Choking can cause death and is the leading cause of "accidental" death. In the most dire situations, if the Heimlich maneuver fails, a tracheotomy or cricothyroidotomy may have to be performed to save the person's life. This procedure should be used as a last resort because it is very dangerous. Ideally, this procedure is performed by a medical practitioner, such as a surgeon or medical emergency specialist. Remember, the first thing you should always do when you are in an emergency situation is call emergency services.
Step
Part 1 of 3: Checking for a Choking Person
Step 1. Check for common signs of choking
People who are choking may exhibit the following symptoms:
- Difficulty breathing
- Noisy breathing
- Unable to speak
- Unable to cough
- Blue skin color (called cyanosis, occurs due to lack of circulating oxygen in the blood)
- Decreased level of consciousness
Step 2. Ask someone to call emergency services
This is important, emergency medical personnel need to be contacted immediately via 119, 118, or local numbers when someone is choking; more than three or five minutes of oxygen not flowing to the brain is likely to result in death.
Step 3. Understand the Red Cross recommendations regarding assistance to people who are choking
Recommendations include five "back blows" and five alternate "abdominal thrusts" (also known as the Heimlich maneuver), repeating the cycle until the object causing the choking is removed, emergency personnel arrive, or the victim becomes unconscious due to lack of oxygen.
- A "back slap" is applied in the area between the two shoulder blades (scapula) and is applied firmly with the "heel" of the hand (the area above the wrist), the victim's position is bent so that the body is fairly parallel to the ground (this way, if If you manage to remove the blocked object, the object will fall out of the victim's airway following the force of gravity).
- The "back pat" is optional, depending on your skill level at doing it effectively (otherwise skip this step and just do the "abdominal push" which is described in the next section).
Part 2 of 3: Doing Abdominal Push
Step 1. Reach the victim's body from behind
Wrap your arms around the victim's abdomen.
- If the victim is sitting or standing, position yourself directly behind him or her. If the victim is in a lying position, lie down behind him.
- If the victim is unconscious, check the pulse. If a pulse is not palpable, continue with CPR (Cardiopulmonary Resuscitation) at a rate of 100 chest compressions per minute. Do not attempt to perform abdominal thrusts at this time (and do not perform rescue breathing in this situation because the airway is blocked).
Step 2. Make a fist with your dominant hand
The thumb of the needle is in the fist. Position this fist more or less above the navel and below the victim's breastbone (sternum).
Step 3. Lock this fist firmly with the other hand
To prevent injury to the victim, ensure that the thumb is not pointing at the victim's body.
Step 4. Perform an inward and upward pull, pressing on the victim's abdomen, followed by a strong, rapid upward thrust
Do the movement like the letter "J" – in, then up.
Step 5. Continue the Heimlich maneuver
Perform this procedure as long as there are signs of respiratory sounds from the victim (including gasping breaths, choking sounds or responses, or other audible indicators of breath sounds).
- If the victim is unable to breathe at all and the Heimlich maneuver fails to remove the blockage, proceed with a tracheotomy.
- This procedure is very risky and should only be used as a last resort; if possible, a tracheotomy should be performed by a qualified medical professional.
Part 3 of 3: Performing a Tracheotomy
Step 1. Call 119 or 118 before you get started
Make sure you dial the number before starting to make sure that a tracheotomy is necessary. An emergency response team may be nearby.
If you really have no other choice but to perform a tracheotomy, then you need to stay connected to emergency telephone services. An emergency medical technician (dispatcher) may be able to communicate with you during the procedure or put you in contact with others who can. Having a companion on the phone can also help you stay calm
Step 2. Locate the area of the cricothyroid membrane on the surface of the victim's neck
This area is the soft spot on the neck where the incision will be made.
- To locate this area, locate the Adam's apple or larynx. Both men and women have Adam's apple, however, the Adam's apple is more prominent in adult men. You may need to feel the victim's neck for Adam's apples in women or children.
- Slide your finger from the Adam's apple down until you feel another bulge; The protrusion is the cricoid cartilage (cartilage).
- There is a slight indentation between the Adam's apple and the cricoid cartilage. An incision will be made in this area.
Step 3. Make horizontal slices one quarter centimeter long and about one quarter centimeter deep
At the site of the incision, you will see the cricothyroid membrane (the yellowish elastic membrane that sits between the layers of cartilage that surrounds it). Make an incision in the membrane itself. The depth of the incision made should be sufficient to gain access to the airway.
- Given the urgency of this procedure, formal sterilization may not be carried out. Time is of the essence and problems related to potential infections can be handled when emergency personnel arrive.
- However, if gloves are available-even if they are not sterile-use them to protect yourself from blood-borne diseases such as HIV and hepatitis.
Step 4. Keep the wedge hole to facilitate breathing
Do this by inserting a soda straw about 5 cm (2 inches) deep into the trachea.
- You can suck on the straw and check if there is a response of air returning to you to make sure that the straw is positioned properly in the victim's airway.
- An empty ballpoint pen chassis (without a fill or ink tube inside) is also a good option as a "breathing tube."
Step 5. Give two rescue breaths through a breathing tube
Each of these breathing assistance is carried out for approximately one second. The victim is expected to begin to breathe on their own (you will see the victim's chest rise and fall if she can breathe on her own).
- If the victim is able to breathe on their own, continue to monitor the victim and wait for emergency personnel to arrive to handle the situation more closely.
- If the victim is unable to breathe on their own, continue to give rescue breaths and check the pulse. If a pulse is not palpable, continue with CPR.
- A CPR cycle is 30 chest compressions (at a rate of approximately 100 chest compressions per minute) followed by two rescue breaths through a breathing tube. Repeat this cycle approximately five times.
- If the victim does not respond after five cycles, use an AED (automated external defibrillator) if you are trained to use it. If not, follow instructions from emergency personnel who can give you directions over the phone while waiting for them to arrive.
- It should be noted that if you are not trained in performing CPR, chest compressions are more important than rescue breaths so you may perform chest compressions only (at a rate of 100 breaths/minute) and skip the rescue breaths until emergency personnel arrive. Remember, "doing something" is better than doing nothing when someone's life is in critical condition!
Tips
- While the victim is conscious, reassure the victim that she will be fine. Panic will only make the situation worse.
- Pair the diagram of the cricothyroid membrane with the label as a visual aid.
Warning
- This procedure is very dangerous. This procedure carries a high risk of causing death or other injury to the victim if performed incorrectly.
- Perform a tracheotomy only as a last resort when all other procedures have been tried without success and there are no skilled medics around.
- Understand the legal consequences if a tracheotomy fails. You certainly don't want to be sued or blamed for someone's death.
- If possible, try to make sure that the hose you are using is clean. Otherwise, infection can occur, leading to more serious complications.
