LESSON 5
PERFORM FIRST AID TO CLEAR AN OBJECT STUCK IN THE THROAT OF A CONSCIOUS CASUALTY
(TASK 081-831-1003)
TASK:
Identify procedures for aiding a conscious person with an upper airway obstruction.
CONDITIONS:
Given multiple-choice questions pertaining to recognizing and removing an upper airway obstruction from a conscious person.
STANDARD:
Score 70 or more points on a 100-point comprehensive examination.
REFERENCES:
STP
21-1-SMCT, Soldier's Manual of Common Tasks: Skill Level 1.
FM
21-11, First Aid for Soldiers
NOTE: Some of the task titles and information have changed and are not reflected in FM 21-11 and STP 21-1-SMCT. Refer to the Army Training Support Center, Common Core Task internet site at: http://www.atsc.army.mil/dld/comcor/comcore.htm for up-to-date task information.
An upper airway obstruction (blockage) occurs when a piece of food or some other object enters the person's trachea (windpipe). When a person has suffered a facial injury, blockage may be caused by blood clots or loose teeth that have become lodged in the person's throat. Blockage may also occur when the contents of the stomach are regurgitated (vomited) and some of the vomitus is inhaled.
The blockage must be removed and full breathing restored. A blockage which greatly reduces the amount of air which can be inhaled and exhaled or which stops all air exchange can quickly lead to unconsciousness and death.
5-2. RECOGNIZE A PERSON WITH AN AIRWAY OBSTRUCTION
A person with an airway obstruction will automatically begin to cough or at least try to cough. In addition, he will probably clutch his throat. This clutching action is natural, but it has also been adopted as the universal distress signal for choking. This sign alerts other people that the problem is an airway obstruction rather than another problem such as a heart attack or nausea.
FIGURE 5-1. UNIVERSAL DISTRESS SIGNAL FOR CHOKING
Partial Blockage With Good Air Exchange
If the person with an obstruction can speak or cough forcefully, he is said to have a partial blockage with good air exchange. (A partial blockage means that the airway is not completely blocked and air can still get to and from the person's lungs. Good air exchange indicates that the person can still inhale and exhale enough air to carry on all life processes.) A person may have good air exchange even though he makes a wheezing sound between coughs.
Partial Blockage With Poor Air Exchange
A partial blockage with poor air exchange is indicated by a weak cough, high-pitched noises (like crowing) while inhaling, and signs of shock (bluish tint of the fingernail beds and the lips). A person with poor air exchange is not inhaling sufficient air to continue carrying on all life processes. If the person is not helped, he will probably become unconscious and die.
| CAUTION: If you cannot decide whether a conscious casualty has good or poor air exchange, tell him to speak to you. If he does not speak, assume he has poor air exchange. |
Complete Blockage
If the person's airway is completely blocked, he can neither speak, breathe, nor cough at all (no air exchange occurring) and may be clutching his or her neck. Quick action is needed to clear the airway.
5-4. DETERMINE WHAT ACTIONS ARE NEEDED
Partial Blockage With Good Air Exchange
If the person has good air exchange, encourage him to continue his efforts to cough up the obstruction. Do not interfere with his efforts. Do not leave the person since "good" air exchange can rapidly deteriorate to "poor" air exchange or complete blockage, either of which can result in unconsciousness and death. Be prepared to administer manual thrusts should his condition worsen.
Partial Blockage With Poor Air Exchange/Complete Blockage
If the person has poor air exchange or a complete blockage, call for help and begin administering manual (abdominal or chest) thrusts. If possible, send someone to seek medical help.
Abdominal Thrusts. If manual thrusts are required, abdominal thrusts are normally used to expel whatever is blocking the airway.
Chest Thrusts. If the person has abdominal injuries, is noticeably pregnant, or has a waist that is too large to encircle, chest thrusts are used instead of abdominal thrusts.
| CAUTION: The manual thrusts presented in this lesson are used with a conscious casualty who is sitting or standing. If the casualty becomes unconscious or is lying down, start rescue breathing (see Lesson 6, Mouth-to-Mouth Resuscitation, task 081-831-1042). |
| WARNING | |
| Back blows are no longer used to dislodge an airway obstruction in an adult. | |
5-5. ADMINISTER ABDOMINAL THRUSTS
A manual thrust acts like a strong cough. Each thrust is delivered with the intent of dislodging and expelling the object causing the blockage. The following procedures are used to administer abdominal thrusts to a casualty who is conscious and is either standing up or sitting.
FIGURE 5-2. HAND PLACEMENT FOR ADMINISTERING AN ABDOMINAL THRUST
Stand behind the casualty and wrap your arms around his waist.
Make a fist with one hand and place it slightly above the casualty's navel (belt buckle) and well below the tip of the casualty's breastbone. (The xiphoid process is the pointed bone at the bottom of the breastbone.) Make sure that your fist is not resting on any ribs. The thumb side of your fist should be against the casualty's abdomen.
| WARNING | |
| A thrust delivered directly to the xiphoid process or ribs can result in damage to breastbone, ribs, and internal organs such as the lungs and heart. | |
Grasp your fist with your other hand.
Thrust using a quick inward and upward motion, then relax the hold.
Continue administering abdominal thrusts until the obstruction is expelled or the casualty becomes unconscious. If the casualty loses consciousness, call for help, lay the casualty on his back, perform a finger sweep, and start rescue breathing (see Lesson 6, Mouth-to-Mouth Resuscitation, task 081-831-1042).
FIGURE 5-3. ADMINISTERING AN ABDOMINAL THRUST (STANDING CASUALTY)
Chest thrusts are used for a standing or sitting conscious casualty if the casualty is noticeably pregnant or has abdominal injuries or if your arms will not reach around his waist.
Stand behind the casualty, place your arms under his armpits, and encircle his chest.
| WARNING | |
| A thrust delivered directly to the xiphoid process or ribs can result in damage to breastbone, ribs, and internal organs such as the lungs and heart. | |
Grasp your fist with your other hand.
FIGURE 5-4. ADMINISTERING A CHEST THRUST
(STANDING CASUALTY)
Thrust inward so that the sternum is depressed about 1 to 2 inches; then relax the hold.
| CAUTION: If the casualty is a child (8 years old or less) instead of an adult, the sternum should be depressed 1 to 11/2 inches. |
Continue administering chest until the obstruction is expelled or the casualty becomes unconscious. If the casualty loses consciousness, call for help, lay the casualty on his back, perform a finger sweep, and start rescue breathing (see Lesson 6, Perform Mouth-to-Mouth Resuscitation, task 081-831-1042).