mandates immediate intervention such as the Heimlich maneuver, or direct laryngoscopy if ALS personnel are present. Other less invasive maneuvers may be appropriate in individuals with partial obstruction. However, in instances of partial obstruction with compromised air exchange, cyanosis, or loss of consciousness, the rescuer must approach the case as though it involves a complete airway obstruction [5].
The incidence of choking varies with age. For pediatrics, the majority are witnessed by the caregiver. While most of the 12,435 annual ED visits for pediatric choking episodes are nonfatal, there are approximately 175 deaths annually in the United States (Figure 24.1). Children younger than 1 year of age are most likely to choke, with food and liquids causing most of these episodes. While food remains the most common and dangerous, toddlers ages 1 to 4 years have the highest incidence of choking on nonfood items such as coins, latex balloons, or toys. The U.S. Consumer Product Safety Commission has instituted monitoring systems, legislation, and regulations to protect children from nonfood items, but no similar interventions exist for preventing food‐related choking in children or adults. Hard candy, gum, nuts. and hot dogs are just some of the high‐risk foods [3–6].
Choking incidence rises again at age 60 years from concurrent conditions impairing chewing and coordinated swallowing (e.g., Alzheimer dementia, stroke, drinking alcohol, poor dentition, seizure, or Parkinson disease). A prior choking episode significantly increases the chances of future choking [2, 4, 7].
Reviewing the epidemiology of choking victims in these at‐risk groups provides valuable information. Japan found that 10% of fatal choking incidents came from mochi rice and 25% of those deaths occurred in a 3‐day window around the New Year [8]. Community education regarding this danger, coupled with first aid and CPR training for the community and caregivers, led to fewer choking deaths in subsequent years [9].
Table 24.1 Ten leading causes of nonfatal injury emergency department visits 2001–2018
Source: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
| Age Groups | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Rank | 1 | 1‐4 | 5‐9 | 10‐14 | 15‐24 | 25‐34 | 35‐44 | 45‐54 | 55‐64 | 65+ | All Ages |
| 1 | Unintentional Fall 2,312,376 | Unintentional Fall 15,301,388 | Unintentional Fall 11,351,088 | Unintentional Fall 10,580,755 | Unintentional Struck by/Against 17,032,229 | Unintentional Fall 13,530,813 | Unintentional Fall 13,552,907 | Unintentional Fall 15,410,152 | Unintentional Fall 14,444,824 | Unintentional Fall 41,481,463 | Unintentional Fall 153,068,392 |
| 2 | Unintentional Struck by/Against 554,993 | Unintentional Struck by/Against 6,295,205 | Unintentional Struck by/Against 7,140,347 | Unintentional Struck by/Against 10,100,827 | Unintentional Fall 15,093,453 | Unintentional Overexertion 11,576,122 | Unintentional Overexertion 10,229,414 | Unintentional Overexertion 7,848,208 | Unintentional Struck by/Against 4,311,610 | Unintentional Struck by/Against 4,575,935 | Unintentional Struck by/Against 77,580,582 |
| 3 | Unintentional Other Bite/Sting 221,793 | Unintentional Other Bite/Sting 2,617,647 | Unintentional Cut/Pierce 1,996,896 | Unintentional Overexertion 4,994,013 | Unintentional MV‐Occupant 13,417,475 | Unintentional Struck by/Against 11,385,533 | Unintentional Struck by/Against 9,014,836 | Unintentional Struck by/Against 7,165,831 | Unintentional Overexertion 4,203,366 | Unintentional Overexertion 3,566,705 | Unintentional Overexertion 57,789,568 |
| 4 | Unintentional Foreign Body 176,287 | Unintentional Foreign Body 2,219,957 | Unintentional Other Bite/Sting 1,771,965 | Unintentional Cut/Pierce 2,372,524 | Unintentional Overexertion 12,495,035 | Unintentional MV‐Occupant 10,287,114 | Unintentional MV‐Occupant 7,756,641 | Unintentional MV‐Occupant 6,304,279 | Unintentional MV‐Occupant 3,914,121 | Unintentional MV‐Occupant 3,486,633 | Unintentional MV‐Occupant 48,532,866 |
| 5 | Unintentional Fire/Burn 173,831 | Unintentional Cut/Pierce 1,469,752 | Unintentional Pedal Cyclist 1,473,465 | Unintentional Pedal Cyclist 1,852,108 | Unintentional Cut/Pierce 8,038,092 | Unintentional Cut/Pierce 7,510,102 | Unintentional Cut/Pierce 5,972,740 | Unintentional Cut/Pierce 4,929,580 | Unintentional Cut/Pierce 3,087,781 | Unintentional Cut/Pierce 2,481,957 | Unintentional Cut/Pierce 37,971,682 |
| 6 | Unintentional Other Specified 143,148 | Unintentional Overexertion 1,368,694 | Unintentional Overexertion 1,408,912 | Unintentional Unknown/Unspecified 1,683,118 | Unintentional Other Specified 4,325,205 | Unintentional Other Specified 4,700,730 | Unintentional Other Specified 4,487,109 | Unintentional Other Specified 4,755,187 | Unintentional Other Specified 2,662,423 | Unintentional Other Bite/Sting 1,547,982 | Unintentional Other Specified 24,073,540 |
| 7 | Unintentional Inhalation/Suffocation 123,256 | Unintentional Other Specified 972,698 | Unintentional MV‐Occupant 1,137,559 | Unintentional MV‐Occupant 1,489,226 | Unintentional Other Bite/Sting 3,077,272 | Unintentional Poisoning 3,111,629 | Unintentional Poisoning 3,171,028 | Unintentional Poisoning 3,505,168 |
