Emergency Airway Management
Managing Emergency Airway Obstructions -Choking
Have you seen someone strangle on water and a helpful friend slap them on their back as they are attempting to cough the water out of their lungs? Should you interfere if someone is successfully coughing while trying to bring something up from their lungs?
No, let them cough. They aren’t choking. Coughing is the body’s way of ridding itself of unwanted stuff from the lungs. When we cough, the lungs are open. However, the cough is a signal the airway is a risk and the body’s natural defense mechanism (the cough) was on the job.
Coughing Best Defense Against Choking
Coughing creates increased internal pressure. It forces air upward and outward, expelling what is in front of the pressure it builds on its way out. Therefore, if someone is coughing forcefully, there is no reason to intervene. Stand by in case the cough is unsuccessful in getting the obstruction freed and the person passes out.
If a severe obstruction develops and they stop breathing, you must get ready to intervene quickly. The absence of air to the brain can lead to death in 4-6 minutes. Therefore, if you ask them, “Can you speak,” and the answer is…………… (That’s silence, in case you’re wondering), then you need to read the article “Heimlich Maneuver Procedure–Conscious Adult or Child.”
A-B-C's of Emergency Airway management
When learning to provide emergency care, one of the ways we remember “what to do when” is to think of our A-B-C’s. A=Airway, B= Breathing, C=Circulation.
As you can see, airway management is a big part of that grouping. Making sure first of all that you don’t have an obstructed airway, and then clearing it using the Heimlich maneuver, takes priority. However, following close in second place is rescue breathing because if there is no oxygen to circulate, then what are we going to use to keep the body alive? All are essential functions.
The steps to how to perform these essential duties appear on this page with videos on the Emergency Response page. I hope between the two; they help you feel comfortable with the process though I encourage you to take a class in Emergency response if you have not already done so.
Emergency Airway Management - Rescue Breathing
If you discover a person lying on the group and they appear unconscious, first check to make sure they are not sleeping. Shake them and shout to see if they respond. If they do not, then follow the steps below.
- Place your fingers from one hand on their chin and the heel of your other hand on their forehead.
- Then lift the person’s chin while tilting their head back to open their airway.
- Lean in close to their mouth to listen for breathing and determine if you feel their breath on your cheek.
- If not, pinch their nose and cover their mouth with your mouth. (this is assuming you are doing respirations for your family member; not a stranger). Note: You want your lips to be somewhat loose and relaxed as you do this, so you get a good seal. If they are rigid, it won’t work as well.
- If you hear a squeak, there is an air leak. Try again. Adjust your mouth’s seal until it fits securely onto the mouth of the other person, and you can blow in enough air to see the chest rise.
- Once the chest rises, give a breath once every three-five seconds.
Resource: American Heart Association CPR Course Information https://lastingcompressions.com/
Heimlich Maneuver Procedure – Conscious Adult or Child
Initiating the Heimlich Maneuver
If an airway is blocked (obstructed), a person cannot speak. Call 9-1-1 to get help right away and begin the steps for the Heimlich maneuver.
- Standing behind the person, wrap your arms around their waist. Make a fist with one hand. Place the thumb side against the abdomen slightly above the belly button and well below the xiphoid process (tip of the breastbone). Then grasp your fist with the other hand.
(Note: If the person is pregnant or you can’t get your arms around their belly, you can put your arms under their armpits and encircle their chest doing chest thrusts instead of abdominal thrusts. In that case, set your clenched fist against the middle of the sternum avoiding the margins of the ribs.)
- Squeeze the person’s abdomen using quick inward, and upward thrusts. Each thrust should be a separate and distinct movement. Each thrust should be forceful enough to create an artificial cough that will dislodge the object.
- Continue providing thrusts until the obstruction clears or until the person passes out.
- If the person stops breathing, begin emergency respiratory breathing.
Heimlich Maneuver Procedure – Unconscious Adult or Child
- If the person becomes unconscious while you are attempting to remove the obstruction, carefully help them to the floor. If someone has not called 9-1-1 yet, make sure someone does now.
- Tilt the person’s head back to open the airway. Check for breathing and a pulse. If either is missing, begin CPR.
1 Look in the infant’s mouth to see if anything is present, but do not put your finger in the mouth.
2 Lean the infant facedown, so he/she is straddling your arm with head lower than their trunk. Rest your forearm on your thigh and deliver five back blows with the heel of your hand between the infant’s shoulder blades.
3. If that does not remove the obstruction, turn them over and supporting their head, jaw, and chest, lean the baby’s head down over your thigh and administer chest thrusts between the nipple lines on the sternum. Use only two fingers (index and middle finger) for chest compressions.
4. Repeat until the airway is clear or the infant becomes unconscious.
Emergency Response beyond Airway Management
If a choking victim becomes unconscious, they relax, and the object may fall out. However, at times, the obstruction is so tight, it won’t come out, and no air can get through. When you check for breathing, you find none–within seconds, there is no pulse. Your only choice is to start CPR or wait for the ambulance to arrive with help.
Do you know CPR?
If you have never taken a CPR class as a caregiver, I recommend that you enroll in one. I realize it’s intimidating. Truthfully, it doesn’t matter if you pass or not. What matters is that you know what you need to do.
Why? Because when an emergency happens, you need to have something you can do to help. Waiting on that ambulance to arrive seems like a lifetime. You need to have something you can do that you know can be helpful to the situation. If you know something about how to do CPR, even if you’re not good enough to pass the class, anything you can do is better than nothing. You can help both the person in need and yourself at that moment because you were able to contribute to trying to help the person survive—regardless of the outcome. So, take a class. Hopefully, you’ll never need it, but if you do, you’ll be glad you did.
I do not intend to teach CPR on this website. I will provide you a website with a video to review and a link to the American Heart Association site to take a course in CPR. However, I don’t want to give incorrect information on something so important; therefore, I’ll recommend that you learn CPR.