How to respond to choking on bedridden geriatric patient

Zookeeper3 · Jul 10, 2010

heimlick from abdominal thrusts, like you would when a victim becomes unconscious and hits the floor. Give several aggressive abd. thrusts, do not blind swipe mouth but check it.

happy2learn · Jul 10, 2010

hello,
i am a new nursing assistant in california and just came from an aha bls for healthcare provider course, and some thoughts and questions were raised from application in the setting of a long-term care facility or home health environment regarding choking.
1) if i am feeding my patient in bed and they begin to choke, what should i do?
you need to determine if it's a partial or complete obstruction first. if it's a partial airway obstruction, you let them try to cough it out. if they cannot cough, speak, or breathe, or lose consciousness, you need to perform the heimlich.
they will need to by lying flat, just as zookeeper mentioned. so you need to lower the head of the bed, or do something to get them flat.
2) if my patient is on comfort care/hospice and on a soft diet, would that change my medical action/response?
your employer will give you directions in regards to this.
3) as i will also be providing in-home care without a licensed nurse present, what is my legal obligation in either previously mentioned scenarios?
thanks.

what you can do to help the patient will be controlled by your employer. you do everything you are permitted to do.

Ericm · Jul 10, 2010

happy2learn & Zookeeper3:

Thank you for the responses, especially such quick ones!

I absolutely understand that the facility/company/otherwise would be what dictates the appropriate response. However, as one of the companies I'm working for is non-medical in-home without a medical team in some cases, I was wondering what the legally appropriate response would be that would not jeopardize my Nursing Assistant certification.

Also, to sum up my understanding of your advice, you're recommending that the most appropriate thing to do if it's a complete obstruction is to in essence climb on top of the bed and apply abdominal thrusts to the best of my ability? In the case of softened food where it would be aspiration/drowning, how does that change the circumstance?

happy2learn · Jul 10, 2010

Can't answer the aspiration question. I just got through Nurse Aide training as well. I would assume you would call 911.

It would be better to have them on the floor. A harder surface will allow you to thrust more efficiently since their body won't smush down on the bed, but if that's not possible, then yes, on the bed. With you being at home, I would call 911 first. I mean, we are told to yell for help in the nursing homes, before we perform the heimlich. Obviously yelling will do you no good, lol.

As long as you do everything that is in your scope of practice with your employer, you won't lose your NA certification. Your employer would be held responsible.

I would ask your employer about aspiration, and ask them these questions so they can clarify. I would be a little intimidated being out there alone.

heron, ASN, RN · Jul 10, 2010

A patient being on hospice shouldn't be a factor ... even though we are "letting nature take its course" we don't let them choke to death, if only because it's a miserable, frantic way to die. A heimlich is unlikely to clear the airway if pt is on a puree diet, but worth a try anyway. The main thing is to get someone in there who can suction out the mouth.

katkonk, BSN, RN · Jul 11, 2010

You do know that you never feed anyone lying down, correct? You would always have them in a sitting position while feeding. ESPECIALLY with soft food and/or G-Tube feeding.