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CHAPTER 24 Choking
Gregory H. Gilbert
Introduction
Choking emergencies are important in EMS because of their time‐sensitive nature. Victims of choking can rapidly progress from airway obstruction to loss of consciousness and cardiac arrest. Bystanders must act quickly to resolve true choking episodes. EMS personnel will likely arrive on scene several minutes after the onset of choking. Therefore, they must be prepared to manage a patient in advanced stages of crisis. Choking is an emergency that must be solved on scene; there is limited value in bringing an unresolved choking victim to the emergency department for definitive treatment [1].
Pathophysiology and epidemiology
Choking results from obstruction of the trachea by a foreign object. It is the nature of the so‐called “café coronary” that occurs during or shortly after a meal [2]. Although most choking episodes are associated with food, nonedible objects may also cause airway occlusion, particularly in children who may inadvertently aspirate coins, toys, or other objects. Choking can occur with liquids as well as solid substances [3].
Although most obstructions occur in the hypopharynx, a small foreign body may lodge in either bronchus, causing selective obstruction of a lung or lung segment. Because the right bronchus travels more directly off the trachea, most selective obstructions involve the right lung. These tend to be nonfatal and are much more common in the pediatric population (Table 24.1) [4].
Choking may be classified as partial or complete. A complete obstruction impairs the ability to breathe, to talk, and to cough and is an immediate life threat. A partial obstruction results in incomplete occlusion of the airway. In these instances, the individual may still be able to breathe,
