Foreign-Body Airway Obstruction (FBAO)

Choking or foreign body airway obstruction is a true medical emergency that if not quickly resolved will likely cause the person to suffer respiratory and cardiac arrest. It can occur from a multitude of causes, but the most common airway obstruction is caused by food in a conscious person and the tongue in unconscious victims.

Remember; a person will suffer brain damage when they are deprived of oxygen for as little as three to four minutes and will be clinically dead in six minutes. Therefore, the chain of survival is very important for the treatment of choking victims.

It is common for a conscious choking victim to grasp their necks with both hands when they realize they are choking and can't dislodge it themselves. The victims will have a look of terror on their face and often panic. Panicking makes them hard to manage. If the victim is flailing around and not cooperating with your commands, make sure you are stern but polite. Don't panic yourself a choking victim is very manageable if you take control of the situation and follow your training.

Always introduce yourself and ask permission to help anytime a victim is conscious enough to give you consent. Never assume the victim is choking just because it appears they are; always ask the potential victim.

"My name is _________ and I am
trained to help. Are you choking"?

"The Universal Sign for Choking"

Keeping that in mind, we will begin with"

Conscious Choking Adult (FBAO Adult)

Foreign-Body Airway Obstruction/Partial Occlusion

A conscious adult with a partially blocked airway will be able to breathe somewhat through the obstruction. This will be evident with wheezing or a high-pitched squealing sound. If the victim is able to move air at all, it is important to encourage them to cough as forcefully as possible. This will dislodge the obstruction and, in many cases, instantly end the crisis.

Foreign-Body Airway Obstruction/Complete Occlusion

Conscious adults/children with a completely blocked airway caused by a foreign body such as food are not able to move air in or out of their lungs at all. This is a true medical emergency that will become life-threatening very quickly if it isn't properly resolved within a couple of minutes. In this situation, it is imperative to initiate back blows and abdominal thrusts (the Heimlich maneuver) as quickly as possible after asking them if they are choking.

Remember: If the victim can answer you, a complete obstruction is not likely present. If they can't or don't answer you and show signs that no air is moving in and out of their lungs, a complete airway obstruction is most likely present and the victim must be treated accordingly.

Back Blows:

Back blows are suggested for use initially in adults and children with a foreign body airway obstruction. Back blows, also known as backslaps, are a first aid technique that can help dislodge a blockage from someone's airway. The force of the blows should be relative to the person's size and your own strength.

• 1. Stand to the side and behind the victim.
• 2. Place your arm across the person's chest to support their body.
• 3. Bend the person over at the waist to face the ground.
• 4. Deliver five back blows between their shoulder blades with the heel of your hand.
• 5. Check if the blockage has been removed after each blow.
  

If back blows don't dislodge the blockage, move to abdominal thrusts, also known as the Heimlich maneuver

Procedures for abdominal thrusts (the Heimlich maneuver):

• 1. For an adult or child who is tall enough, stand behind the choking victim. For a smaller child, kneel down on one knee behind them, while reassuring them. (Infant FBAO will be discussed separately.)
• 2. Make a fist with one-hand and place the thumb side of that hand down into the victim's abdomen just above their "belly-button" (umbilicus).
  (Make sure that your fist is not touching the victims lower rib cage to prevent unintentional injury.)
  
• 3. Deliver 5 forceful, yet gentle (not jerking or jabbing), inward and upward abdominal thrusts, all in one-smooth-fluid motion.
  
• 4. Continue with cycles of 5 back blows and 5 abdominal thrusts until the blockage dislodges, help arrives, or the victim becomes unresponsive. (Unconscious adult FBAO instructions to follow.)

If the victim is too large for you to get your arms around them effectively:

• 1. Have a conscious choking victim stand against the nearest stable wall.
• 2. Make a fist and place the pinky (lateral) side of that fist directly above the victim's "belly button" (umbilicus).
  (Ensure that your hand doesn't touch the rib cage before delivering abdominal thrusts as this could cause significant rib cage injury/fracture.)
• 3. Place your second-hand over top of the fisted hand against the victim's abdomen.
• 4. Deliver inward abdominal thrusts by pushing straight inward (not inward and upward), until the foreign body is expelled or the victim loses consciousness.

The only unfortunate aspect of this maneuver is there is a good possibility that the stuck object may end up landing on you after it exits. We can all agree that this is a small price to pay to save a life.

Pregnant Victims with a Foreign-Body Airway Obstruction (FBAO)

• 1. Stand behind the pregnant victim and deliver 5 back blows.
• 2. Place your arms under the victim's arm pit area and wrap your arms around their chest.
• 3. Make a fist with one hand and place the thumb side of that hand in the center of their chest (sternum).
• 4. Grab the fisted hand with the opposite hand and deliver 5 inward chest thrusts.
• 5. Deliver gentle, yet forceful back blows and chest thrusts until the foreign material becomes dislodged or the victim loses consciousness.
  (Unconscious pregnant FBAO instructions to follow.)

Being Alone and Choking

If you are alone and find yourself suffering from a foreign body airway obstruction, it is possible for you to relieve the obstruction yourself. The first and most important thing to remember is to not panic! You must remain calm and conscious to effectively help yourself!

• 1. You can attempt to relieve the airway obstruction by self-administering the same abdominal thrusts you would give to a conscious choking victim. Make a fist with one hand and place the thumb side of that hand down into your abdomen just above your "belly-button" (umbilicus).
  (Make sure that your fist is not touching the lower rib cage to prevent unintentional injury.)
  
• 2. Deliver forceful, yet gentle (not jerking or jabbing), inward and upward abdominal thrusts, all in one-smooth-fluid motion until the obstruction is relieved.

  OR

• 3. Bend over a solid object such as the back of a chair, a railing, or a kitchen sink corner and repeatedly and forcefully press the object into your abdomen as if it were delivering abdominal thrusts.
  (Make sure the object isn't sharp to avoid unintentional injury.)
  

Unconscious Foreign-Body Airway Obstruction

It is appropriate to attempt to deliver two rescue breaths to a victim who is found to be unconscious before delivering chest compressions when they are suspected of sustaining a foreign-body airway obstruction. If the rescue breaths fail to cause the victim's chest to rise and fall adequately, then immediate chest compressions are indicated.

Use the same technique for unconscious choking victims as you would for victims of cardiac arrest.

• 1. Quickly position the victim so they are lying flat on their back (supine position).
  (The victim should be positioned on a hard stable surface, not a bed or sofa.)
• 2. Position your body on either side of the victim in the area of their upper chest.
• 3. Locate the proper hand position by placing the heel of one hand on the center of the victim's sternum (breastbone). The heel of your hand will be on the imaginary line between the nipples. If you feel the "notch" (xiphoid process) at the bottom of the sternum, you should move your hand up about two finger widths so that the heel of your hand is centered on the sternum. Place your other hand directly over the first hand. (Try to keep your fingertips off the chest by interlacing them or holding them upward.)
  
• 4. Position your body so that your shoulders are directly above your hands and the victim's chest. Keep your arms straight for consistently powerful compressions. This position helps you to deliver smooth straight-down compressions and helps prevent early rescuer fatigue.
  
• 5. Deliver "fast-n-hard" chest compressions at a rate of 100 to 120 per minute for adult and child choking victims.

  The proper chest compression depth for adults is between 2 and 2.4 inches(5 to 6 cm) and for children between 1.5 and 2 inches (4 to 5 cm). (Infant airway obstruction is discussed separately.)

  Compressions that are too shallow will not effectively dislodge the foreign body airway obstruction. Compressions that are administered too deeply can cause rib fractures and damage the victim's heart.

• 6. Do not remove your hands from their chest between compressions. This practice keeps the hands in the proper position and allows you to feel when the chest fully recoils.
• 7. After completing the first 30 chest compressions (about 15-17seconds), open the victim's airway by using the head tilt/chin lift maneuver, as long as spinal trauma is not suspected.
• 8. With the victim flat on their back, place one hand on their forehead and other hand underneath their chin. Gently push down on the forehead while lifting the chin to effectively open the victim's airway. Avoid lifting on the chin too hard as this can close the mouth or cause unintentional injury.
  
• 9. Open the victim's mouth and look for any expelled material before opening their airway. If material is present, remove the material with one-finger. If nothing is visible and the airway is properly opened, pinch the victim's nose and attempt to deliver a rescue-breath through the replaced barrier device. Each rescue breath should take about one second to deliver and cause the chest to visibly rise and subsequently fall if the breaths are getting in and being exhaled.
  
• 10. Continue cycles of 30 chest compressions followed by 2 rescue breaths until:
  • The foreign-body is removed or expelled and the victim is clearly breathing on their own.
  • An EMS crew or higher-trained first-responder takes over care of the victim.
  • You are too physically exhausted to continue care safely.
  • It becomes too unsafe to continue care at the present location.
  
• 11. If the foreign-body-airway-obstruction is cleared and the victim is breathing on their own but remains unconscious, place the victim in the recovery position and monitor them closely until an EMS crew arrives to take over the care of the victim.

Choking Infant (FBAO-Infant)

Infants haven't completed mastered the technique of swallowing, and they place everything they can grasp into their mouths as early as two-months-old. Therefore, an airway obstruction should be suspected anytime an otherwise healthy infant suddenly can not breath. If they can cry or make any verbal noise, a complete occlusion is unlikely, and they should be monitored closely while awaiting EMS arrival. If they are completely silent and have no obvious chest rise, a complete occlusion is most likely.

When a complete occlusion is present, but the infant remains conscious:

• 1. Quickly and firmly hold the infant face down (prone), laying the infants chest on your forearm and supporting their head with your hand.
• 2. Position the infant so that their head is slightly pointed downward and deliver five well-placed back blows.
  (Back-blows should be delivered between the victim's shoulder blades with a flat hand.)

If the occlusion fails to clear after five back-blows:

• 3. Quickly turn the infant over onto their back (supine) while supporting their head.
• 4. Deliver five chest thrusts (compressions) in the center of the infants chest, using only two or three fingers of your prominent hand.
  

If the occlusion fails to clear after five chest thrusts:

• 5. Repeat steps 1 and 2 followed by steps 3 and 4 until the occlusion is clear or the infant becomes unconscious/unresponsive or EMS arrives and takes over the care of the infant.

If the infant becomes unconscious/unresponsive before the occlusion is cleared:

• 6. Immediately begin infant CPR. In addition: After every 30th compression, inspect the infants mouth for the presence of foreign material before opening the airway and attempting to deliver two rescue-breaths.
  (If foreign material is visible in the infant's mouth, gentle scoop it out with one or two fingers-never administer blind finger sweeps of the infants mouth.)
  
• 7. Continue delivering 30 chest compressions followed by airway inspection and 2 rescue breath attempts. (If the chest doesn't rise when rescue breaths are delivered, then re-position the infant�s head/airway and re-attempt the rescue-breath.)
  

Congratulations!

You have completed the choking training material. If you are comfortable with this material, please proceed to the AED training. If you are unclear on any topics, please review them before proceeding.

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