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Sea Sick: Quick, someone’s choking! What do you do?

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Sea Sick: by Keith Murray

You are having lunch with a crew mate, talking about the busy schedule for the day, and suddenly he stands up and looks directly at you. He looks scared and does not appear to be breathing. What can you do to help?

Choking, or foreign body airway obstruction, is caused by inhalation of a foreign object that partially or fully blocks the airway. If the airway is not cleared quickly, the victim will likely die.

Choking often happens with adults in restaurants or at dinner parties where the victim is eating, maybe having a few alcoholic beverages, laughing and having a good time. The combination of food, talking, laughter and a few cocktails can be deadly if food accidentally becomes lodged in the airway.

Also, beware of the bathroom, as this is the worst place for a choking person. Sensing there is something stuck in their throat, the victim often leaves the dinner table thinking they might throw up. This is a big mistake. They need help, and without quick action they could die.  If you see someone who appears to be choking heading to the restroom, it is wise to ask if assistance is needed.

Assistance is performed with the Heimlich maneuver. Henry Heimlich was a thoracic surgeon at Jewish Hospital in Cincinnati. At the time, back slaps were thought to be the best treatment for choking. But Heimlich condemned back slaps, calling them “death blows.” Back slaps could force the obstruction deeper into the throat, whereas the abdominal thrusts he advocated could only force the object out.

If you have ever been punched in the stomach and had the wind knocked out of you, then you understand what we are trying to accomplish here.  We are literally trying to knock the wind (and lodged food) out of the choking victim. Exerting pressure on the bottom of the diaphragm compresses the lungs, which exerts pressure on the object lodged in the trachea.

While the Heimlich maneuver, as outlined in the list at the end of the article, is the standard treatment for a choking victim, some circumstances call for adaptations.

Pregnant women

Performing the Heimlich on a pregnant woman is different, since abdominal  thrusts on the mother’s stomach could injure the unborn child. To help a choking pregnant woman your hands must be above the belly, on the sternum – the flat bone in the center of the chest between the nipples. You are squeezing the victim’s chest, trying to squeeze the lungs, which should hopefully push out whatever is caught in the airway.

Men who look pregnant

Although this sounds funny, a lot of men have big beer bellies. This often means you can’t wrap your arms around their midsection. If the victim has more belly than you have arm span, move your hands up to the victim’s sternum and administer the Heimlich just as you would for a pregnant woman.

When infants are choking

Unintentional choking and suffocation is the leading cause of death for infants, which according to the American Heart Association, is any patient less than 1 year old. Treatment for a choking baby is different from treatment for children over the age of 1 and adults. We do not perform abdominal thrusts on infants because of possible damage to their internal organs. Instead, we do what I like to refer to as the “Heinz Ketchup technique.” This means  smacking the baby on the back, called “back blows,” then performing “chest thrusts.”

If the infant is not breathing, place the baby on your arm with the baby’s face in your hand, being sure not to cover the baby’s nose and mouth with your hand. Hold the baby’s head stable at an angle lower than the baby’s bottom – you want gravity to assist you. With the opposite hand, smack the baby between the shoulder blades five times,  just as if you were trying to get ketchup out of a bottle. Then roll the baby onto your other arm, this time face up. While still supporting the head, press down on the baby’s chest with two fingers. Give the baby five chest thrusts to compress the lungs and hopefully force out whatever is caught in the baby’s airway. Repeat this process until the baby cries. Once the baby is crying,  there is airflow.

Very large people

If the choking person is too large for you to reach around, I suggest putting the person’s back against a wall. Then push inward and upward, 1 inch above their belly button. This is the same basic abdominal thrust on their diaphragm, only from the front. But look out – the object lodged in the patient’s throat is aimed right at you when it pops out.

If you are alone and choking

A nurse in a recent CPR AED class I taught told the class that a friend of hers died when opening a pack of cigarettes while driving. Trying to open the pack with her teeth, she accidentally inhaled the cellophane wrapper and it blocked her airway. If you are alone and choking, find something like a chair or couch and fall on the back of it so that your diaphragm hits it. If in a car, pull off the road, put the car in park, roll down the window and fall on the car door. If you hit your diaphragm hard enough, it should knock the wind out of you– and the object blocking your breath.

Remember, this information is not a substitute for professional instruction by a qualified CPR instructor. Captains and crew should recertify every two years.

EMT Keith Murray provides onboard CPR, AED and first-aid training as well as AED sales and service. His company can be found at TheCPRSchool.com. Comments are welcome below.

HOW TO HELP SOMEONE WHO IS CHOKING

Step 1: Ask, “Are you choking?” Someone who is truly choking will not be able to answer you, but they should nod their head.

Step 2: Ask, “May I help you?” In the U.S., you need permission to touch a conscious person.

Step 3: If given permission to help, go behind the victim. If the person is sitting, get them to stand. Wrap your arms around the victim’s waist, like in a hug. Make a fist with your dominant hand and place the thumb side about 1 inch above the victim’s belly button. Place your other hand on top of the first.

Step 4: Strongly squeeze in an upward manner, thrusting your fist into the victim’s abdomen, just above the belly button. You are trying to squeeze the body, forcing the air out, which should cause the food lodged in the throat to shoot out like a cork from a Champagne bottle. Keep doing this until the food is dislodged and the victim can breath. If the victim passes out and is still not breathing, you will most likely need to begin CPR.  If choking persists, seek emergency medical services immediately.

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