Cough

Updated 16 January 2017

Choking

Choking happens when an object gets stuck in the airway instead of passing through to the stomach, thereby partially or completely blocking the airway.

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Possible signs of choking

  • Coughing
  • Hands clutching the throat (universal distress signal)
  • Eyes show fear
  • Gasping for air
  • Cannot speak
  • Redness, then blueness in the face
  • High-pitched, noisy breathing

Get help immediately if:

  • The person is unconscious: 10177 (ambulance)

Home treatment
Note: If the person can speak, cough and breathe, encourage the person to cough. Don’t interfere - the person should be able to cough up the object.

If the person cannot speak, cough forcefully or breathe, follow these instructions:

Conscious adult (9 years and older) – abdominal thrusts (Heimlich manoeuvre):

  • Step 1. Don’t remove the object unless it can be clearly seen and reached.
  • Step 2. Stand behind the person with your foot between the person’s feet.
  • Step 3. Reach around the waist. Place left fist above the navel and below the rib cage.
  • Step 4. Place other fist over the left fist.
  • Step 5. Pull clenched fist forcefully in an inward and upward motion under the rib cage.
  • Step 6. Repeat until the object is dislodged or the person becomes unconscious.
  • Step 7. Get the person to a doctor.

Unconscious adult (9 years and older):

  • Step 1. Call an ambulance.
  • Step 2. Lie person on his back and push forehead backward.
  • Step 3. Finger sweeps: Open the mouth. Move the tongue and jaw upwards. If object can be clearly seen and is easy to remove, carefully remove object with a hooked finger.
  • Step 4. Resuscitation: Pinch the nose shut and give 5 slow breaths.
  • Step 5. Abdominal thrusts: If unsuccessful, kneel astride the person and place the heel of the right hand midway between the navel and rib cage. Place the other hand over right hand with fingers raised. Give five inward and upward thrusts.
  • Step 6. Continue steps 3-5 until object is dislodged and the person breathes normally.
  • Step 7. Place the person in the recovery position and monitor breathing and pulse until help arrives.

Conscious child (1 – 8 years):

  • Step 1. Let your child bend forwards or place a small child face down across your lap with head low.
  • Step 2. Give 5 hard back slaps between the shoulder blades with the heel of your hand.
  • Step 3. If you can see the object clearly, remove it with a hooked finger.
  • Step 4. If this does not help, kneel behind the child. Place fist on the lower breastbone and place other hand over the fist. Pull inwards and upwards up to 5 times.
  • Step 5. Check the mouth to see if object can be removed.
  • Step 6. If this is unsuccessful, give 5 abdominal thrusts (see above).
  • Step 7. If it still fails, call emergency services.
  • Step 8. Repeat steps 2-6 until object is dislodged or medical help arrives.

Unconscious child (1 – 8 years):

  • Step 1. Call an ambulance.
  • Step 2. Open the mouth and check if the object is clearly visible. Remove with a hooked finger.
  • Step 3. Resuscitation: If breathing has stopped, pinch the nose shut and give 5 slow breaths.
  • Step 4. Back slaps: If above is unsuccessful, roll child onto his side. Give 5 sharp back slaps between the shoulder blades.
  • Step 5. Check the mouth to see if object can be removed.
  • Step 6. If this fails, turn the child onto his back. Place the heel of one hand on the child’s lower breastbone and give five sharp inwards thrusts. (Chest thrusts)
  • Step 7. Check the mouth to see if the object can be removed.
  • Step 8. If unsuccessful, kneel astride the child and place the heel of one hand midway between the navel and the breastbone with fingers raised. Give five inward and upward thrusts. (Abdominal thrusts)
  • Step 9. If breathing doesn’t start, repeat steps 2 – 8 until medical help arrives.
  • Step 10. If the child starts breathing again, place the child in the recovery position and monitor breathing and pulse until help arrives.

Conscious baby (younger than 1 year):

  • Step 1. Lay baby face downwards on your forearm or lap, with the head lower than the trunk and supporting the chin between your fingers.
  • Step 2. Give 5 hard backslaps between the shoulder blades.
  • Step 3. Check if the object is clearly visible, then remove with a hooked finger.
  • Step 4. If object cannot be removed, lay the baby face upwards along your forearm or your lap, with head lower than the trunk. Place 2 fingers on the breastbone a finger’s width below the nipples and give 5 downward chest thrusts.
  • Step 5. Check the mouth again and remove object if visible.
  • Step 6. If unsuccessful, call an ambulance.
  • Step 7. Continue with back slaps and chest thrusts until help arrives.

Unconscious baby (younger than 1 year):

  • Step 1. Call an ambulance.
  • Step 2. Open the child’s mouth and remove object if clearly visible with a hooked finger.
  • Step 3. If object cannot be removed, place baby on his back and tilt the head back.
  • Step 4. Place your mouth over the mouth and nose and give 2 breaths.
  • Step 5. Lay baby face downwards on your forearm or lap, with the head lower than the trunk and supporting the chin between your fingers.
  • Step 6. Give 5 hard back slaps between the shoulder blades.
  • Step 7. Check if the object is clearly visible, then remove with a hooked finger.
  • Step 8. If this doesn’t help, lay the baby face upwards along your forearm or your lap, with head lower than the trunk. Place 2 fingers on the breastbone a finger’s width below the nipples and give 5 downward chest thrusts.
  • Step 9. Check the mouth again and remove object if visible.
  • Step 10. If unsuccessful, repeat steps 2-9 until medical help arrives.

Call you doctor if:

  • The person is unconscious.
  • Abdominal thrusts were performed as they can cause internal injuries.
  • Swelling of the airway from an infection, injury or allergic reaction caused choking.

Prevention

  • Always supervise young children while eating.
  • Make sure they sit quietly while eating.
  • Do not give foods to a small child that can break off into hard pieces.
  • Do not give popcorn, nuts, hard lollies, cornchips or other similar foods.
  • Check toys for small parts that may come off.
  • Drink alcohol in moderation. Alcohol impairs coordination of the muscles used in swallowing.
  • Don’t gulp drinks with food in your mouth.

If you are alone:

  • Try to cough up the object.
  • If this doesn’t help, do abdominal thrusts on yourself using your fists.
  • Alternatively, use a solid piece of furniture: Place the object just above your hips and press down forcefully to simulate abdominal thrusts.

Removing an object
Only remove an object if it is clearly visible. Searching for an object with your finger can only push the object further down the airway.


 

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Cough Expert

Professor Keertan Dheda has received several prestigious awards including the 2014 Oppenheimer Award, and has published over 160 peer-reviewed papers and holds 3 patents related to new TB diagnostic or infection control technologies. He serves on the editorial board of the journals PLoS One, the International Journal of Tuberculosis and Lung Disease, American Journal of Respiratory and Critical Medicine, Lancet Respiratory Diseases and Nature Scientific Reports, amongst others. Read his full biography at the University of Cape Town Lung Institute.

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