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Choking usually results from foreign body aspiration in the
form of small toys, pieces of food like nuts and candies, put inside the
nose by little children. These things obstruct the airway when it lodge on
the bronchus and the airway obstruction is a medical emergency.
Initially the condition can be asymptomatic or it may cause a mild
cough.When severe there can be coughing out of blood with either partial or
complete obstruction of the lungs. A chest x-ray can be done but a normal
result does not rule out foreign body aspiration nor does it help in
improving the condition of the child.
If the child is conscious nothing should be done to dislodge the foreign
body. He should be immediately brought to a surgeon who can do laryngoscopy
or bronchoscopy.
If the child is unconscious because of airway obstruction, he should be
resuscitated immediately by applying up to eight abdominal thrusts (Heimlich
maneuver) until the foreign body is dislodged.
This maneuver is done in several ways depending on the age of the child. In
a child less than 7 years old, he should placed on his back with you on left
his side. Position the heel of your left hand on his abdomen between the
umbilicus and the rib cage. Using your hand perform rapid inward and upward
thrusts.
In an older child the procedure can be with the child in the same position
as above or in sitting or standing position. In the sitting or standing
position you should stand behind him, wrap your arms around his waist, and
make a fist with your right hand. Your left hand should be grasping the
right while making a quick upward thrust in the abdomen. Make sure that the
thumb of the right fist is against his midline abdomen slightly below the
xiphoid process and above the umbilicus.
This procedure can be done alternately with mouth-to-mouth resuscitation if
there is no spontaneous respiration. If the maneuver fails open the mouth
and lift the jaw forward.This position improves the respiration in an
unconscious child. The head of the child is placed in a “sniffing position”
avoiding hyperextension to prevent airway obstruction. A foreign body inside
the mouth can be manually extracted using a forcep.
If everything fails then intubation or cricothyroidotomy should be done.
This must be done by a surgeon.
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