How Does Cpr Differ In An Unresponsive Adult Choking Victim

Cardiopulmonary resuscitation (CPR) is a life-saving technique used when someone's breathing or heart has stopped. However, when the unresponsive person is also choking, the standard CPR procedure is modified to address the airway obstruction. This article explains how CPR differs in an unresponsive adult choking victim, providing a detailed guide for responders.

Recognizing the Signs of Choking

Before initiating CPR, it's crucial to identify whether the unresponsive adult is choking. Here are some key signs:

Sudden inability to speak, cough, or breathe: This is a primary indicator that the airway is blocked.
Clutching the throat: The universal sign for choking.
Bluish skin color (cyanosis): Indicates a lack of oxygen.
Loss of consciousness: If the obstruction is not cleared quickly, the person may become unresponsive.

If the person is responsive but choking, encourage them to cough forcefully. If they are unable to dislodge the object on their own, abdominal thrusts (Heimlich maneuver) should be performed. However, if the person becomes unresponsive, the protocol shifts to modified CPR.

Initial Steps: Assessing Responsiveness and Activating Emergency Services

The first steps are similar to standard CPR:

Assess Responsiveness: Gently tap or shake the person's shoulder and shout, "Are you okay?" If there is no response, proceed to the next step.
Call for Help: Immediately call emergency services (911 in the US) or ask someone else to do so. If you are alone, use your mobile phone on speaker mode to call for help, so your hands are free.
Position the Person: Lay the person on their back on a firm, flat surface.

Modified CPR for Unresponsive Choking Adult

The key difference in CPR for a choking victim is the addition of checking for and removing the obstruction in the airway. Here’s a step-by-step guide:

1. Chest Compressions

Hand Placement: Place the heel of one hand in the center of the person's chest, between the nipples. Put your other hand on top of the first, interlacing your fingers.
Compression Depth: Compress the chest at least 2 inches (5 cm) but no more than 2.4 inches (6 cm).
Compression Rate: Perform compressions at a rate of 100-120 compressions per minute. It’s helpful to use a metronome app on your phone if you’re not used to giving compressions.
Technique: Use your body weight to deliver effective compressions, keeping your arms straight and shoulders directly over your hands.

Chest compressions are crucial, even in choking situations, as they create pressure that may help dislodge the object.

2. Check for an Obstruction Before Rescue Breaths

Open the Airway: Use the head-tilt/chin-lift maneuver. Place one hand on the person's forehead and gently tilt the head back. With the fingertips of your other hand, lift the chin upward. Avoid pressing deeply into the soft tissue under the chin, as this may obstruct the airway further.
Look for an Obstruction: Open the person’s mouth and look for any visible object.
Finger Sweep (If Object is Visible): If you see an object, use a finger sweep to remove it. Use your index finger to hook the object and carefully remove it from the mouth. Be cautious not to push the object further down the airway. Note: Finger sweeps are only recommended if you can see the object. Blind finger sweeps can push the object further down.

3. Attempt Rescue Breaths

Prepare to Give Breaths: Pinch the person's nose closed with your thumb and index finger of the hand on their forehead. Allow the mouth to open slightly, but maintain the chin lift.
Give Breaths: Take a normal breath and seal your mouth over the person's mouth, creating a tight seal. Give two rescue breaths, each lasting about one second. Watch for the chest to rise with each breath.
Check Effectiveness: If the chest does not rise, reposition the head and try again. The airway may still be obstructed.

4. Continue CPR with Modifications

Continue Compressions and Breaths: Alternate between 30 chest compressions and two rescue breaths. After each set of compressions, check the mouth for an obstruction before giving breaths.
If Breaths Don’t Go In: If your breaths still don't make the chest rise, assume the airway is still blocked. Continue chest compressions. Each chest compression may create enough pressure to dislodge the object. After each set of 30 compressions, recheck the mouth for the obstruction.
Repeat: Continue this cycle of compressions, checking for obstructions, and attempting breaths until one of the following occurs:
- The object is removed and the chest rises with breaths.
- The person starts to breathe on their own.
- Emergency services arrive and take over.
- You are too exhausted to continue.

Common Mistakes to Avoid

Blind Finger Sweeps: Avoid performing blind finger sweeps, as they can push the object further into the airway. Only perform a finger sweep if you can see the object.
Neglecting Chest Compressions: Chest compressions are essential, even if you suspect choking. They help create pressure that can dislodge the object and maintain circulation.
Giving Excessive Breaths: Give only two breaths, each lasting about one second. Excessive breaths can cause gastric inflation, which can lead to vomiting and further complications.
Not Calling for Help: Always call emergency services or ask someone else to do so. Professional medical help is crucial for managing the situation.

Special Considerations

Pregnant Women: If the unresponsive choking victim is pregnant, perform chest compressions as usual. Avoid abdominal thrusts, as they are not effective in unresponsive individuals.
Obese Individuals: Perform chest compressions as usual. Focus on delivering effective compressions to create the necessary pressure to dislodge the object.
Infants and Children: CPR techniques for infants and children differ from those for adults. It is crucial to be trained in pediatric CPR to respond effectively to choking in these age groups.

The Science Behind Modified CPR for Choking

Modified CPR for choking incorporates elements of standard CPR while addressing the unique challenge of an obstructed airway. Here's the scientific rationale behind each modification:

Chest Compressions and Airway Obstruction

Mechanism: Chest compressions generate intrathoracic pressure, which can create an artificial cough. This pressure can help force the obstructing object upwards and out of the airway.
Evidence: Studies have shown that chest compressions alone can dislodge foreign objects in some choking victims. The effectiveness is enhanced when combined with regular checks for the object in the mouth.

Importance of Airway Checks

Direct Visualization: Opening the airway with the head-tilt/chin-lift maneuver allows for direct visualization of the oropharynx. This visual check enables the rescuer to identify and manually remove the obstructing object.
Preventing Further Obstruction: The head-tilt/chin-lift maneuver helps to align the airway, potentially creating a better path for air if any space remains around the obstruction.

Rescue Breaths and Their Role

Potential Effectiveness: If the airway is only partially obstructed, rescue breaths may deliver some oxygen to the lungs. Even minimal oxygenation can prolong the time before irreversible brain damage occurs.
Risk Management: If rescue breaths do not cause the chest to rise, it confirms a complete airway obstruction. The rescuer must then focus on chest compressions to try and dislodge the object, rather than wasting time on ineffective breaths.

Finger Sweeps: When and Why

Rationale: A finger sweep is intended to remove a visible object from the mouth without pushing it further down the airway.
Caution: Guidelines emphasize avoiding blind finger sweeps because they can cause the object to become more deeply lodged, exacerbating the obstruction.

Continuous Cycle of Assessment and Action

Integration: The cycle of compressions, airway checks, and attempted rescue breaths is designed to maximize the chances of clearing the obstruction while maintaining basic circulation.
Adaptive Approach: This approach allows the rescuer to adapt to the changing situation, adjusting their actions based on whether the obstruction is cleared or remains in place.

Considerations for Special Populations

Pregnancy: Standard abdominal thrusts are not recommended for unresponsive pregnant women due to the risk of injury to the uterus and fetus. Chest compressions are the preferred method for generating intrathoracic pressure in these cases.
Obesity: In obese individuals, the rescuer may need to use more force during chest compressions to achieve adequate depth, which is essential for creating the necessary pressure to dislodge the object.

Training and Preparedness

Knowing how to perform CPR on an unresponsive choking adult can significantly increase the chances of survival. Here are steps you can take to be prepared:

Take a CPR Course: Enroll in a certified CPR course that covers adult, child, and infant CPR techniques. These courses also teach how to handle choking emergencies.
Regular Refresher Courses: CPR guidelines are updated periodically. Take refresher courses to stay current with the latest recommendations.
Practice Regularly: Practice CPR techniques on mannequins to build confidence and muscle memory.
Keep Emergency Numbers Handy: Have emergency numbers readily available on your phone or posted in a visible location.
Educate Family and Friends: Share your knowledge with family and friends, so they are also prepared to respond in an emergency.

Conclusion

Performing CPR on an unresponsive adult choking victim requires a modified approach that combines standard CPR techniques with specific actions to address the airway obstruction. By following these steps, you can provide critical support until professional medical help arrives, significantly improving the person's chances of survival. Remember, immediate action and proper technique are key to saving a life.

Frequently Asked Questions (FAQ)

Q: What is the first thing I should do if I find someone unresponsive and possibly choking?

A: The first thing you should do is assess their responsiveness by tapping their shoulder and shouting, "Are you okay?" If there is no response, immediately call for help (911 in the US) and begin CPR.

Q: Should I still perform chest compressions if I suspect the person is choking?

A: Yes, chest compressions are crucial. They create pressure that can help dislodge the object and maintain circulation.

Q: When should I perform a finger sweep?

A: Only perform a finger sweep if you can see the object in the person's mouth. Avoid blind finger sweeps, as they can push the object further down the airway.

Q: What if the person is pregnant?

A: If the unresponsive choking victim is pregnant, perform chest compressions as usual. Avoid abdominal thrusts, as they are not effective in unresponsive individuals.

Q: How often should I check for an obstruction during CPR?

A: After each set of 30 chest compressions, open the person’s mouth and look for any visible object.

Q: What should I do if rescue breaths don’t make the chest rise?

A: If your breaths still don't make the chest rise, assume the airway is still blocked. Continue chest compressions. Each chest compression may create enough pressure to dislodge the object. After each set of 30 compressions, recheck the mouth for the obstruction.

Q: Is it possible to learn CPR online?

A: While online resources can provide valuable information, it is best to take a hands-on CPR course. These courses allow you to practice techniques on mannequins and receive feedback from certified instructors.

Q: How often should I renew my CPR certification?

A: CPR certifications typically last for two years. It is important to renew your certification regularly to stay up-to-date with the latest guidelines and techniques.

Q: Can I cause harm by performing CPR?

A: While there is a risk of injury (such as broken ribs), the potential benefits of CPR far outweigh the risks. Performing CPR can save a life, and it is better to attempt CPR than to do nothing at all.

Q: What if I am alone and don't know CPR?

A: If you are alone and don't know CPR, call emergency services immediately. They may be able to provide guidance over the phone until help arrives. Additionally, many emergency services have dispatchers trained to provide CPR instructions over the phone.