choking


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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.

chok·ing

pnigophobia.

chok·ing

(chōk'ing)
Upper airway obstruction resulting from a foreign object in the trachea or oropharynx, laryngeal spasm or edema, or external compression of the neck. A life-threatening situation such as asphyxia, hypoxia, and death may occur if the victim is unable to clear the airway by coughing. The inability to speak indicates a complete airway obstruction. The universal sign for choking is the grasping of the throat by the person choking.
See also: Heimlich maneuver

choking

Partial or total obstruction of the main air passage (the LARYNX or TRACHEA) by foreign body or external pressure. This induces a protective COUGH response which often clears the obstruction.
References in periodicals archive ?
alsw Research by St John Ambulance reveals that four-fifths of parents would not know how to save their baby from choking.
The swallowing mechanism is all at the front of the mouth, they are front feeders and they know if there's something there that they don't like they just spit it out, so the best advice for parents is not to panic if you think your child is choking act in a calm manner starting with the back slaps.
* By 12 months of age, nearly all babies had been offered at least one food which could be considered to have presented a choking hazard (such as a piece of raw apple or small diced meat).
Meyers and Bond (1989) evaluated a compilation of 195 choking incidents reported by the CPSC between July 1973 and May 1983, roughly a ten-year span, and found that 57% of the children's products whose size was available had diameters larger than the 1.25-inch standard [6].
[6-8] Indian data on choking phobia is almost not available, though it is not uncommonly encountered in routine clinical practice by otorhinolaryngologists and psychiatrists.
An employee at the Deupree House in Cincinnati, where Dr Heimlich lives, said the retired chest surgeon was in the room when an 87-year-old woman began choking.
LWMC Managing Director Khalid Majeed paid visits to several sensitive choking points to review arrangements particularly at walled city, Data Ganj Bakhsh town, Shalamar town and Gulberg town.
A few months later, Ami went along to a St John Ambulance first aid course to learn life-saving skills, including how to deal with someone who is choking.
First aid charity St John Ambulance revealed more than four-fifths of West Yorkshire parents (81%) do not know how to save a baby from choking, despite four in 10 having witnessed such an incident.
St John Ambulance has revealed that two-thirds of parents in Newcastle don't know the correct technique for saving their baby from choking, despite it being a major fear and 42% having witnessed it.
Relatives of an autistic student who died after choking on lunch at school are planning a lawsuit they hope will spur closer supervision of special-needs students, their lawyer said Friday.
The House Committee on Oversight and Government Reform, chaired by Darrell Issa (R-Calif.), conducted hearings and issued a report titled: "The Department of Justice's 'Operation Choke Point': Illegally Choking Off Legitimate Businesses?"