First Aid for Choking: Dealing with Mild and Severe Airway Obstructions

Choking is a life-threatening situation where the airway is blocked, preventing normal breathing. Choking can be divided into two main categories: mild choking and severe choking.

Mild Choking

Mild choking occurs when there is a blockage in the throat, but air can still pass through. The person may cough, breathe heavily, and show signs of distress, but they are able to make noise, cough, or even talk.

Example: A fishbone caught in the throat.

Procedure for Mild Choking

• Try to calm the person and encourage them to cough to expel the object.
• If the object is not expelled, seek medical help immediately and call emergency services (EMS).

Severe Choking (Severe Airway Obstruction)

Severe choking occurs when there is a complete blockage in the throat, preventing any air from passing through. This is a critical condition and requires immediate action.

For example, a person may eat a large piece of food, such as steak, that gets stuck in their throat, particularly when eating quickly, laughing, or talking while eating.

Signs of Severe Choking

• Inability to cough or make any noise
• Severe distress
• They may lose consciousness within a minute if not treated
• The universal sign of choking is the casualty placing their hands on their throat

Procedure for Severe Choking

Step 1: Check for Consent

Approach the person and ask, "Are you choking?" If they can respond verbally, it is not a severe obstruction. However, if they cannot speak, they may nod or use hand gestures to indicate distress and give their non-verbal consent for help.

Step 2: Perform Back Slaps and Abdominal Thrusts

Two key procedures must be performed to help dislodge the obstruction:

Back Slaps

1. Stand behind the person and place one arm around their waist to support them if they lose consciousness.
2. Using the heel of your other hand, deliver five back slaps between their shoulder blades.
3. After each slap, quickly check if the obstruction has been dislodged.

Abdominal Thrusts

1. If the back slaps do not work, perform five abdominal thrusts (also known as the Heimlich manoeuvre).
2. Place the thumb side of your fist just above the belly button and below the ribcage.
3. Place your other hand over the top of your fist and deliver five upward and inward thrusts.
4. After each thrust, check if the object has been expelled.

Continue alternating between five back slaps and five abdominal thrusts until the obstruction is removed or the person becomes unconscious.

Step 3: If the Obstruction is Removed

• Allow the person to breathe and rest.
• Seek medical attention, as abdominal thrusts can cause internal injuries.

Step 4: If the Person Becomes Unconscious

• Activate emergency services (EMS) if not already done so.
• Begin CPR at the chest compression stage. CPR may help expel the object by forcing trapped air out of the lungs.

Choking in Pregnant Women

If the person choking is pregnant, you should not perform abdominal thrusts. Instead, perform chest thrusts, targeting the area where CPR compressions are given—at the centre of the breastbone.