Brief Summary
This video provides a comprehensive guide on how to recognise and respond to choking emergencies in adults, children, and infants. It covers techniques like back blows, abdominal thrusts (Heimlich manoeuvre), and chest thrusts, with modifications for pregnant women and infants. The video also details CPR procedures, including chest compressions and rescue breaths, tailored for different age groups and scenarios, emphasising the importance of quick action and proper technique.
- Recognising choking signs and severity
- Performing appropriate first aid techniques for adults, children and infants
- Adapting techniques for specific situations, such as pregnancy
- Understanding CPR procedures and modifications for different age groups
Choking Emergency: Recognition and Initial Response
Choking is a life-threatening emergency requiring swift action. It occurs when a foreign object obstructs the airway, either partially or completely. Signs of partial obstruction include coughing or difficulty speaking, while complete obstruction prevents speech or coughing, often accompanied by cyanosis (blue skin) due to lack of oxygen.
First Aid for Adults and Children Over One Year
For adults and children over one year, encourage coughing if they can still breathe. In cases of complete obstruction, administer five back blows between the shoulder blades, followed by five abdominal thrusts (Heimlich manoeuvre). To perform abdominal thrusts, stand behind the person, place your fist above their navel, and thrust upwards and inwards to dislodge the object.
First Aid for Infants Under One Year
For infants under one year, support the infant face down on your forearm and deliver five back blows. Then, turn the infant over and perform five chest thrusts using two fingers. This technique is safer for their delicate anatomy.
CPR and Post-Choking Care
If the patient becomes unresponsive, start CPR immediately. After every 30 chest compressions, check the airway for obstruction before giving rescue breaths. Avoid blind finger sweeps, as they can worsen the situation. Always seek medical evaluation after clearing the obstruction, as choking can cause complications like airway swelling or internal injury.
Scenario: 6-Year-Old Choking on Candy
A 6-year-old child choking on candy is unable to speak or cough, indicating a complete obstruction. After delivering five back blows without success, five abdominal thrusts dislodge the candy. The child is then comforted and checked by a medical professional to rule out complications.
Scenario and Treatment of Mild Airway Obstruction
A 40-year-old man at a dinner party begins coughing after swallowing steak, clutching his throat but still able to cough and speak in short phrases, indicating a mild airway obstruction. The treatment involves encouraging forceful coughing, reassuring the person, and monitoring for worsening conditions. Physical intervention is avoided unless the condition deteriorates.
Cautions and Outcome for Mild Airway Obstruction
Back blows or abdominal thrusts should not be performed for mild obstructions, as they could force the object deeper. Blind finger sweeps are also discouraged. After a few seconds of forceful coughing, the man dislodges the steak and breathes normally. Medical advice is suggested due to throat discomfort.
Scenario and Treatment for Severe Airway Obstruction
A seven-year-old child swallows a marble, causing a complete airway blockage, indicated by inability to cough, speak, or breathe, along with cyanosis. Treatment involves confirming the severe obstruction and performing alternating back blows and abdominal thrusts until the object is expelled or the child becomes unresponsive.
Treatment for Severe Airway Obstruction in Infants
For infants under one year, support the infant face down along your forearm and deliver five back blows between the shoulder blades. Then, turn the infant face up and deliver five chest thrusts using two fingers. Alternate between back blows and chest thrusts until the object is expelled or the infant becomes unresponsive.
CPR and Cautions for Severe Airway Obstruction
If the patient becomes unresponsive, begin CPR immediately, delivering 30 chest compressions and checking the airway for the object. Attempt rescue breaths, and if the chest does not rise, recheck the airway and continue CPR until professional help arrives. Avoid blind finger sweeps and abdominal thrusts on infants.
Outcome of Severe Airway Obstruction Scenario
After three cycles of back blows and abdominal thrusts, the marble is dislodged, and the child begins coughing and breathing again. The child's breathing is monitored, and medical attention is sought to confirm no further complications.
Scenario and Treatment: Managing a Choking Pregnant Woman
A pregnant woman chokes on bread, showing signs of complete airway obstruction. Abdominal thrusts are avoided due to the risk to the baby; instead, chest thrusts are performed. If she becomes unresponsive, CPR is initiated, focusing on chest compressions, and emergency services are called.
Cautions and Outcome for Choking Pregnant Woman
Abdominal thrusts should not be attempted on pregnant individuals, and blind finger sweeps are avoided. Extra vigilance is needed to ensure the woman's oxygenation. After three chest thrusts, the bread is dislodged, and the woman begins breathing normally. Medical professionals evaluate both her and the baby for any complications.
Steps for Managing a Choking Infant
Assess the infant's condition, looking for signs of severe obstruction such as cyanosis and distress. Position the infant face down along your forearm, head lower than chest, and deliver five back blows between the shoulder blades. Turn the infant face up and perform five chest thrusts using two fingers.
Continuing Treatment and Seeking Help for Choking Infant
If the object is not expelled, continue alternating five back blows and five chest thrusts. If the infant becomes unresponsive, begin CPR immediately, performing 30 chest compressions. Open the airway, look for the object, and attempt rescue breaths. Call emergency services even if the object is successfully dislodged.
Summary of Choking Management in Infants
Choking in infants requires swift and precise action. Recognise the signs, position the infant correctly, deliver back blows and chest thrusts, and if necessary, begin CPR. Always seek medical evaluation to rule out complications.
Clearing the Airway of an Unconscious Patient
When an unconscious patient struggles to breathe, ensure their airway is clear. Use the head tilt chin lift technique, unless a spinal injury is suspected, in which case use the jaw thrust maneuver. Check for visible obstructions and remove them carefully.
Cautions and Considerations for Airway Management
Avoid the head tilt chin lift method on patients with suspected spinal injuries. Do not perform a finger sweep while the patient is lying on their back; turn them on their side first. Ensure proper precautions are taken while clearing the airway, preventing matter from falling back into the airway.
Questionnaire Reminder
Complete the questionnaires in your notebook to deepen your understanding of the material and apply first aid concepts in real-life situations. Review your answers and identify key areas for improvement.
True or False: Choking and Airway Management Questions 1-3
- A person with a partial airway obstruction should be encouraged to cough if they are still able to breathe (True).
- The universal choking sign is when a person places their hands on their stomach (False, it's on their throat).
- If someone has a complete airway obstruction and cannot cough or speak, you should immediately begin back blows and abdominal thrusts (True).
True or False: Choking and Airway Management Questions 4-6
- Abdominal thrusts should always be used for choking infants under one year old (False, use back blows and chest thrusts).
- For a choking infant, you should first place them face down along your forearm and deliver five back blows (True).
- If a choking person becomes unresponsive, you should begin CPR immediately (True).
True or False: Choking and Airway Management Questions 7-10
- The head tilt chin lift technique should always be used to open an unconscious person's airway, even if a spinal injury is suspected (False, use jaw thrust).
- Performing a blind finger sweep in a choking victim's mouth is the best way to clear an airway obstruction (False, it may push the object deeper).
- After successfully removing an airway obstruction, medical evaluation is still recommended (True).
- If a person is unresponsive and has vomit or blood blocking their airway, you should roll them onto their side before attempting to clear it (True).
CPR Definition and Key Acronyms
CPR (cardiopulmonary resuscitation) is an emergency procedure combining chest compressions and rescue breaths to restore blood circulation and breathing. Without oxygen, the brain starts to suffer damage within 4 to 6 minutes, leading to cardiac arrest and potentially biological death.
CPR Notes and Good Practices
Performing CPR might cause minor harm like broken ribs, but the alternative is far worse. Start chest compressions immediately after confirming the patient isn't breathing. Combine chest compressions with rescue breaths whenever possible, especially for children. Switch with another trained rescuer if you're getting tired.
Positioning for CPR
Move the patient onto a firm, flat surface and lay them flat on their back with their arms at their sides. Ensure their head is positioned to maintain an open airway using the head tilt chin lift technique (unless a spinal injury is suspected, then use the jaw thrust maneuver). Kneel beside the patient so that your shoulders are directly over their chest.
Calling for Help Before Starting CPR
If you're alone, dial emergency services yourself and put the phone on speaker. If others are present, instruct someone to call EMS. Early intervention is key to increasing survival rates.
Hands Ready for Chest Compressions
Locate the compression point by tracing an imaginary line between the nipples and placing the heel of one hand on the sternum at the centre of this line. Place your other hand on top of the first and interlock your fingers. Maintain proper form with shoulders directly above your hands and elbows locked.
Chest Compressions: Adults, Children, and Infants
For adults, use both hands to compress the chest 5 to 6 cm at a rate of 30 compressions followed by two rescue breaths. For children (ages 1 to 8), use one hand (or both if the child is larger) and compress to about 1/3 of the chest's depth, using a 15:2 ratio when two rescuers are present. For infants (under one year), use two fingers to compress to a depth of about 1/3 of the chest's diameter, also at a 15:2 ratio with two rescuers.
CPR as a Single Rescuer
As a single rescuer, place the heel of your hand on the sternum, interlock your fingers, and begin compressions at a rate of 100-120 per minute. For every 30 compressions, give two rescue breaths. Continue CPR until help arrives, the patient shows signs of life, or you're too exhausted to continue.
Persistence in CPR Despite No Visible Recovery
Even if there are no visible signs of recovery, continue CPR unless the patient regains signs of life, professional help arrives, or you become physically unable to continue. Every attempt at CPR matters.
Adult CPR for the Single Healthcare Professional Rescuer
The healthcare professional ensures the scene is safe, puts on gloves, and uses a rescue mask with a one-way valve. They check for responsiveness by calling out to the victim and tapping on the collar bone. If there is no response, they activate EMS and check for normal breathing and a carotid pulse for no more than 10 seconds. If the patient is not breathing normally and has no pulse, CPR is initiated with 30 chest compressions to two rescue breaths.
Real-Time CPR Scenario with a Single Rescuer
A person finds someone not breathing and calls for help. A first aider responds and assesses the situation, calling emergency services and requesting an AED. Chest compressions are performed, and after the AED arrives, its instructions are followed to deliver a shock and continue CPR.
Adult Basic Life Support Algorithm for Healthcare Providers
Ensure the scene is safe, check for responsiveness, shout for help, and activate the emergency response system. Check for normal breathing and a pulse for no more than 10 seconds. If there's no normal breathing but a pulse is felt, provide rescue breathing. If there's no breathing or pulse, begin CPR immediately, using an AED as soon as it's available.
Two-Rescuer CPR Dynamics
With two trained rescuers, one kneels at the patient's head while the other positions themselves at the chest. The chest rescuer begins compressions, and after 30 compressions, the head rescuer delivers two breaths. Switch roles every five cycles to prevent fatigue, maintaining consistent compressions and oxygen delivery.
Two-Rescuer Adult CPR for Healthcare Professionals
With two trained rescuers, responsibilities are shared to prevent fatigue. After assessing the patient and finding no normal breathing or pulse, one rescuer begins chest compressions while the other provides rescue breaths using a bag valve mask. They coordinate a switch every two minutes to ensure no one is doing more than 2 minutes of CPR compressions at a time.
CPR on a Child: Key Adjustments
When performing CPR on a child, use one hand for compressions (or both for larger children), compressing the chest to about 1/3 to 1/2 of its depth. Maintain the same rate as for adults (100-120 compressions per minute). If working alone, use the standard 30:2 ratio; with a second rescuer, switch to 15:2.
One-Rescuer Child CPR for Healthcare Providers
The healthcare provider ensures the scene is safe, checks the child's responsiveness, and activates EMS. They assess for normal breathing and a cored pulse for no more than 10 seconds. If the child is not breathing and has no pulse, CPR is initiated with 30 compressions to two rescue breaths, compressing the chest one-third of its depth.
CPR on an Infant: Precision and Technique
Check the infant's responsiveness, check for a pulse on the brachial artery, and if no pulse is felt, start CPR. Place your index and middle fingers on the center of the chest below the nipple line and compress to about 1/3 to 1/2 the chest depth, maintaining 100-120 compressions per minute. Use a 30:2 ratio alone or a 15:2 ratio with a second rescuer.
Airway Management and Rescue Breaths for Infants
Keep the infant's head in a neutral or sniffing position, avoiding over-tilting. Cover both the nose and mouth with your mouth and gently blow until the chest rises, then allow it to fall before giving the next breath. Continue CPR cycles until the infant shows signs of life or emergency medical services arrive.
One-Rescuer Infant CPR for Healthcare Professionals
The healthcare professional ensures the scene is safe, checks the infant's responsiveness, and activates EMS. They check for breathing and a brachial pulse for no more than 10 seconds. If there is no normal breathing and no pulse, they draw an imaginary line across the nipples and drop two fingers down on the lower third of the sternum to begin compressions.
Pediatric Basic Life Support Algorithm for Healthcare Providers (Single Rescuer)
Ensure the scene is safe, check for responsiveness, and shout for help. Check for breathing and pulse simultaneously. If there's normal breathing and a pulse, monitor the child. If there's no normal breathing but a pulse is present, provide rescue breathing. If there's no breathing or pulse, start CPR immediately, using an AED as soon as available.
Pediatric Basic Life Support Algorithm for Two or More Rescuers
Ensure the scene is safe, check for responsiveness, and have one rescuer activate the emergency response system while the other stays with the child. Check for breathing and pulse simultaneously. If there's no normal breathing but a pulse is present, provide rescue breathing. If there's no breathing or pulse, start CPR immediately, switching to a 15:2 compression-to-breath ratio once the second rescuer returns.
Critical Notes for Effective CPR
Start CPR immediately after confirming the patient is unresponsive and not breathing. CPR may cause minor injuries, but these are outweighed by the need to save the patient's life. Always check for visible obstructions in the airway before starting rescue breaths. For children and infants, it's crucial to deliver both compressions and breaths.
Best Practices for Effective CPR
Maintain proper compression depth, ensure the chest fully recoils after each compression, and keep a steady compression rate of 100-120 per minute. Focus on correct hand placement, minimise interruptions between compressions and rescue breaths, and switch rescuers every five cycles to avoid fatigue.
Hands-Only CPR: When and How
Hands-only CPR is a vital technique for situations where providing rescue breaths isn't possible. It's particularly effective in adult sudden cardiac arrest, focusing solely on chest compressions to maintain circulation. While less effective for children and infants, it's encouraged if a rescuer is unable or unwilling to perform rescue breaths.
Questionnaire Reminder
Complete the questionnaires in your notebook to deepen your understanding of the material and apply first aid concepts in real-life situations. Review your answers and identify key areas for improvement.
True or False: CPR Questionnaire with Explanations (Questions 1-3)
- Chest compressions should be performed at a rate of 60 compressions per minute (False, it should be 100-120).
- You should start CPR immediately after confirming the patient is unresponsive and not breathing (True).
- For adult CPR, compressions should be 5 to 6 cm deep (True).
True or False: CPR Questionnaire with Explanations (Questions 4-6)
- Rescue breaths are always necessary during hands-only CPR (False).
- It's okay to stop CPR once you get tired, even if no one else can take over (False).
- When performing CPR on an infant, use two fingers to compress the chest (True).
True or False: CPR Questionnaire with Explanations (Questions 7-10)
- An AED can be used by anyone, even without prior training (True).
- For children, CPR compressions should compress the chest to about 1/3 to 1/2 its depth (True).
- After delivering a shock with an AED, you should immediately resume CPR (True).
- CPR is less effective for children and infants if you don't include rescue breaths (True).
