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Chocking with a foreign body

Autor: dr Sonja  Ilić   


Among the deaths caused by an accident, chocking with a foreign body is at the high 6th place. The victims of choking are children up to 3 years of age as well as older people. Children inhale a foreign body most commonly during the period when they make a transition from liquid food to solid food, or when they put everything into their mouth because they still do not make a difference between food and other objects and toys. Older people inhale a foreign body because their swallowing reflexes are weakened, so that a bite or artificial teeth can go into the airways.

When a foreign body gets stuck in the throat, it partially or completely closes the opening of the trachea, thus making it impossible for the air to flow. Foreign bodies that can cause the obstruction of the airways can be very different: undigested food, toys, grains, parts of artificial teeth, pulled or knocked out teeth, a bigger clot after a medical intervention in the mouth cavity and cetera.

The closing of the throat and the larynx by undigested food is usually the case with people who have swallowing reflex disorder, with senile people, with mentally retarded people, with drunken people and sometimes with children.

The clogging of the trachea and the bronchi with an inhaled foreign body leads to their partial or complete closing, which is manifested by a sudden stoppage of breathing, or by more difficult breathing with partial obstruction. An inhaled foreign body can be solid (toys, grains, earth, sand), mush (mud, gastric content), liquid or half-liquid state (blood).

Clinical chart

When it comes to a partial clogging a wheezing breathing is heard, breath is taken with difficulty, there is a fit of cough, and voice is distorted. Usually a strong coughing and strong tapping on one’s back between the shoulder blades help. When it comes to a complete clogging, the unfortunate one does not breathe, does not cough and cannot speak. One runs around in panic fear, first they turn pale and then blue. Because of the lack of oxygen in the brain, heart failure occurs and then in 4 to 7 minutes death.

How to react?

A person whose airways are completely clogged can be saved if they are helped as soon as possible. Firstly, the Heimlich move is used. This is an already tested move which usually helps, but it is not harmless. Namely, if you press the stomach too hard, you can hurt the stomach, liver or spleen. Therefore, you should adjust the strength of the pressure to the constitution of the person choking.

By using your closed hand, you press strongly across the middle between the person’s chest bone edge and the navel, and you put your other hand around the person. You press the stomach fast towards the inside and upwards. Wile doing this you must not press the top of the chest bone, that’s how the possibility of hurting the organs inside the rib cage is reduced. You deeply press five times and that’s how you push the air from the lungs to the trachea and to the larynx. This pushing of the air should push the foreign body out. After first five moves, you can try five strong taps between the shoulder blades. Then you try again by using five Heimlich moves again. Only with obese people as well as pregnant women you can not put your arms around that area, therefore, you press across the lower third of the breast bone, across the place where usually an outer heart massage is performed.

You do the Heimlich moves until the foreign body is pushed out or until the person loses consciousness. Then you should clear the throat and turn the person sideways (if they breathe after you have removed the foreign body). If we have taken out the foreign body and the person is still not breathing then you should give them mouth to mouth. If the person is unconscious you use another five Heimlich moves. Then, you try to carefully remove the foreign body from the larynx with your fingers, for you do not want push it any further. If there is no one to help, the unfortunate person can throw themselves onto the edge of the back of a chair, or onto something similar, with the part of the abdomen between the navel and the lower edge of the chest bone, or one should try pressing themselves with the palm of one hand pressed by the other hand.

The same thing goes for the children between 1-8 years of age, but with one hand only. With the children that are only one year old one should begin with five strokes between the shoulder blades. If it does not work the Heimlich maneuver is applied, but not as with the others, but as with the outer heart massage across the middle of the middle third of the chest bone (between the nipples) using two fingers. Pulling a foreign body out of the larynx of a little child is risky for it can easily be pushed deeper. Young children and babies, if they are unconscious, one should lie down with their stomach on one hand with their head softly leaned downwards, and with the other hand one should tap softly between the shoulder blades. After that, turn the child so that they lie with their back on your forearm and press the chest bone with two fingers. Don’t ever press the abdomen!

Sonja Ilic, MD

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