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We are now going to have a little bit of a look at the theory of adult choking and actually what we are trying to achieve. What we have got to remember is, the airway is a pipe that goes into two bags. That pipe and those two bags are designed to carry air and nothing else. There is a small amount of mucus in there. There is a few cilia, little hairs and bits and pieces. But the air must be able to flow in and out without any restrictions whatsoever. So if we get a choking patient, they will panic because their brain is panicking then it is not going to get any air into the lungs, it is going to then basically expire. So, you will see the obvious grabbing of the throat, staggering, thrashing about.

The one thing that we need to realize with dealing with a choking patient is, it is not going to be easy, it is going to be quite traumatic. They are going to actually potentially want to fight you because their fight or flight mechanism is trying to protect their airways, trying to keep them alive. Also, what we have got to understand is, the faster we work, the better the patient can help us. And if a patient can help us, that is going to make the situation far easier. So if we can get the patient while they are still standing or staggering around and do back slaps and encourage them to cough and blow that airway clear, that is going to be far, far easier than if they are in a prone position on the floor and we are going to have to do all this manually, all by hand. Because we may not be able to see, we may not be able to get down deep enough to remove it. But if they can cough it up, if they can actually help us, that is going to work in our favour.

Also, the abdominal thrust from behind the patient. The whole theory about the abdominal thrust is, if somebody has punched you in the stomach and you have doubled over, it pushes your diaphragm up which expels air from your lungs and that pressure blasts free the blockage that is in the airway. Well, we cannot go around punching patients, but what we can do is put the arms from behind the patient, into their abdomen, clenched just underneath their sternum and an inward and upward pull, and it has to be a sharp pull. You are trying to compress gas in the lungs by lifting their abdominal contents and their diaphragm and force that out under pressure.

So if you do it nice and gently and slowly, actually, it will not achieve hardly anything at all. It has to be an upward inward pull, a jerky motion, a fast motion to try and pressurize the lung and force the blockage clear. Again, if the back blows and abdominal thrusts do not work, we are then dealing with a patient now that is collapsed. And once they are collapsed, we go into to the resus process. The resus process, 30 compressions, check the airway to see whether the compressions have brought anything into the back of the throat and we can clear it before the two breaths. The two breaths will then potentially blow the blockage down into one lung and it tends to go into the right lung as the passageway tends to be shorter and in a slightly more direct angle, so blockages tend to fall into the right lung rather than the left. But again, remember what we said when we started, we have go to blow it up or get it out because if that airway stays blocked, the outcome to the patient is not good at all. So one way or another, it has got to go chest compressions will take it north, breaths will take it south, but we have to move it one way or the other.

One thing we also need to remember is, not everybody is built the same. We may have obese patients, and we might have pregnant patients who choke. Pregnancy, we do not do abdominal thrusts for obvious reasons. Where we would normally do an abdominal thrust, there is now a child. So we cannot go pressing in on that child and doing the same manoeuvre that we would on a non-pregnant female. So with a pregnant female, we do a chest compression, which again the same compression as we would do for CPR, we will force air from the lungs, the lungs tend to get pushed up, the diaphragm gets pushed up when a female becomes pregnant, especially in their second and third trimester. Everything starts to be pushed north which is why pregnant females like to sit up in bed to be able to breathe better. So we are now going to push those lungs with a chest compression to do exactly the same job that we would do with a non-pregnant female with an abdominal thrust.

Obesity also can give you a problem because the patient might be very heavy, it might be very difficult to get your arms around. If you cannot get your arms around an obese patient, you may again end up reverting to a chest compression. But we have got to find a way to clear that airway. We cannot just sit there and watch. One way or another, we have gotta get it sorted. There is no good outcome if we do not.