15.Management of Choking and Vomiting

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Explanation

The airway is the pathway down which air travels, and obstruction at any point in that pathway (usually in the upper airway) by a foreign body such as food or vomit is called foreign body airway obstruction. Complete obstruction of the airway stops breathing, and the resulting state of functional impairment of the body's organs due to hypoxemia caused by lack of gas exchange is called asphyxia. Serious or complete airway obstruction is a critical condition that is life-threatening if not treated immediately. Partial airway obstruction produces symptoms such as coughing and wheezing, but patients with complete airway obstruction cannot use their voice and sometimes make "choking signs" such as clutching their throat with both hands or scratching at their throat. Their face becomes cyanosed and their breathing gradually weakens, which causes convulsions and loss of consciousness. The elderly and other people with weakened cough or impaired swallowing function are at high risk of airway obstruction due to aspiration of vomitus from stomach contents or eating foods such as bread, meat, and mochi (chewy rice cakes). We must be cautious of these risks.

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Explanation

Airway obstruction in adults typically occurs during mealtimes. Foreign body airway obstruction should be suspected when someone suddenly shows symptoms such as dyspnea, cyanosis, or loss of consciousness with no clear cause. ①Partial airway obstruction: Encourage active coughing and forced breathing, and stay at the patient's side to monitor their condition while calling loudly for assistance. Also report the situation through the emergency system (in accordance with institutional policy) and, in some cases, attempt to suction out the obstructing material. ②Complete airway obstruction (choking): The person immediately becomes unable to breathe. The signs of this are inability to speak, weak and ineffective coughing, high-pitched inspiratory sounds (or absence of breath sounds despite respiratory effort), facial cyanosis, and making choking signs. If not treated immediately, the person will become unresponsive and die quickly.

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Explanation

If you suspect choking, ask the person if they are choking, and if they nod "yes", confirm whether or not they can talk. If they cannot talk, you will know they are choking. In this case, try to resolve the airway obstruction by promptly removing the foreign body from the airway. While calling loudly for assistance, report the situation through the emergency system (in accordance with institutional policy) and attempt rescue procedures such as the Heimlich maneuver or back blows until the person responds or loses consciousness. The Heimlich maneuver strengthens exhalation from the lungs by lifting up the diaphragm. This induces an artificial cough that can expel a foreign body from the airway. In addition to the above techniques, (in unresponsive individuals) you can attempt to remove the foreign body by securing the airway using the tongue-jaw lift maneuver, inspecting the airway, and doing a finger sweep of the airway. Next, mouth-to-mouth resuscitation should be performed. This should be done by someone certified in basic or advanced life support.

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Explanation

The following two methods can be used to address choking.

・Abdominal thrusts (Pictures 1, 2): Clench your right hand into a fist and position it at the pit of the stomach. Place your left hand over the fist and forcefully compress the abdomen with an upward motion. This raises abdominal pressure and applies pressure to the chest cavity, which produces strong exhalation that can expel the foreign body that is obstructing the airway.

・Back blows (Pictures 3-7): Stand slightly behind the patient, support the chest or chin of the patient with one hand, and tilt their head down. * If the patient has fallen down, position them on their side in front of you, support their chest using your leg, and support their face with one hand. Make the palm of your other hand into a cup shape and forcefully slap the area between the patient's left and right scapulae.

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Explanation

Heimlich maneuver (Picture 1)

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Explanation

Heimlich maneuver (Picture 2)

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Explanation

Back blows (Picture 3)

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Explanation

Back blows (Picture 4)

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Explanation

Back blows (Picture 5)

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Explanation

Back blows (Picture 6)

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Back blows (Picture 7)

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Explanation

People with dysphagia frequently vomit because of gastroesophageal reflux due to reduced esophageal peristalsis. They are also at risk of choking on or aspirating the vomitus. Take the following measures to address vomiting.
・Rub the back to promote vomiting.
・Remove food residue from the mouth.
・Suction out the mouth. If medical equipment such as a suction device is not available, use gauze or similar material to wipe food residue from the mouth.
・Loosen clothing.
・Put a pulse oximeter on the patient and evaluate oxygenation. If SpO2 is less than 90%, start oxygen administration.
・Promptly clean up vomit and rinse the mouth with water.
・Quickly clean up any nearby vomitus because it can induce repeated vomiting.
・To prevent aspiration of vomitus, position the patient's head to the side and body to the side or to the upward, with the lower body slightly bent to relieve pressure on the abdomen, and allow the patient to rest.
・Collect vomitus to show doctors at a later point.
・The patient may vomit again, so ensure that a washbasin is available.
・Call an ambulance immediately in the event of repeated vomiting or symptoms of neurologic deficit (impairment of consciousness or paralysis), headache, or dizziness.
・If you suspect aspiration, attempt to expel the material by physical therapy techniques such as coughing or huffing. Suctioning is also an option, but it must be performed with due care because irritation caused by suctioning may induce further vomiting.

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Explanation

Methods for addressing vomiting (Picture 8)

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Explanation

Methods for addressing vomiting (Picture 9)

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References

  1. American Heart Association: Basic Life Support for Healthcare Providers Handbook, based on the 2010 AHA Guidelines. Synergy International, 2011.
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