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Ask "Are You Choking?"

By Bill Kellogg, Teacher Educator Cal Poly, San Luis Obispo

The American Heart Association recently reported that nearly 3,800 Americans die each year from foreign-body airway obstruction (choking). While these statistics are indeed grim, we ought to realize that through prevention and knowing what to do when choking is occurring, we can save someone’s life, maybe even our own! By the nature of our jobs as agriculture teachers, we should be even more on the alert for choking victims, and be prepared to assist if necessary. Whenever you attend/host certain types of functions, you should be on alert for someone who might need assistance. A good example of this is when we attend banquets. Think about it. What is the environment like at banquets? Often times filled with laughter, nervousness, generous servings of meat provided, people talking, alcohol being served (not at a FFA function of course!), and often times a very unusual circumstance for many people. Banquets are a "prime time" for choking to occur. Be ready!

        It is interesting to note that choking usually occurs during eating. In adults, meat is the most common cause of obstruction, although a variety of foods and foreign bodies have been the cause of obstruction in children and some adults.

        There are certain "risk factors" that increase the likelihood of choking. These include large, poorly chewed pieces of food; elevated blood alcohol levels; persons who wear dentures; and playing, crying, laughing, or talking while food or foreign bodies are in the mouth. Prevention is the key for alleviating these risk factors. Cut food into small pieces and chew slowly and thoroughly, especially if you wear dentures. Avoid excessive intake of alcohol during meals. Avoid laughing and talking while chewing and swallowing. Prevent children from playing, walking, or running with food or foreign objects in their mouths. Keep foreign objects (for example, marbles, beads, and coins) away from infants and small children. Hot dogs are the number one object that causes respiratory arrest in infants!

        Because early recognition of airway obstruction is the key to successful treatment, it is important to distinguish this emergency from fainting, stroke, heart attack, drug overdose, or other conditions that cause sudden respiratory failure which are managed differently.

        Airway obstruction may also be due to infections that cause airway swelling. Your students with an infectious cause of airway obstruction, or even those with severe allergic reactions (i.e. bee stings), need prompt medical attention in a hospital’s emergency room, and time should not be wasted on a futile attempt to relieve this kind of obstruction.

        Foreign bodies may cause either partial or complete airway obstruction. With partial airway obstruction, the victim may be capable of either "good air exchange" or "poor air exchang". With good air exchange, the victim remains conscious and can cough forcefully, although frequently there is wheezing between coughs. Encourage a victim with good air exchange to attempt to cough out the object. Do not give them back blows, as was at one time recommended. Be ready, however, to assist them should poor air exchange occur! With complete airway obstruction the victim is unable to speak, breathe, or cough. Call "911" if necessary.

        If you notice a person choking (usually giving the "universal distress signal" - grabbing their neck with both hands), provide assistance immediately. Determine if they are able to cough or speak. Ask them "Are you choking?" Again, if they have good air exchange, encourage them to cough out the object. If they have poor air exchange, perform the Heimlich maneuver until the object is expelled or the victim becomes unconscious. To perform the Heimlich maneuver: stand behind the victim and wrap your arms around the victim’s waist. Press your fist into their abdomen with quick inward and upward thrusts. For victims who are in advanced pregnancy or who are obese, provide chest thrusts: Stand behind the victim and place your arms under their armpits to encircle the chest. Press on their chest with quick backward thrusts.

        Knowing how to deal with choking and other emergencies are good skills to know. If you have not taken a Cardiopulmonary Resuscitation (CPR) course, or if it has been some time ago that you did, why not look into completing a course this fall? This very popular course is also offered during "Agriskills" every summer, in conjunction with our annual CATA Summer conference.

        If you have an area of safety you would like addressed in this column, send Bill Kellogg an e-mail note or call him at (805) 756-2973. He will discuss questions or concerns. Notes can be addressed to bkellogg@calpoly.edu.

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