# CPR on Choking Victim



## MrPookie (Jul 25, 2008)

Hello.  I have a CPR practical on Monday, and realize that I am unsure about a step in the process of helping a choking victim.  

If I came across a choking adult, according to my book, I am supposed to:

1)  Ask them if they're choking
2)  Perform the Heimlich maneuver.
3)  If they go unconscious, lay them down and do I:

      a)  Begin compressions and breathing 
                  or do I still have to
      b)  Look listen and feel for breathing, give two breaths, check the pulse,        THEN perform compressions and breathing.

I am unsure if I skip the assessment part and go straight to compressions and breathing if I know they are unresponsive due to choking.

Any help would be greatly appreciated.


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## taporsnap44 (Jul 25, 2008)

In the AHA book I have the steps say if you the victim is unresponsive because of choking you open the airway remove the object if you see it, and begin CPR. The chart says to provide 2 breaths, check for pulse. If no pulse and no breathning, perform chest compressions and attach the AED.


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## Flight-LP (Jul 26, 2008)

It doesn't matter if they have a pulse or not. You start compressions if they go unconscious.

You do not need to check it and you certainly don't grab and attach an AED. The compressions in this case is not primarily for circulation and perfusion, it is for attempting to unlodge the obstruction. 

Waste time and then check the pulse.............You probably will find it gone!


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## johnrsemt (Jul 26, 2008)

plus you don't need to assess them since you already know what happened and why they went unconscious.  you were there and watched them do it.


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## MrPookie (Jul 26, 2008)

johnrsemt said:


> plus you don't need to assess them since you already know what happened and why they went unconscious.  you were there and watched them do it.



That's what I was thinking.  So I guess if you saw somebody choking, you perform the Heimlich.  Then, if they go unresponsive, you would skip getting the AED, skip the look, listening, and feeling for breaths, skip the pulse, just give two breaths while looking for the obstruction, and then start chest compressions?


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## johnrsemt (Jul 26, 2008)

correct;

    If you are around other people when it starts,  have someone else call 911, and get an AED if one is available.    
   Because if they do go unresponsive;  but you get the choking object out with Chest compressions, the pt may still not be breathing or have a pulse;  that is why you need the AED.

   And as a Paramedic I would rather respond on a choking pt, who isn't any longer; and not be needed    but it would give us a few minute headstart in case we were needed.


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## MrPookie (Jul 26, 2008)

Thanks a lot for the replies.  This made sense when I started thinking about the ABC's, and how the airway has to be taken care of first.  I appreciate the help.


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## BirdtheEMTB (Jul 27, 2008)

Direct from my Handy Dandy BLS Field Guide.....
1. If patient can not talk or has stridor, or cyanosis:
2. Perform Heimlich Maneuver, Repeat until successful or pt. is unconscious:
3. Begin CPR/ Call for assistance
4. Open airway; head tilt-chin lift (look and remove object if visible):
5. Ventilate with two breaths..if unable:
6. Reposition head; attemt to ventilat..if unable:
7. Perform chest compressions (30:2)
8. Repeat: inspect mouth..remove object..ventilate...chest compressions until successful.
9. (intermediate in some states) consider laryngoscopy and removal of object by forceps, ET intubation, cricothyrotomy.
10.
If pt. resumes breathing, place in the recovery position.h34r:


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## johnrsemt (Jul 27, 2008)

*calling 911*

All the books and training say "call 911 when the choking patient becomes unresponsive":    As a CPR instructor and a Paramedic  CALL 911 AS SOON AS YOU START ABDOMINAL THRUSTS ON A CONSCIOUS, CHOKING PATIENT.    
    give your self the head start on definitve care if the patient does go unresponsive.    I would rather show up and not be needed than be the few minutes longer when we are needed.


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## MrPookie (Jul 27, 2008)

Helpful responses, helpful responses.  I am definitely learning, and thanks to all this studying I've been cramming in, the reasons for the above steps are actually making sense.  The EMT-B class (even though not as rigorous as higher levels) can definitely be discouraging and the assistance from people on here helps to make it a little more bearable ^_^


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## BirdtheEMTB (Jul 27, 2008)

are you being tested from the American Heart, or Red Cross standards?


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## MrPookie (Jul 27, 2008)

BirdtheEMTB said:


> are you being tested from the American Heart, or Red Cross standards?



Our book is AHA.  Do they have different protocols from Red Cross?


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## mycrofft (Jul 28, 2008)

*Oh my aching head. AHA versus ARC*

Yes, I think they get together to make sure their annual repainting of the Titanic's deckchairs does NOT result in identical standards. I'll spare you the fiasco of 1978.

The only field CPR I have seen work was on a pt who was choking, we were sent for, and she coded as we arrived. Do activate EMS, any pt who loses consciousness and airway (with one exception maybe) will require hosp in any event, go to step two and try to save a life.


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## BossyCow (Jul 28, 2008)

mycrofft said:


> Yes, I think they get together to make sure their annual repainting of the Titanic's deckchairs does NOT result in identical standards. I'll spare you the fiasco of 1978.



AHA has included in their last BLS update a reason for each change with references to the science behind it. They are primarily a research organization and the research they do results in changes to what works. This is the first year I've seen them share that with the general public. 

As far as the choking victim on the original thread: If a pt can't breathe, their heart will stop. Period...... they will either get air, or their heart will stop. You do want the AED present and EMS on the way if you start treating someone who is choking.


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## Jeremy89 (Oct 24, 2008)

Okay,

I know this forum has been dead for a couple months but I still don't get it.  I was randomly reading the following:

http://www.imdb.com/title/tt0108757/goofs

and came across the part about CPR on live patients.  Is that correct?  Isn't it okay to do CPR for choking victims?  But instead of beating their heart, you're attempting to dislodge an object.  But in that case, can't you still screw up their sinus rhythm?


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## BossyCow (Oct 24, 2008)

Without a cleared airway and the object out, there will be no rhythm.


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## JPINFV (Oct 24, 2008)

Jeremy89 said:


> Okay,
> 
> I know this forum has been dead for a couple months but I still don't get it.  I was randomly reading the following:
> 
> ...





> "ER" (*1994*)





> Miscellaneous: CPR is not to be performed on a live person who is not in full cardiac arrest as performing CPR may disrupt normal heart rating of person in good condition. That is why even EMTs and other responders are taught on mannequins and never on live people





> Incorrectly regarded as goofs: None of the doctors or nurses performs CPR correctly, but if done with straight arms and enough force to make a difference, it can (and often does) break the patient's ribs. Obviously it's better to go without a factually accurate portrayal of the procedure than to injure the actors in the name of realism.



For when this was written, yes, it is correct. The 2005 AHA CPR guidelines changed unconscious foreign body obstruction treatment guidelines from abdominal thrusts to CPR since chest compressions approach or exceed the intrathoracic pressure obtained by abdominal thrusts. After all, why teach a technique that can be matched by one that is already being taught?




> If the adult victim with FBAO becomes unresponsive, the rescuer should carefully support the patient to the ground, immediately activate EMS, and then begin CPR. A randomized trial of maneuvers to open the airway in cadavers273 and 2 prospective studies in anesthetized volunteers274,275 show that higher sustained airway pressures can be generated using the chest thrust rather than the abdominal thrust (LOE 7). Each time the airway is opened during CPR, the rescuer should look for an object in the victim’s mouth and remove it. Simply looking into the mouth should not increase the time it takes to attempt the ventilations and proceed to the 30 chest compressions.
> 
> ...
> 
> ...



-2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2005;112:IV-19 – IV-34.
http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-19#R273-166553


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