I was watcing a real-life show re medical emergencies. The phone operator, who was advising the person at the actual emergency where a woman was choking, said NOT to hit her on the back, because if the person that is choking has swallowed food (or an object), it can make the object slide down their trachea more and cut off their airway completely.
I have never been taught this. We have only recently been taught this is what you keep doing, until emergency services arrive. One of the senior RNs I work with was only doing this the other day when an elderly patient we had choked on a dry, coconut dessert (which she was guzzling down too fast anyway). There isn't anything else you CAN do is there except keep pummelling them on the back to try & dislodge whatever is blocking their airway.
What would you do, or what have u been taught to do? Just interested to hear different view points.
Specializes in MPH Student Fall/14, Emergency, Research.
In my BLS course, we were also taught not to hit the backs of choking adults, because it could worsen the obstruction. That advice has been consistent throughout the years. We only do J-thrusts (not same as Heimlich, I'm told) if they are standing, or chest compressions if collapsed.
No back slapping. If partial obstruction and cough present offer reassurance and encourage cough. For complete obstruction start HM. (see how I got out of spelling this )
I'm a CPR instructor for AHA. We teach not to touch anyone if air is being exchanged. If you can hear them coughing, you wait and let them try to get it out. We teach back blows only on an infant...otherwise once the object obstructs the airway you do the HM until the object is either projected out, or the person becomes unresponsive- at which point you initiate your CPR.
I work in LTC. Had a resident violently coughing, spewing and speaking with raspy voice during lunch. Daughter in visiting. I hear all the commotion and go to check out the situation. Daughter is screaming at me to do the heimlich, slap her on the back do SOMETHING!. Tried to calmly reassure her that the best thing to do is nothing at this point. Daughter SCREAMING "I've taken CPR classes and know more than you and I demand you do this now". Had the entire dining room of residents, staff and other visitors looking at me like I was a villian. Daughter finally starts slapping Mom on the back hard enough to break spine/ribs. Calmly, I step in between Mom and Daughter and gently rub Mom's back - thinking the daughter is gonna start whacking me any minute. Daughter is screaming at me the entire time. Eventually the Mom is able to catch her breath and breath normally again & daughter trots down the hall to tell the DON. Oh Well..her Mom is OK and free of fractures from the daughter! Crazy dang people.
I have recently completed my BLS, and my ALS at work. Here is Australia... we are now taught NEVER use the Heimlich.. 5 firm blows to the back, 5 firm blows to the front under the sternum. Repeat, repeat. The object will either move up or down, generally up - but anything is better than stuck.
Edit: And this is only if the person has stopped breathing altogether... otherwise encourage coughing and they will dislodge themselves. From my experience this is the case more often than not.
Wow, just goes to show the international differences.
Our BCLS teaches the following:
You only interfere if the person is severely choking. How do you know? Ask them, "are you choking?" and if they can speak, cough or breathe, watch and wait. If the person is unable to speak or can't breath or has wheezy breathing, you perform HM, for both adults and children (may have to kneel for the child.)
For pregnant women or very large people, it's a modified HM - chest thrusts instead of abd thrusts. Never blows to the back for an adult. If you're the one choking and alone, you're supposed to impale yourself on the back of a chair.
A baby is the only one you do back thrusts - b/t the shoulder blades while baby is face down straddling your non-dominant arm, - 5 thrusts then flip baby over and 5 quick compressions with two fingers b/t the nipples. Repeat.
Of course only ever on a conscious person, if/when unconscious - it's CPR time.
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OCNRN63, RN
5,979 Posts
I only remember being taught back blows for infant choking.