Patient choking on food

[rejoyce]

I'm a nursing student who needs some advice. I was in the room with a stroke patient with left side paralysis. An emergency, temporary tracheotomy had been done at the time of the stroke. The trach tube had been out about 5 days. Her chart cautioned aspiration precautions. She is a large lady and was propped up in bed while she ate breakfast. She choked on her food and I heard that awful "plugged" sound. I wasn't sure what to do. Because of her position I couldn't do the Heimlich and she was too big for me to pull her forward and slap her back. There was no suction machine in the room. I ran to get help and we stood next to her until she was able to move the food. I felt helpless! What should I have done? Also, I did run into the hallway because I needed help ASAP. What if no one would have been there? How appropriate is it to yell "HELP!!" I shook for the rest of the day. Any advice would be appreciated. Thanks ~

[Ilithya]

Firstly know your hospital policy, at my facility you pick up the phone in the room and dial 2 numbers to connect you to the emergency line of the hospital operator, who will then send in the appropriate personell so that you do not have to leave the patient.

As far as what I would do it depends on how badly they are choking. If they can talk/ cough they can breath and don't do anything. But I would send someone to get a suction apparatus just in case it was needed

[rejoyce]

Thank you ~ I’ve done clinicals at several hospitals, nursing homes, and re-habs and have never been informed any emergency number to call or procedure to use. You can bet next time I’m in a new facility I’ll find out what their policy is when there’s an emergency.

[woknblues]

Heimlich can be performed on a supine patient, no matter how obese. You must lower the bed to flat, then straddle the patient and perform thrusts.

Also, get that woman an NGT.

Just some ideas.

[NurseCard, ADN]

Yikes! What a scary situation! :icon_hug:

First of all, prevention is key. When a patient has aspiration precautions in place, it means (or should mean) that they have been evaluated by a speech therapist and/or had a swallowing study. There should be guidelines for their feeding on their chart, and/or preferably, posted above their bed. Always make sure that these guidelines are being followed. They may include: Honey thickened liquids only, spoon feeding only, bed elevated 60 degrees during feeding, etc. etc...

The patient should also have already had suction at the bedside.

You did the right thing by going and grabbing help. I would have had one or two people stay with her while I went and grabbed suction equipment. I may have gone ahead and summoned the Rapid Response team, if my hospital had one. If the patient is clearly not moving ANY air, as in not able to cough or make any noise whatsoever, I'd go ahead and call a code blue, particularly if, as you said, a Heimlich cannot be performed.

[NurseCard, ADN]

Heimlich can be performed on a supine patient, no matter how obese. You must lower the bed to flat, then straddle the patient and perform thrusts.

Also, get that woman an NGT.

Just some ideas.

Hmmm... :yeahthat:

[CaLLaCoDe, BSN, RN]

Heimlich can be performed on a supine patient, no matter how obese. You must lower the bed to flat, then straddle the patient and perform thrusts.

Also, get that woman an NGT.

Just some ideas.

This is exactly how I would have dealt with this situation. Bravo!

[newohiorn, BSN, RN, EMT-P]

If you need help...yell help. I work in neuro ICU and you hear "HELP!" every now and again. No shame in that. When you are the only person in the room and your hands are full suctioning, keeping a patient from falling etc., sometimes yelling is the best and fastest way to get help. I've yanked the stupid call light cord that is supposed to signal an emergency and waited and waited while I kept someone from falling but yelling "help" got me the hands I needed much quicker.

[Straydandelion]

I assumed aspiration precautions WAS having a suction machine at the bedside as part of it.

[woknblues]

I should also add in my suggestions the first thing would have been to yell "HELP!"..

[casi, ASN, RN]

There's absolutely nothing wrong with yelling for help when the situation calls for it. I'm sure there are some hospital administration that would frown upon it, but keeping your patient breathing comes before making the head honchos happy.

[leslie :-D]

i think i would have started thrusting from the front...

and yes, aspiration precautions would mandate need for bedside suction.

leslie