Definition

Choking happens when an object from the environment blocks the airflow in the throat, leading to potential disturbance.

Choking can block the airway and make air flow in or out of the throat difficult. If it persists and is not addressed, the oxygen supply to the brain will be interrupted and can be life-threatening to the person. If the brain does not receive oxygen for more than 4 minutes, brain damage or tissue death can occur. Therefore, first aid must be administered as quickly as possible to someone experiencing choking.

Causes

There are two passages at the back of the mouth. The first is the esophagus, which connects the mouth to the stomach, and the second is the trachea, which connects the throat to the lungs. When swallowing food, the epiglottis valve closes the trachea to prevent food from entering the lungs. The airway is narrow. Therefore, if a foreign object becomes lodged in the airway, a person will have difficulty breathing and lack oxygen. If left untreated, this can have fatal consequences.

Adults often choke when they consume food or drinks too quickly or when they eat while laughing. The epiglottis valve does not close the trachea, allowing food to enter the airway. Meanwhile, young children often choke when they swallow or put small objects into their mouths.

Common objects or foods that regularly cause choking in children include:

• Popcorn
• Chewing gum or hard candy
• Erasers
• Nuts
• Toys
• Coins
• Marbles

Risk factor

Children are at high risk of choking because they tend to be curious and have a tendency to put small objects into their mouths. These objects can become lodged in their airways, leading to choking.

In adults, factors that can increase their risk of choking include:

• Aging
• Alcohol or drug consumption
• Parkinson's disease
• Ill-fitting dentures

Symptoms

Common signs of choking include clutching or pointing to the throat. If the person does not show signs of choking, you may observe other signs, such as:

• Appearing panicked
• Inability or difficulty speaking
• Difficulty breathing or wheezing when breathing
• Coughing, either weak or strong
• Lips, nails, or fingertips turning blue or black due to oxygen deprivation
• Redness of the skin, followed by paleness or blueness
• Beginning to lose consciousness
• In choking infants, they may have weak cries, weak coughs, or both

Diagnosis

Diagnosis is based on the symptoms presented by the choking individual and the history of the event as reported by the patient or accompanying person. Because this is an emergency, immediate management to remove the obstructive object is prioritized. However, doctors in hospitals can perform imaging tests to identify the object causing the choking and ensure that no other objects obstruct the airway.

• Chest X-ray can be performed to identify the cause of airway obstruction in the patient. Although not all objects may appear on X-ray results, those that do will appear white on the X-ray reading.
• Bronchoscopy is another imaging test performed by inserting a camera-equipped tube into the airway to identify and remove foreign objects from the airway.

Management

In cases of choking, oxygen flow to the lungs is blocked. However, this oxygen is needed to supply the body's brain and other vital organs. The brain is the first organ to die when the body lacks oxygen. If the brain does not receive oxygen for more than 4 minutes, it will experience damage or death. Therefore, first aid must be administered as quickly as possible to someone experiencing choking.

Heimlich maneuver and abdominal thrust

Treatment for choking varies based on age. In children older than 1 year and adults, abdominal thrusts, also known as the Heimlich maneuver, can be performed to create an artificial cough. The object obstructing the airway will be expelled when a strong cough or abdominal thrust occurs.

A quick upward thrust from the abdomen will force the diaphragm to move upward suddenly. This will cause the chest cavity to shrink rapidly, resulting in lung compression. Then, air will be forced out. The outgoing airflow will also force the obstructing object out of the airway.

Back blows

In infants under one year of age, abdominal thrusts cannot be performed due to their small stomach size, so back blows are performed instead. The baby should be held and positioned with their head tilted downwards to allow gravity to help clear the airway. Then, sharp blows are delivered to the back using the heel of one hand in the middle of the baby's back between the shoulder blades. Repeat these blows five times.

If you see someone choking but are unsure of what to do, immediately contact the nearest hospital so that the choking individual can receive medical assistance promptly. You may remove the obstruction by performing the maneuvers described above. However, medical teams can provide the best care. Contact medical teams so the choking individual can receive a thorough evaluation and further treatment if needed.

Complications

If choking is left untreated without further intervention, serious complications, up to and including death, can occur. Choking complications may include throat irritation, throat damage, and asphyxia. Asphyxia is a condition where the body experiences oxygen deprivation due to disrupted or abnormal breathing, causing the individual to experience decreased consciousness, brain injury, or even death.

Prevention

Keep small toy parts, coins, and other small objects out of your child's reach. Choose safe toys for children and supervise them closely while eating or playing to prevent them from putting toys or other small objects into their mouths. Children under 5 should not eat small, round, or hard foods, including pieces of hot dogs, cheese sticks, hard candy, nuts, grapes, marshmallows, or popcorn.

Avoid eating or drinking hastily to prevent choking. Chew food thoroughly. Avoid talking or laughing while eating.

When to see a doctor?

Immediately contact a doctor or hospital so medical personnel can properly evaluate the person experiencing choking. Continue to contact medical personnel even if you have successfully stopped the choking. This ensures that the choking individual is evaluated and receives further treatment if needed.