Choking is lethal and the leading cause of accidental death. In the worst situations, when the Heimlich maneuver fails, a tracheostomy, or cricothyroidotomy, is required to save the victim's life. This is a procedure that is used as a last resort, as it is very dangerous and only medical personnel are authorized to perform it. Remember that the very first thing you really need to do in an emergency is to specifically ask a person to call for help.
Steps
Part 1 of 3: Assessing the Choking
Step 1. Look for the classic signs of choking
A person who cannot breathe shows this symptomatology:
- Difficulty in breathing.
- Loud breathing.
- Inability to speak.
- Inability to cough.
- Bluish skin (called "cyanosis" caused by insufficient oxygen in the blood).
- Decreased level of consciousness.
Step 2. Ask someone to call an ambulance
It is essential to call for medical assistance as soon as you notice that the victim is choking, because lack of oxygen to the brain for more than 3-5 minutes potentially leads to death.
Step 3. Remember the advice the Red Cross gives in case of choking
The initial protocol involves alternating five "blows on the back" with five "abdominal thrusts" (Heimlich maneuver), repeating the sequence until the foreign body is moved, help arrives or the victim faints from asphyxiation.
- Back strikes are quick movements performed with the part of the hand closest to the wrist. You will need to aim for the space between the victim's shoulder blades after tilting them forward, so that their torso is parallel to the ground. In this position, if you can move the obstruction, the object could fall out of the person's airways.
- The shots are entirely optional; you can do them if you have been trained to do so, otherwise you can avoid them and focus on "abdominal thrusts" (see next section).
Part 2 of 3: Performing the "Abdominal Thrusts"
Step 1. Hug the victim from behind
Bring your arms forward surrounding her abdomen.
- The victim can be sitting or standing while you stand behind him. If the person is on the ground, lie down behind them.
- If he is unconscious, first check his pulse. If there is no heartbeat, proceed with cardiopulmonary resuscitation at the rate of 100 chest compressions per minute. In this phase, avoid abdominal thrusts and also artificial respiration, as the airways are blocked.
Step 2. Close your dominant hand into a fist
The thumb must be inside the fist. Place your hand somewhere between the victim's navel and breastbone.
Step 3. Wrap your fist with your second hand and hold it firmly
The thumbs must be away from the person's body to avoid causing harm.
Step 4. Push in and up by rapidly pressing her abdomen with sharp, sharp strokes
Your hands must perform a movement similar to the letter "J", from bottom to top.
Step 5. Continue with the Heimlich maneuver
Perform it while the victim is making breathing noises (including rattles, whistles, or any sound of moving air).
- If the victim is absolutely unable to breathe and the Heimlich maneuver does not move the obstruction, proceed with a tracheostomy.
- This is a risky procedure, which must be considered as a last resort; if possible let a doctor perform it.
Part 3 of 3: Perform the Tracheostomy
Step 1. Find the area above the cricothyroid membrane on the victim's neck
This is a soft spot in the throat where the incision is made.
- To locate it, first find the Adam's apple, that is, the larynx.
- Slide a finger down along the Adam's apple until you feel another protuberance; this is the cricoid cartilage.
- There is a slight depression between the Adam's apple and the cricoid cartilage and this is exactly where you need to make the cut.
Step 2. Make a horizontal cut of 1.2 cm and equally deep
Right below the cut you will see the cricothyroid membrane (an elastic, yellowish tissue that sits between the surrounding layers of cartilage). Make an incision on the membrane - one hole is enough to gain access to the airway.
As this is an emergency procedure, it is permissible to start without sterilization. Time is of the essence and concerns about possible infection will be addressed later when help arrives
Step 3. Keep the incision open to facilitate opening
To do this, insert a 5 cm straw into the trachea.
- You can suck in the straw to make sure that the air comes out and that the tube is properly inserted into the victim's windpipe.
- Alternatively, you can also use the straw of a ballpoint pen (after removing the inner tube with the ink).
Step 4. Blow twice into the straw
Each insufflation should last approximately one second. Hopefully the victim will resume breathing on their own (you should see their chest rise and fall).
- If the victim regains spontaneous breathing, continue to monitor his condition and wait for help who will take care of the situation.
- If she doesn't start breathing on her own, then continue with the insufflations and heart rate control. If there is no pulse, proceed with cardiopulmonary resuscitation.
- Cardiopulmonary resuscitation involves a sequence of 30 chest compressions (at the rate of 100 compressions per minute) followed by 2 breaths through the tracheal tube. Repeat this cycle about 5 times.
- If the victim continues to be unresponsive after 5 cycles, then use an AED if you have been trained to use it. If not, follow the instructions the 118 operator gives you over the phone while you wait for the ambulance.
- Remember that if you have not been trained in CPR, chest compressions are far more important than insufflations; for this reason you can limit yourself to them (with a rate of 100 compressions per minute) and neglect artificial respiration until medical personnel arrive. Remember that doing something is better than doing nothing, as a person's life hangs in the balance!
Advice
- While the victim is conscious, reassure and soothe them. The panic only makes the situation worse.
- Obtain a diagram of the cricothyroid membrane as a visual reference.
Warnings
- This is an extremely dangerous procedure. There is a high risk of death or other complications for the victim if the maneuver is performed incorrectly.
- Only perform a tracheostomy as a last resort, when you have no alternative and there are no doctors nearby to refer the emergency to.
- If possible, make sure the tube is clean, otherwise infections and even more serious complications could develop.
- Be aware of the legal implications of a failed tracheostomy; you may be sued or charged with the person's death.
