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Halloween Safety - Choking Risks

Tuesday 13th October 2020
Direct Training GB Ltd.

It's the middle of October and Halloween 2020 is fast approaching. Although this Halloween may be a little different due to how the world currently is one thing is still for sure. Children (and adults alike) will be enjoying lots of sweets and treats around this spooktacular evening, even if things are a little different to the common tradition.

Whilst Halloween can be fun, like many other things it does come with its risks and one of those risks is choking. In today's blog we are going to be discussing the risk of choking, how to recognise choking and what actions you can take in the instance of it happening.

What is choking?
First of all, let's start with the basics. What exactly is choking? Choking is when there is a severe difficulty in breathing due to a constricted or obstructed throat or a lack of air. It is possible for anyone to choke on a variety of things such as food, liquids such as tea and predominately in small children, items such as small objects or toys.

What can cause choking?
In the back of the mouth there are two openings. One of these is called the esophagus (which leads to the stomach; food goes down this pathway.) The other one is the trachea, (which is the opening air must pass through to get to the lungs.) When swallowing occurs, the trachea is covered by a flap called the epiglottis, which prevents food from entering the lungs. The trachea splits into the left and right mainstem bronchus. These lead to the left and right lungs. They branch into increasingly smaller tubes as they spread throughout the lungs.

Any object that ends up in the airway will become stuck as the airway narrows. Many large objects get stuck just inside the trachea at the vocal cords.

In adults, choking most often occurs when food is not chewed properly. Talking or laughing while eating may cause a piece of food to "go down the wrong pipe." Normal swallowing mechanisms may be slowed if a person has been drinking alcohol or taking drugs and if the person has certain illnesses such as Parkinson's disease.

In older adults, risk factors for choking include advancing age, poorly fitting dental work, and alcohol consumption.

In children, choking is often caused by chewing food incompletely, attempting to eat large pieces of food or too much food at one time, or eating hard candy. Children also put small objects in their mouths, which may become lodged in their throat. Nuts, pins, marbles, or coins, for example, create a choking hazard.

With this considered it is no surprise that at halloween it is common for choking to occur whilst consuming sweets and other treats as they are often very small and sweets which are designed to be sucked on such as lollipop and mints are very hard to chew and break down into smaller, more manageable pieces.

How to recognise choking:
Choking has many visible signs which make it often quite easy to recognise and act upon. Below you will find a list of signs that indicate that somebody could be choking:
The person is coughing and gagging.
The person is giving hand and signals and panicking (often pointing to the throat.)
The person has a sudden inability to talk.
The person is clutching at their throat (this is a natural response to grab the throat with both hands.)
The person is wheezing.
The person may pass out.

How to treat choking:

Step-by-step instructions for helping choking babies:
- Let the baby cough. Coughing is the most effective way to dislodge something from the airway.
- Check choking signs. A choking baby may be unable to cough or cry. Typically, a choking baby will open their mouth wide while their skin turns red or blue.
- Call 911. Ask someone to call 911 immediately. If you are alone with the infant, call 911 after 2 minutes of treatment.
- Begin back blows. Place the baby face down on your forearm, with their jaw cradled in your thumb and forefinger, and their head settled lower than their chest. Use the heel of your hand to firmly hit the baby's back five times between the shoulder blades.
- Begin chest thrusts. Turn the infant over while still resting your forearm on their frontside. Sit down and place the baby's back on your thigh, with their head still lower than the chest. Put two or three fingers between the baby's nipples. Thrust by pushing straight down on the chest 1.5 inches in a smooth motion, and then allow the chest to return. Repeat five times.
- Repeat 5-and-5. Repeat five back blows and five chest thrusts. Check the baby's throat for the choking object after each cycle.
Begin CPR. If the baby becomes unconscious and stops breathing, place them on the flat ground.
- Begin chest compressions. This is similar to chest thrusts, but the baby is kept flat on the ground and your free hand is placed on their forehead. Administer 30 chest compressions with your two or three fingers in the center of the baby's nipples, at a rate of two per second.
- Give two rescue breaths. Open the baby's airway by placing a hand on their forehead and two fingers on the chin. Make a seal over their mouth and nose with your mouth, inhale a normal-sized breath, then blow into the baby's mouth for one second, making sure their chest rises.
- Check airway. If the chest doesn't rise, the baby's airway is blocked. Look into the baby's airway and attempt to dislodge the object.
- Repeat cycle. Continue with chest compressions and rescue breaths until the baby stops choking or medical personnel arrive.

Step-by-step instructions for helping choking toddlers:
- Let the toddler cough. Let the toddler continue coughing to dislodge the object.
- Call 911. Ask someone to call 911 immediately. If you are alone with the child, call 911 after two minutes of treatment.
- Begin back blows. Lay the child over your lap face down, or support the them in a forward-leaning position. Give them five firm back blows between the shoulder blades.
- Begin Heimlich maneuver or abdominal thrusts. While standing or kneeling, wrap your arms around their upper abdomen. Clench your fist and place it above the child's belly button. Grasp your fist with your other hand on top, then pull it inward and upward. Repeat five times.
- Repeat 5-and-5. Repeat five back blows and five abdominal thrusts. Check their throat for the choking object after each cycle.
- Begin CPR. If they become unconscious or stop breathing, place them on the flat ground.
- Begin chest compressions. Place your hands one on top of the other in the middle of the toddler's chest. Deliver 30 chest compressions, two inches deep, at a rate of 100 compressions per minute. Push down firmly, but not too hard as you could break the child's rib cage.
- Give two rescue breaths. Tilt their head to open the airway, plug their nose, and seal your mouth over the top of their mouth. Give two large breaths, delivered at one second each, making sure the chest rises.
- Repeat cycle. Continue with chest compressions and rescue breaths until they stop choking or medical personnel arrive.

Step-by-step instructions for helping choking adults:
- Determine the severity. Ask, "Are you choking?" before performing any first aid. If the adult is coughing, let them cough to continue to dislodge the choking hazard.
- Call 911. Ask someone to call 911 immediately. If you are alone with them, call 911 after two minutes of treatment.
- Begin back blows. Bend the person over at their waist, crossing your less dominant arm over their chest. Use your dominant arm to deliver five powerful back blows between their shoulder blades.
- Begin Heimlich maneuver or abdominal thrusts. Stand up and place your leg between their legs to support them if they faint or pass out. Next, wrap your arms around their upper abdomen. Clench your fist and place it above their belly button. Grasp your fist with your other hand on top, then pull it inward and upward quickly. Repeat five times. If they are pregnant or obese, wrap your arms around their chest instead of their upper abdomen, and put your hands in the middle of their chest.
- Repeat 5-and-5. Repeat five back blows and five abdominal thrusts. Check their throat for the choking object after each cycle.
- Begin CPR. If they become unconscious or stop breathing, lay them on the ground on a flat surface.
- Begin chest compressions. Place your hands one on top of the other in the middle of their chest. Use your body weight and deliver chest compressions two inches deep at a rate of 100 compressions per minute.
- Give two rescue breaths. Tilt their head to open the airway, plug their nose, and seal your mouth over the top of their mouth. Give two large breaths, making sure their chest rises.
- Repeat cycle. Continue with chest compressions and rescue breaths until they stop choking or medical personnel arrive.

Step-by-step instructions for helping a choking older adult:
- Assess whether or not they're choking. Sometimes it can be difficult to tell if an older adult who is coughing during a meal is actually choking, since coughing is a common reflex of aging. - Signs of an older adult choking include being unable to talk or breathe, motioning towards the throat, or skin turning grey or blue. If they are coughing, let them continue to expel the choking hazard. If the person wears dentures, check if they are in the way.
- Call 911. Ask someone to call 911 immediately. If you are alone with them, call 911 after two minutes of treatment.
- Begin back blows. Bend them over at their waist, crossing your less dominant arm over their chest. Use your dominant arm to deliver five powerful back blows between their shoulder blades.
- Begin Heimlich maneuver or abdominal thrusts. Stand up and place your leg between their legs to support them if they faint or pass out. Next, wrap your arms around their upper abdomen. Clench your fist and place it above their belly button. Grasp your fist with your other hand on top, then pull it inward and upward quickly. Repeat five times.
- Repeat 5-and-5. Repeat five back blows and five abdominal thrusts. Check their throat for the choking object after each cycle.
- Begin CPR. If they become unconscious or stop breathing, lay them on the ground on a flat surface.
- Begin chest compressions. Place your hands one on top of the other in the middle of the chest. Use your body weight and deliver chest compressions 2 inches deep at a rate of 100 compressions per minute.
- Give two rescue breaths. Tilt their head to open the airway, plug their nose, and seal your mouth over the top of their mouth. Give two large breaths, making sure their chest rises.
- Repeat cycle. Continue with chest compressions and rescue breaths until they stop choking or medical personnel arrive.

Step-by-step instructions if you're choking:
- Cough it up. The cough reflex is most effective for dislodging an object from your airway.
Call 911. Call 911 and leave your phone on, even if you can't talk. The operator will still send paramedics.
- Begin the self-Heimlich maneuver or abdominal thrusts. You can do an abdominal thrust on yourself, the same way you'd perform it on another person. Clench your fist and place it above your belly button, then grasp your fist with your other hand and pull it inward and upward quickly.
- Repeat. Try to force the object out until medical personnel arrive. You can push your abdomen into the back of a chair or the corner of a table, where you can assert more pressure.
- Medical experts recommend visiting a doctor after a choking incident at any age to make sure no damage has been done to the airway or body during the Heimlich and CPR process.