Direct care staff were reminded that all inpatient units have a battery-powered, portable compact suction unit available that can be used in a choking emergency. The hospital’s cardiopulmonary resuscitation instructors emphasize the importance of the abdominal thrust maneuver during all staff training sessions.
The hospital’s administration and staff did not reach a consensus on whether physicians should attempt a tracheotomy when other measures to dislodge a foreign object from a patient’s throat fail. Instead, the focus remains on assessing and treating the clinical emergency and obtaining rapid intervention by emergency medical technicians.
The authors’ observations
The following recommendations may help minimize or prevent choking events in inpatient units:
- Ensure all staff who care for patients are trained regularly on emergency first aid for choking victims, including proper use of abdominal thrusts (Heimlich maneuver) (Table 2).20
- Educate staff about which patients may be at higher risk for choking.
- Assess for a history of choking incidents and/or the presence of swallowing problems in patients at risk for choking.
- Supervise meals and instruct staff to look for patients who display dysphagia.
- Consider ordering a swallowing evaluation performed by a speech therapist in patients who manifest dysphagia.
- Avoid polypharmacy of drugs with anticholinergic and/or potent dopamine blocking effects, such as olanzapine, risperidone, or haloperidol.
- Teach safe eating habits to patients who are at risk for choking.
- Contact outpatient care providers of patients at risk for choking and inform them of the need for further education on safe eating habits, a dietary evaluation, and/or a swallowing evaluation.
Implementing these measures may reduce choking incidents and could save lives.
Table 2
American Red Cross guidelines for treating a conscious, choking adult
| Send someone to call 911 |
| Lean person forward and give 5 back blows with heel of your hand |
| Give 5 quick abdominal thrusts by placing the thumbside of your fist against the middle of the victim’s abdomen, just above the navel. Grab your fist with the other hand. In obese or pregnant adults, place your fist in the middle of the breastbone |
| Continue giving 5 back blows and 5 abdominal thrusts until the object is forced out or the person breathes or coughs on his or her own |
| Source: Reference 20 |
Related Resources
- Hwang SJ, Tsai SJ, Chen IJ, et al. Choking incidents among psychiatric inpatients: a retrospective study in Chutung Veterans General Hospital. J Chin Med Assoc. 2010;73(8):419-424.
- American College of Emergency Physicians Foundation. What to do in a medical emergency. Choking. www.emergencycareforyou.org/EmergencyManual/WhatToDoInMedicalEmergency/Default.aspx?id=224.
Drug Brand Names
- Aripiprazole • Abilify
- Haloperidol • Haldol
- Olanzapine • Zyprexa
- Risperidone • Risperdal
Disclosures
Dr. de Nesnera reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products. Dr. Folks is a consultant and speaker for Pfizer Inc., a speaker for Forest Pharmaceuticals, and has received a research grant from Janssen Pharmaceuticals.