choking

Choking

Definition

Choking is the inability to breathe because the trachea is blocked, constricted, or swollen shut.

Description

Choking is a medical emergency. When a person is choking, air cannot reach the lungs. If the airways cannot be cleared, death follows rapidly.

Anyone can choke, but choking is more common in children than in adults. Choking is a common cause of accidental death in young children who are apt to put toys or coins in their mouths, then unintentionally inhale them. About 3,000 adults die each year from choking on food.

People also choke because infection causes the throat tissue to swell shut. It is believed that this is what caused George Washington's death. Allergic reactions can also cause the throat to swell shut. Acute allergic reactions are called anaphylactic reactions and may be fatal. Strangulation puts external pressure on the trachea causing another form of choking.

Finally, people can choke from obstructive sleep apnea. This is a condition where tissues of the body obstruct the airways during sleep. Sleep apnea is most common in obese men who sleep on their backs. Smoking, heavy alcohol use, lung diseases such as emphysema, and an inherited tendency toward a narrowed airway and throat all increase the risk of choking during sleep.

Causes and symptoms

There are three reasons why people choke. These are:

mechanical obstruction
tissue swelling
crushing of the trachea.

Regardless of the cause, choking cuts off the air supply to the lungs. Indications that a person's airway is blocked include:

the person cannot speak or cry out
the person's face turns blue from lack of oxygen
the person desperately grabs at his or her throat
the person has a weak cough and labored breathing that produces a high-pitched noise
the person has all of the above symptoms, then becomes unconscious
during sleep, the person has episodes of gasping, pauses in breathing, and sudden awakenings.

Diagnosis

Diagnosing choking due to mechanical obstruction is straightforward, since the symptoms are obvious even to an untrained person. In choking due to infection, the person, usually a child, will have a fever and signs of illness before labored breathing begins. If choking is due to an allergic reaction to medication or insect bites, the person's earlobes and face will swell, giving an external sign that internal swelling is also occurring.

Choking due to sleep apnea is usually diagnosed on reports of symptoms by the person's sleep partner. There are also alarm devices to detect the occurrence of sleep apnea. Eventually sleep may be interrupted so frequently that daytime drowsiness becomes a problem.

Treatment

Choking, except during sleep apnea, is a medical emergency. If choking is due to allergic reaction or infection, people should summon emergency help or go immediately to an emergency room. If choking is due to obstructed airways, the Heimlich maneuver (an emergency procedure in which a person is grasped from behind in order to forcefully expel the obstruction) should be performed immediately. In severe cases a tracheotomy (an incision into the trachea through the neck below the larynx) must be performed.

Patients who suffer airway obstruction during sleep can be treated with a device similar to an oxygen mask that creates positive airway pressure and delivers a mixture of oxygen and air.

Prognosis

Many people are treated successfully for choking with no permanent effects. However, if treatment is unsuccessful, the person dies from lack of oxygen. In cases where the airway is restored after the critical period passes, there may be permanent brain damage.

Prevention

Watching children carefully to keep them from putting foreign objects in their mouth and avoiding giving young children food like raisins, round slices of hot dogs, and grapes can reduce the chance of choking in children. Adults should avoid heavy alcohol consumption when eating and avoid talking and laughing with food in their mouths. The risk of obstructive sleep apnea choking can be reduced by avoiding alcohol, tobacco smoking, tranquilizers, and sedatives before bed.

Resources

Organizations

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. http://www.americanheart.org.

Key terms

Trachea — The windpipe. A tube extending from below the voice box into the chest where it splits into two branches, the bronchi, that go to each lung.

Tracheotomy — The surgical creation of an opening in the trachea that functions as an alternative airway so that the patient may breathe.

choking/lung/pulmonary agents,

chemicals that cause severe irritation or swelling of the respiratory tract. Agents include ammonia, bromine, chlorine, osmium tetraoxide, phosgene, phosphine, and phosphorus. When inhaled, they cause damage to the lungs, either by their corrosive effects or by cytotoxicity, leading to respiratory distress and death from respiratory failure. Treatment consists of supportive care.

choking,

the condition in which a respiratory passage is blocked by constriction of the neck, an obstruction in the trachea, or swelling of the larynx. It is characterized by decreased movement of air through the airways or sudden coughing and a red face that rapidly becomes cyanotic. The person cannot breathe and clutches his or her throat. Emergency treatment requires removal of the obstruction and resuscitation if necessary. See also Heimlich maneuver.