A breathtaking experience
Each year, 3,000–4,000 Americans die from choking, or pulmonary
aspiration. Choking happens mainly during meals, and meat is the chief
culprit. But food and small objects aren’t the only causes. Swelling
from a severe allergic reaction — or in an unconscious person,
the tongue — can prevent air from flowing into the lungs.
Things go down the wrong way and cause us to choke because of an anatomical
flaw that we share with most other air-breathing vertebrates. Our breathing
tube, the windpipe or trachea, isn’t segregated from the one we
use for swallowing, the esophagus. Air, food, and drink all share the
same commute down the throat until the trachea branches off, right around
your Adam’s apple.
Normally, the epiglottis keeps food and drink from going down the windpipe.
This sturdy flap of cartilage is designed to snap shut automatically
when we swallow, closing off the airway and shunting the sustenance down
the esophagus to meet its digestive fate.
Another automatic body function, the gag reflex, sometimes keeps unwanted
objects out of the upper respiratory tract by triggering a reverse contraction
of throat muscles. Gagging can feel like choking, but it’s not
the same. In fact, the gag reflex can prevent choking by clearing the
throat of an unwanted substance.
Who’s at risk?
Choking is most likely to occur in very young children, particularly
toddlers, and in the elderly. Toddlers, those wonderfully curious creatures,
like to explore their surroundings with their mouths — which often
means putting things in them. Older people are vulnerable because they
lose some of the reflexes and muscle tone needed to eject an object from
the trachea. A condition like Parkinson’s disease makes an older
person even more vulnerable. Cognitive disorders like Alzheimer’s
disease can lead to swallowing difficulties and a greater likelihood
Drinking can be a contributing factor because alcohol suppresses the
airway’s protective reflexes.
Signs of choking
Once you know the signs of choking, they’re easy to spot even
without medical training. They include
- grabbing at the throat
- difficulty speaking
- weak, ineffective cough or labored breathing, sometimes accompanied
by wheezing or whistling
- face turning blue from lack of oxygen (cyanosis).
When you see someone choking, speed is of the essence. Without adequate
oxygen, the person will quickly lose consciousness and could suffer permanent
brain damage in as little as four to five minutes.
What should you do?
First ask him or her, “Are you choking?” If the person indicates
yes, then ask in a calm voice, “Can you speak?” Don’t
perform the Heimlich maneuver on anyone who’s able to talk. “If
a person can speak, there isn’t a major obstruction and the airway
is at least partially intact,” says Dr. Toby Nagurney, an emergency
department physician at Massachusetts General Hospital. In this situation,
- Encourage the person to continue breathing and to cough forcefully,
which is the best way to dislodge items stuck in the airway.
- Stay with the person until he or she feels better or medically trained
personnel have arrived.
- If someone is vomiting or seems to be losing consciousness, lay the
person on his or her side. An upright position could be dangerous because
an object that is partially blocking the trachea could be pulled further
into it, creating a complete obstruction.
If the person can’t talk, then you should try the Heimlich maneuver
while having someone call 911 for help.
August 2006 Update
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