 to 3 years old and people over 60 years old. In 2015, it was reported that 5,051 people died because of choking. Out of these people, around 56% or 2,848 were older than 74. Choking is the fourth leading cause of accidental deaths and is the number one cause of death in infants. It’s also a leading cause of death among pre-school age children.
The most common things that children choke on are food, coins, balloons, and other toys. According to a review by the Center for Disease Control, 13% of choking incidents that were dealt with in the emergency room were related to coins and 19% were caused by candy or gum. Latex balloons are the most dangerous objects that children can swallow, accounting for 29% of choking deaths from 1972 to 1992. During the same period, hot dogs caused 17% of feeding-related choking fatalities.
In adults, especially the elderly, there is a strong link between choking and neurodegenerative diseases like dementia (including Alzheimer’s disease) and Parkinson’s disease. Reduced saliva production in older people can also contribute to choking, as it can make it harder to swallow food.
Anatomy and Physiology of Choking
When a foreign object gets stuck in your voice box or windpipe, it can be very dangerous because it may block your airway completely. Sometimes, small objects like beads or bits of food might slip past the vocal cords and stick at the point where the trachea splits into the main airways (bronchus), leading to your lungs.
In adults, the anatomy of the lungs is such that foreign objects are more commonly found in the right main bronchus. However, in children, there’s an equal chance of the object getting stuck in either the right or left bronchus. This is because, until around the age of 16, both the bronchi grow at the same rate.
Why do People Need Choking
When a medical incident occurs, it can be either witnessed or unwitnessed. If the event is witnessed, it becomes easier to identify the issue and provide immediate treatment. However, in cases where no one witnesses what happens, health professionals need to be highly alert to other signs that may indicate a problem. Unfortunately, in some cases, patients may be unable to express or explain what has happened to them.
For instance, in children, symptoms like drooling or making a high-pitched whistling sound while breathing (known as stridor), could indicate a possible health problem. In adults, symptoms to watch out for may include a sudden and intermittent cough, wheezing (a whistling sound when breathing), difficulty breathing (dyspnea), or noticing less air is inhaled/exhaled than usual.
The term “café coronary” is used to describe a situation where a person chokes on food, leading to a sudden stop of breathing, which can look similar to a heart attack. However, unlike a heart attack, a café coronary is caused by food blocking the airway, not by a problem with the heart itself.
How is Choking performed
When a child younger than 1 year old accidentally swallows a foreign object, it should be removed by giving the child five back blows alternated with five chest thrusts. This procedure involves holding the infant’s body on one arm or laying an older child across your knees. After delivering five blows between the shoulder blades, the child should be flipped over to perform five chest thrusts similiar to chest compressions.
However, the Heimlich maneuver, which involves abdominal thrusts to help clear a blockage, should not be utilized for infants under 1 year. Similarly, it is suggested to avoid the finger sweep technique, in which a finger is used to reach into the infant’s throat to remove the blockage, as it could potentially push the object further down the trachea or windpipe.
For children older than 1 year, the Heimlich maneuver may be used safely. The most effective way to perform this action is when the provider is on their knees. The provider should place a clenched fist at the level of the child’s belly button and deliver an upward thrust.
When a child loses consciousness, it signals a lack of blood flow. The first response should be to check for a pulse and then move to more advanced techniques to open up the airway. Direct examinations in the throat and removing foreign bodies with specialized tools may be necessary. If the object can be seen but not retrieved, a special kind of ventilation or artificial respiration may be required. When the object can’t be seen and ventilating the patient is possible, a procedure using a thin tube to look into the lungs may be necessary. It is important to note that children under the age of 10 should not have a surgical operation on their airways as their trachea is still developing.
What Else Should I Know About Choking?
Parents should be made aware of the risks attached to toys that have small parts which can break off, as well as coins, balloons, and cylindrical objects. Particularly with food, it’s important to ensure that it’s prepared in a way that minimizes the risk of choking. For example, cut grapes and hot dogs in half before giving them to your child. Make sure children have their molars – their back teeth – and can chew properly before you give them harder foods, like carrots.
When it comes to adults who rely on others to prepare their food, it’s important to ensure their meals are as safe as possible. This might involve cutting food into smaller pieces or making it into a puree. Changing the regularity or texture of food may help reduce the risk of choking. If anyone experiences coughing or choking while eating, drinking, or taking medicine, they might need to be tested for swallowing difficulties.
Here are a few key points to remember:
People most at risk of choking are those aged 0 to 3 and over 60. Choking is the leading cause of death among kids aged 1 to 3 years old and the fourth most common cause of accidental death overall. The objects most commonly choked on are coins and balloons. The food items most often involved in choking are hot dogs, grapes, and steak. It’s important to know that performing the Heimlich maneuver – the standard first aid response to choking – isn’t recommended for children less than 1 year old. To prevent choking, parents need to take care with risky toys, cut round foods in half, and for older people, puree or cut their food into small pieces.
