Elderly patient choked on water

UM Review RN, ASN, RN · Jan 4, 2007

naturally, if someone can get air, breathe, and especially cough, then i would not do a heimlich. :) it's best to let the person cough and clear themselves, which i would encourage the person to do.

that's all a heimlich really does anyway. it uses that little reserve of air to push out an obstruction.

here's a link and an excerpt:

emergencies and first aid — choking

[color=#720c00]choking

a person who is choking will instinctively grab at the throat. the person also may panic, gasp for breath, turn blue, or be unconscious (see p. 1216). if the person can cough or speak, he or she is getting air. nothing should be done.

TrudyRN · Jan 4, 2007

Your patient had a stroke?

Might need thickener in the water.

UM Review RN, ASN, RN · Jan 4, 2007

Your patient had a stroke?
Might need thickener in the water.

Yes, Trudy's right. Is this patient having a hard time whenever she drinks or was that just a fluke?

marilynmom, LPN, NP · Jan 4, 2007

Yes, Trudy's right. Is this patient having a hard time whenever she drinks or was that just a fluke?

She was a cardiac patient, no strokes, and was also very confused and didn't show the typical choking signs...though she was not getting air, could not cough, was very RED and her tongue was sticking out, etc. Thankfully she did end up throwing the water up (maybe she aspirated it?) and was fine after that and didn't seem to even know she had choked! But I felt later on I should have done something to help her, because what if she wouldn't have throw up?

I was floated up to another floor so I wasn't really able to discuss this was anyone (of course I informed her RN before I left).

Thank you for the link. And yes I have taken AHA BLS but that was my first real choking experience and I wanted to just kinda talk about it. I just want to make sure the next time this happens (because I know it will) I feel more confident and prepared when I'm in the room alone with a patient like this.

I just never thought someone could choke on a sip of water like that!

leslie :-D · Jan 4, 2007

i'd be on the lookout for aspiration pneumonia....

also monitor her intake to see if this happens again.

a swallowing eval might be in order.

leslie

AnnieOaklyRN, BSN, RN, EMT-P · Jan 4, 2007

NO! no heimlich on someone who you are POSITIVE is only choking on water. The water probably caused laryngospasm and also set of that darned gag reflex which is why she puked. Water is very unlikely to kill someone if they are "choking" on it as the laryngospasm and gagging/coughing will likely resolve in a short period without any assistance. Remember heimlich is only for people with a COMPLETE airway obstruction.

Swtooth

lovingtheunloved, ASN, RN · Jan 4, 2007

Ah, been there. Happens pretty often where I work. (Alzheimer's pts) Usually they can get it out on their own, but if they're not breathing at all, put their arms over their head if possible, (not all people can tolerate that) it'll give their lungs more room to expand, and they'll usually cough or throw it up. A couple firm whacks on the back can help too. I did have one resident (that little guy was a train wreck and a half) who did that pretty frequently, and a couple of times actually lost consciousness. Pretty scary. I was amazed he lived as long as he did.

bethin · Jan 4, 2007

NO! no heimlich on someone who you are POSITIVE is only choking on water. The water probably caused laryngospasm and also set of that darned gag reflex which is why she puked. Water is very unlikely to kill someone if they are "choking" on it as the laryngospasm and gagging/coughing will likely resolve in a short period without any assistance. Remember heimlich is only for people with a COMPLETE airway obstruction.
Swtooth

Thank you. I was wondering how a liquid could completely cover an airway and then how do you get the liquid out? Heimlich I thought, only removed solid items such as food, pennies, etc. My experience with choking on liquids is, it's not pleasant but they will throw it up.

TiffyRN, BSN, PhD · Jan 4, 2007

Laryngospasm would be my guess. Happens to me off and on. I have to relax completely and try to stop coughing and inhaling forcefully. But you likely can't reason with a patient in the middle of the crisis. My suggestion would be supportive (emotionally), encourage the patient to relax and if they do pass out they will likely relax their airway and that point and breathe normally.

Then do (recommend) a swallow eval. Thin liquids like water are the easiest to aspirate on. And an aspiration episode could be your fist indication of a stroke or TIA in a patient who is high risk (say, someone with a cardiac history).

marilynmom, LPN, NP · Jan 4, 2007

Ok, I feel MUCH better now---thank you all so much!

This was my very first experience with such a thing and I felt so helpless because it was scarey for me to watch. I did what I should have done which was stay with the patient and watch her. I'm still learning, I thought maybe she actuall could have choked to death on the water I guess.

I just felt like I should have done something and then it got me thinking about what to do in that situation (sorry if my first post wasn't clear). I'm going to read about laryngospasm so I can be a little more familiar with that.

marilynmom, LPN, NP · Jan 4, 2007

Ah, been there. Happens pretty often where I work. (Alzheimer's pts) Usually they can get it out on their own, but if they're not breathing at all, put their arms over their head if possible, (not all people can tolerate that) it'll give their lungs more room to expand, and they'll usually cough or throw it up. A couple firm whacks on the back can help too. I did have one resident (that little guy was a train wreck and a half) who did that pretty frequently, and a couple of times actually lost consciousness. Pretty scary. I was amazed he lived as long as he did.

Thanks!