Choking is a common but seldom deadly affliction.  It is however concerning enough to warrant a good familiarization with its treatment.

Choking is also known as foreign body airway obstruction.  Food items are a very common cause of choking but it is also possible to choke on debris after a fall or other objects. 

Choking can be divided into three categories or presentations.  The choking person can present as follows:

1. Partial obstruction with adequate air passage- This person has an object partially obstructing their airway and is generally coughing forcefully in order to dislodge the obstruction.  The airway for this patient is often open enough to allow speech and the person may actually be stating "Im choking". 

The intervention for this presentation is observation and encouragement to continue to cough. They should be observed until the obstruction is dislodged and they return to normal.  It is important to not allow this person to seek privacy in a bathroom or other place as in rare cases the obstruction can become worse. 

2.Responsive patient with a full obstruction- A person who has a fully blocked airway and is responsive only has a few minutes to resolve the problem.  This patient is going to be found making little to no sounds as there is not sufficient air passing through the vocal cords.  As the realization of the situation becomes more clear the patient is likely to begin pacing and becoming very anxious. 

Intervention for the responsive patient with a full obstruction is abdominal thrusts.  Also known as the Heimlich Maneuver, the abdominal thrusts are intended to increase pressure within the chest cavity forcing air up the airway hopefully forcing the obstruction upward into the mouth. If your patient is pregnant or so much larger than you that you are unable to encircle their abdomen with your arms standing chest compressions can be attempted.  Abdominal thrusts should be continued until the object is dislodged and the patient regains a patent airway or they become unresponsive. 

3. Unresponsive patient with a full obstruction- The person with a fully obstructed airway who is unresponsive may become so during abdominal thrusts becoming heavy in your arms then be lowered to the ground.  The person may also be found unresponsive on the ground.  If found unresponsive it may not be clear that choking is the problem. 

Fortunately the intervention for the unresponsive victim of choking is Cardiopulmonary Resuscitation (CPR).  CPR should be started for patients found unresponsive, not breathing and pulseless which is very likely for the choking person who was not witnessed to be responsive and choking. CPR will be covered in depth in the section: Treating Cardiac Arrest.  Keep in mind that it is not necessary to check for a pulse for a patient who becomes unresponsive during abdominal thrusts.  CPR should be started immediately.   While it may seem wrong CPR should be started including both chest compressions and ventilations (breaths).  The chest compressions are intended to increase chest pressures forcing the object upward.  The ventilations are intended to pass air, under pressure past the object and/or force it downward.  While under normal circumstances a foreign body in the lungs is sub-optimal in the case of unresponsive choking persons it may allow for oxygenation of the opposite lung and prevent death.  It is however important to check the mouth prior to providing ventilations and remove any visible object.  Blindly digging, probing and feeling for an object is not recommended. 

Infant choking. While adult and child treatments for  choking are very similar the infant patient requires alternative techniques.  The three presentation of FBAO are the same.  Infants presenting with a partial obstruction should be held in such a way as to facilitate easy exiting of the object.  Infants presenting responsive with a full blockage require back slaps  and chest thrusts.  Infants presenting unresponsive with a full blockage require Infant appropriate CPR 

Check back again for information regarding treating choking for advanced providers.