# Unresponse choking pt.



## Explorer127 (Jan 8, 2009)

**Unresponsive**

The pt has a pulse, but isn't breathing due to an airway obstruction-

They get CPR with a finger-sweep..

Can't the trauma from the compressions cause the patient to go into cardiac arrest?


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## marineman (Jan 8, 2009)

I'll go on a limb and say possibly but I haven't personally heard of it. The thing is if you don't get the item dislodged from their throat you have a 100% guarantee that they will go into arrest. Take your pick.


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## enjoynz (Jan 8, 2009)

We don't start CPR until the patient has stopped breathing and there is NO pulse. We only start compressions then!

After checking the airway first and doing a finger sweep,
We give them 4 abdominal thrusts if they have collapsed or if they are still standing, we do the Heimlich Manoeuvre, then recheck the airway.

This link may help!
http://www.patient.co.uk/showdoc/40025193/

Cheers Enjoynz

P.S.   It does say to start CPR in an unconcious person...but that would be after trying the Abdo trusts first!


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## enjoynz (Jan 8, 2009)

Just to add to that last post of mine...as we were talking about it in the chatroom.
Re the Finger sweep...it's just that....not putting a finger down the patients throat. And then we only do it to clear the mouth!
Leave the medic's with all the toys, to go fishing!!!

Cheers Enjoynz


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## EMTinNEPA (Jan 8, 2009)

Not CPR, "chest thrusts".  Same idea, only not continuous, and with a different goal.


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## DR_KSIDE (Jan 8, 2009)

Explorer127 said:


> **Unresponsive**
> 
> The pt has a pulse, but isn't breathing due to an airway obstruction-
> 
> ...





** As an AHA Instructor I no longer teach the finger sweep UNLESS you can SEE the obstruction, and this is only when I teach the Healthcare provider course. The Heartsaver course I don't mention the finger sweep at all. As it was mentioned in another thread, the chest compressions are thought to do two jobs in an unconscious pt, keep circulation and to help possibly dislodge the obstruction. We teach that you do abdominal thrusts on the the pt, once the pt becomes unconscious you switch to doing the complete CPR cycle.


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## Jon (Jan 8, 2009)

DR_KSIDE said:


> ** As an AHA Instructor I no longer teach the finger sweep UNLESS you can SEE the obstruction, and this is only when I teach the Healthcare provider course. The Heartsaver course I don't mention the finger sweep at all. As it was mentioned in another thread, the chest compressions are thought to do two jobs in an unconscious pt, keep circulation and to help possibly dislodge the obstruction. We teach that you do abdominal thrusts on the the pt, once the pt becomes unconscious you switch to doing the complete CPR cycle.


+1.

In any case, the current teaching is that if you are doing the Heimlich and they become unconscious, you then start CPR, including giving breaths... in case it does work.


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## johnnyreb132 (Jan 8, 2009)

*Clairification*

Y'all are causing me to doubt my memory:wacko:.  So for AHA Healthcare Provider CPR certification, 

1) Blind finger sweeps ONLY on *adults*

2) For *infants*, 5 back blows and 5 chest thrusts 

3) If patient is too large for the provider, have the patient lay supine and deliver 5 chest thrusts

Only things I'm not 100% about are when to begin CPR, _besides if the obstruction has been dislodged and it is needed_, whether you deliver the 5 chest thrusts on an unconscious supine patient, _as I originally believed_, and where you precisely deliver the chest thrusts in an infant, _the dumbed down explanation please like how they say the nipple line for CPR that way I don't really have to think about it at that much since the British explanation made me question this as well_.


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## marineman (Jan 8, 2009)

With the current AHA standards we don't do blind finger sweeps ever on anybody. Only time your hand goes in their mouth is if you see the object and even then a forceps is better. 

In an unresponsive choking patient you do normal CPR cycles the only difference is that you look for the object in their mouth each time you give breaths.


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## Jon (Jan 8, 2009)

JohnnyReb,

Apologies... but THERE ARE NO BLIND FINGER SWEEPS AT ALL. EVER. anymore. That is on the ECC 2005 Guidelines

Jon
AHA BLS Instructor


***Edit - MarineMan beat me to the punch. He is correct***


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## enjoynz (Jan 8, 2009)

OK...I thought I'd check out an American book, so picked up a Brady Emergency Care.

It says for an unconcious adult or child (not infant)...place the pt in the supine postion and begin CPR.
If (and only if)you see an object, remove it by sweeping your fingers in the pt's mouth...from one side to the other.

I do know of one case here, where a choking patient died because the object was blown further down their airway, because those attending, started CPR straight off.
I guess that was before we started with the new CPR... 30 compressions before delivering a breath.
Although I still think doing abdominal thrusts first..would give more of a push of air back up the airway, than a compression,that's just my opinion though!

And I also agree with Jon...no Blind sweeps...something I forgot to mention!

Cheers Enjoynz


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## johnnyreb132 (Jan 8, 2009)

*Correction*

Sorry, I dug my certification card out of my wallet,  checked, and its for ASHI...learned my lesson there:blush: 

Don't know if there is any real difference between ASHI and AHA guidelines but I'll remember not to do blind finger sweeps. Luckily the Heimlich maneuver has always worked for me so I've never had to do finger sweeps, now that I have probably just cursed myself.  Thanks!


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## traumateam1 (Jan 10, 2009)

Only finger sweep if you see an object when you visually inspect airway.
Other than that.. you are doing chest thrusts, same thing as CPR.. except you are doing it to a patient with a beating heart.

If you can break ribs by doing CPR, than you can break ribs doing chest thrusts. "Life over limb". If we break ribs, it sucks.. but we save their lives.

In the infant its 5 chest thrusts followed by 5 back blows.


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## BossyCow (Jan 10, 2009)

johnnyreb132 said:


> Sorry, I dug my certification card out of my wallet,  checked, and its for ASHI...learned my lesson there:blush:
> 
> Don't know if there is any real difference between ASHI and AHA guidelines but I'll remember not to do blind finger sweeps. Luckily the Heimlich maneuver has always worked for me so I've never had to do finger sweeps, now that I have probably just cursed myself.  Thanks!



ASHI has been updated to match AHA, your cert may be from before this happened.


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## BossyCow (Jan 10, 2009)

enjoynz said:


> I do know of one case here, where a choking patient died because the object was blown further down their airway, because those attending, started CPR straight off.
> I guess that was before we started with the new CPR... 30 compressions before delivering a breath.



No, the patient died because of the obstruction to the airway. I've gotten into many discussions with people about this. If the object is going to be 'blown further down the airway' by CPR breaths as they are supposed to be done, then the object is movable and the heimlich should have moved it. When an object is lodged deeply enough to occlude an airway the attempt to breathe (remember we are breathing here, not attempting to inflate the pt's lungs like a balloon) should be just enough to determine if the passage of air is possible past the obstruction. One of our greatest faults in CPR is over-enthusiastic 'breathing' I've had students actually blow out the lungs on my dummies or blow so hard that they disconnect the place where the connecting tube goes into the dummy's lungs.


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## Melbourne MICA (Jan 10, 2009)

*The "Blade"*

Why bother with finger sweeps? Are EMT-basics in the US not allowed to use the laryngoscope and magills? If the pt was an unconscious non-breathing heroin OD would you not inspect the airway first visually then with a blade before commencing ventilations with an OP/NP inserted as well? 

I thought the heimlich was a no go these days and lateral chest thrusts then ventilations to move the obstruction down the R main bronchus the next steps if the pt is unconscious and obstructed and all steps have failed. If you still can't clear the airway with all the steps you may well go to a crike otherwise the pt is dead.

Not many obstructions will go below the level of the cords.

As for CPR - if the pt had a pulse only EAR would be commenced except in brady children. Not so? If you did'nt know there was an obstruction to begin with you would soon find out when you tried to bag to no effect - hence a blade would/should go down the gullett to have a good look to begin with anyway if the pt is unsconscious - IE GCS 3.

MM


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## mikeylikesit (Jan 12, 2009)

if you unsure before starting CPR just give a few chest compressions, it will only help remove the FBAO. Trauma resulting in CPR with chocking? never heard of anything negative that wasn't already there before the crew started.


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