E M Responding to E R G E N C I E S in the field foreign-body airway obstruction Learn how the guidelines for quickly helping a choking adult have changed. BY DAVID S. SALATI, RN, NREMT-P, CCRN, CEN, BSN

+SEVERE OR COMPLETE foreign- body airway obstruction can kill the victim in minutes if he doesn’t get appropriate treatment. The pri- mary technique to clear an obstruc- tion in a conscious adult is admin- istration of abdominal thrusts—the Heimlich maneuver. In these pho- tos, you’ll learn how to help a choking victim by following the lat- est American Heart Association’s guidelines.1 (See Out with the old, in with the new for details on the latest revisions made in 2005.) Follow standard precautions for all patient contacts, but don’t delay performing the Heimlich maneuver to search for protective gear—the victim could die in even the minute 1. Ask the victim if he’s choking and if you can help him. If he nods yes and or two you spend getting gloves and can’t talk, act quickly—tell him you know what to do and you’re going to help him. a mask, and clearing a foreign body from a conscious adult’s airway shouldn’t expose you to body fluids. But if the victim becomes uncon- scious and needs rescue breathing or cardiopulmonary resuscitation (CPR), use a barrier device with a one-way valve, such as a pocket mask or shield.

Reading the signs Ineffective or absent respirations, a weak ineffective cough, and high- pitched sounds or no sound with inhalation in a conscious person 2. Stand behind him and place your signal severe airway obstruction. foot between his legs so you can help 3. Grasp your fist with your other Most conscious adults with a for- him to the floor if he becomes uncon- hand. Keeping your elbows out away eign body in their airway clutch scious (see photo 4). Reach your arms from the victim, pull in and up sharply their neck with their thumbs and around him. With one hand, make a fist to provide a quick thrust that takes fingers—an action known as the and place it thumb side in, as shown, about 1 second. Repeat thrusts until universal choking sign. If you sus- against his abdomen between the um- the obstruction is cleared or the victim pect choking, proceed as shown. bilicus and the xiphoid process. becomes unconscious.

50 Nursing2006, Volume 36, Number 12 www.nursing2006.com Out with the old, in with the new

In 2005, the American Heart Association revised its guidelines for relief of foreign-body airway obstruction. The Don’ts are steps that have been replaced: • Don’t use the tongue-jaw lift to open the vic- tim’s airway. Do use the head-tilt—chin-lift maneuver. • Don’t perform a blind finger sweep of an unconscious victim’s mouth. This action hasn’t been shown effective and it could injure his mouth or your finger. Remove an object only if you see it. • Don’t perform abdominal thrusts on an unconscious victim. Studies have shown that chest compressions performed during CPR increase intrathoracic pressure as much as or more than abdominal thrusts. 5. Make sure the victim is supine on • Don’t use a 15:2 compression-to-ventilation a firm, flat surface. Using a head-tilt— ratio during CPR. A single rescuer provides bet- chin-lift maneuver, open his airway. If ter blood flow to the victim’s heart, brain, and you can see an object, try to remove it. other vital organs with a 30:2 compressions/ Administer two rescue breaths. If you ventilations ratio. can’t make the victim’s chest rise, repo- • Don’t deliver rescue breaths lasting longer sition his head, reopen his airway, and than 1 second. Too many breaths or too large a 4. If the victim becomes uncon- try again. Each time you open his air- volume may actually reduce the blood flow scious, protect his head and guide him way, look for an object. generated by chest compressions. to the floor. Call 911 or a code. Source: Highlights of the 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, Currents in Emergency Cardiovascular Care, Winter 2005-2006.

Following up Even when properly done, the Heimlich maneuver can injure the patient’s abdominal or thoracic vis- cera or internal organs. A health care provider should assess the victim for these complications or pulmonary aspiration. Report the event to the health care practitioner. For example, tell her you found the victim using the universal choking sign and didn’t detect air movement with respira- tory effort. You administered six abdominal thrusts, dislodging a large piece of food from the vic- tim’s airway. Now he can speak and doesn’t have any complaints.‹› REFERENCE 1. BLS for Healthcare Providers. Dallas, Tex., 6. If you still can’t deliver effective breaths, deliver 30 chest compressions at a rate American Heart Association, 2006. of 100 compressions/minute, then check the victim’s mouth and attempt to venti- David S. Salati is a staff paramedic at Virtua Health in late. Repeat the sequence until the obstruction is cleared or help arrives. Mount Laurel, N.J. www.nursing2006.com Nursing2006, December 51