Just a choke
An octogenarian had a series of coughing fits that caught my sibling’s attention and the people in the restaurant. Thankfully, there was no need for her to be rushed to the emergency room, but the experience was an eye-opener. What do you do when faced with such a situation?
According to the National Safety Council in the United States, choking is the fourth leading cause of unintentional deaths. Identified risk factors include age, with children younger than 3 years and adults aged above 60 being the most affected, including individuals with neurologic conditions that impair their ability to swallow or those with dental issues.
In the elderly, food is almost always the offending agent, while in children, the likely hazards are usually coins, toys, batteries, balloons, and, for food, hot dogs.
Immediate recognition is lifesaving, especially in unwitnessed events. Symptoms may include coughing, stridor, difficulty breathing, cyanosis, and, in children, drooling. In cases of complete obstruction of the airway, one is unable to speak, and a most helpful sign that can indicate that you are choking is to place your hands on your throat.
The American Red Cross recommends that for both adults and children who are choking and conscious, one can initially deliver back blows and follow through with the Heimlich maneuver, also called abdominal thrusts, if those are unsuccessful. Alternate with five back blows and five thrusts until the obstruction is dislodged. For back blows, stand to the side and slightly behind the patient, place an arm diagonally across the chest and bend the patient forward at the waist. Using the heel of your hand, strike between the shoulder blades five times. For the Heimlich maneuver, place the choking person in an upright position. Make a fist and place it above the navel of the patient, grasping the fist with the other hand and pulling inward and upward. It is important to remember that this maneuver is not to be used for children less than one year old.
In the event that a person is able to forcefully cough out the object, encourage them to do so, but be prepared to assist. Never perform blind finger sweeps as they can dislodge the item farther down the airway. If you happen to choke while alone, bend forward against a firm object, like the back of a chair, and perform abdominal thrusts. Keep in mind that while these, in general, are steps to be followed, there are certain situations that may alter how one carries them out.
Safety precautions are best observed and adhered to in order to prevent choking incidents. While age has been mentioned as a risk factor, certain food items may also pose a risk. In general, nuts, seeds, and dried fruits are to be avoided in children less than four years of age. Hard gelatin, which can be slippery, round items such as hard candies or vegetables cut cylindrically, and sticky food such as peanut butter have been identified as potential choking hazards. Nonfood items such as toys with small parts or those that smell like or look like food should also be kept out of reach.
Children model what adults do. Be their example for good table manners. Avoid speaking or laughing with your mouth full, and practice mindful chewing before swallowing. Finish your meal while staying in place and avoid having gadgets on the table that could serve as distractions. Unfortunately, this is a common sight wherever we go. Never drink or eat while lying down.
Children should also be instructed not to take in food that is too big for them to swallow, and that it is fine to spit out seeds or pieces of bone. For parents or caregivers, cut food like meat into small, bite-sized pieces, and fruits or vegetables like grapes or tomatoes lengthwise.
These precautionary rules are also applicable to the elderly, who are at increased risk because of decreased saliva production and the presence of dentures that can impair oral sensitivity. Make sure that they are a proper fit. For adults, it is important to be reminded to avoid excessive intoxication, which can impair motor and sensory coordination. Embedded in history are some prominent figures who have died from aspiration of their own vomitus.
Given the dangers that may arise from choking, it would be prudent to review our current home, work, and school environment to ensure that these incidents do not occur. Supervise meals and keep a close watch. Do not be complacent when attending to children and the elderly, as it can be costly. Avoid multitasking when eating. Mealtimes are to be respected and should provide a relaxed space for meaningful interactions.
Last but not least, knowing how to perform first aid will always come in handy. Take time to review, and even better, practice. While these may all sound like common sense, these skills go a long way in helping save a life.
Choking is never a joke.
