The Resuscitation Council UK guidelines (2000a) identify a three-stage approach to recognising and responding to the choking adult. These relate to the choking conscious casualty, the casualty who is conscious but deteriorating and finally the unconscious casualty.

Fig. 5.5a Putting the patient in the recovery position.

Fig. 5.5b Putting the patient in the recovery position.

Conscious, breathing casualty

If the casualty appears to be choking but is conscious and coughing, no further action should be necessary other than to encourage continued coughing, observing for relief of the obstruction.

Casualty is deteriorating

If the casualty becomes tired, has been unable to relieve the obstruction or exhibits signs of cyanosis, such as blueness around the lips, perform the following manoeuvres.

• Commence back blows. Clear the mouth of any obvious obstruction. Stand to the side and slightly behind the casualty. Encourage the casualty to lean forwards, to support outward projection of any obstruction. Deliver up to five blows with the heel of your hand, between the scapulae (see Figure 5.6).

• If the obstruction persists, start abdominal thrusts. Stand behind the casualty, wrap your arms around the waist and ensure the casualty is leaning forwards. Make a fist with one hand and close the other hand on top of it. Position your hands below the xiphisternum. Pull your hands inwards and upwards (see Figure 5.7). Check to see if the obstruction has cleared.

• Up to five back blows and five abdominal thrusts can be alternated until the obstruction is cleared.

Casualty collapses and is unconscious

If back blows and abdominal thrusts fail and the casualty becomes unconscious, a sequence of life support is recommended, as in the managing of the choking adult algorithm (Resuscitation Council UK 2000a) (see Figure 5.8). If there is no evidence of breathing then ventilation should be attempted. Where this fails, chest compressions should be maintained. If it is possible to ventilate the casualty, circulation should be checked. If this is absent then start BLS.

Fig. 5.8 Management of choking in adults (reprinted with permission from the Resuscitation Council UK).

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