Choking Classification and external resources
ICD-10	F41. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings 0, R06. 8, T17, W78-W80
ICD-9	784.9, 933.1

Choking is the mechanical obstruction of the flow of air from the environment into the lungs. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. Choking prevents breathing, and can be partial or complete, with partial choking allowing some, although inadequate, flow of air into the lungs. Breathing takes Oxygen in and Carbon dioxide out of the body Aerobic Organisms require oxygen to create energy via respiration, in Prolonged or complete choking results in asphyxiation which leads to hypoxia and is potentially fatal. Chronic Hypoxia is a pathological condition in which the body as a whole ( generalized hypoxia) or region of the body ( tissue hypoxia) is deprived of adequate

Choking can be caused by:

• Introduction of a foreign object into the airway, which becomes lodged in the pharynx, larynx or trachea. The airways are those parts of the Respiratory system through which air flows to get from the external environment to the Alveoli. The pharynx (plural pharynges) is the part of the Neck and Throat situated immediately Posterior to (behind the Mouth and Nasal The larynx (plural larynges) colloquially known as the voicebox, is an organ in the Neck of Mammals involved in protection of the The traceartes, or windpipe, is a tube that has an inner diameter of about 20-25 mm and a length of about 10-16 cm in humans
• Respiratory diseases that involve obstruction of the airway. Respiratory Disease is the term for Diseases of the Respiratory system.
• Compression of the laryngopharynx, larynx or trachea in strangles. In human anatomy the hypopharynx (or laryngopharynx) is the bottom part of the Pharynx, and is the part of the Throat that connects to the Esophagus

Contents 1 Foreign objects 2 Symptoms and Clinical Signs 3 Treatment 3.1 Encouraging the victim to cough 3.2 Back slaps 3.3 Abdominal thrusts 3.3.1 Other uses of abdominal thrusts 3.3.2 Modified chest thrusts 3.4 CPR 3.5 Finger sweeping 3.6 Direct vision removal 4 Notable victims 5 References 6 External links

Foreign objects

The type of choking most commonly recognised as such by the public is the lodging of foreign objects in the airway. This type of choking is often suffered by small children, who are unable to appreciate the hazard inherent in putting small objects in their mouth. A hazard is a situation which poses a level of threat to Life, Health, Property or environment. In adults, it mostly occurs whilst the patient is eating. A patient is any person who receives medical attention care or treatment.

Symptoms and Clinical Signs

• The person cannot speak or cry out.
• The person's face turns blue (cyanosis) from lack of oxygen. Cyanosis is a blue coloration of the Skin and mucous membranes due to the presence of deoxygenated Hemoglobin in Blood vessels near the skin surface
• The person desperately grabs at his or her throat.
• The person has a weak cough, and labored breathing produces a high-pitched noise.
• The person does any or all of the above, and then becomes unconscious.

Treatment

Choking can be treated with a number of different procedures, with both basic techniques available for first aiders and more advanced techniques available for health professionals. First aid is the provision of initial care for an Illness or Injury.

Many members of the public associate abdominal thrusts, also known as the 'Heimlich Maneuver' with the correct procedure for choking, which is partly due to the widespread use of this technique in movies, which in turn was based on the widespread adoption of this technique in the USA at the time, although it also produced easy material for writers to create comedy effect. The United States of America —commonly referred to as the

Most modern protocols (including those of the American Heart Association and the American Red Cross, who changed policy in 2006^[1] from recommending only abdominal thrusts) involve several stages, designed to apply increasingly more pressure.

The key stages in most modern protocols include:

Encouraging the victim to cough

This stage was introduced in many protocols as it was found that many people were too quick to undertake potentially dangerous interventions, such as abdominal thrusts, for items which could have been dislodged without intervention. Also, if the choking is caused by irritating liquids (alcohol, spice, mint, gastric acid, etc. In Chemistry, an alcohol is any Organic compound in which a Hydroxyl group ( - O[[hydrogen H]]) is bound to a Carbon A spice is a dried Seed, Fruit, Root, Bark or vegetative substance used in Nutritionally insignificant quantities as a Food additive Mentha ( mint) is a Genus of about 25 Species (and many hundreds of varieties) of Flowering plants in the family Gastric acid is one of the main Secretions of the Stomach, together with several Enzymes and Intrinsic factor. ) or anything without a solid shape, and if conscious, the patient should be allowed to drink water on their own to try to clear the throat. Since the airway is already closed, there is very little danger of water entering the lungs. Coughing is normal after most of the irritant has cleared, and at this point the patient will probably refuse any additional water for a short time.

Back slaps

The majority of protocols now advocate the use of hard blows with the heel of the hand on the upper back of the victim. The number to be used varies by training organisation, but is usually between 5 and 20.

The back slap is designed to use percussion to create pressure behind the blockage, assisting the patient in dislodging the article. In some cases the physical vibration of the action may also be enough to cause movement of the article sufficient to allow clearance of the airway. Vibration refers to mechanical Oscillations about an equilibrium point.

Almost all protocols give back slaps as a technique to be used prior to the consideration of potentially damaging interventions such as Abdominal thrusts^[2][3]

Abdominal thrusts

Abdominal thrusts, also known as the Heimlich Maneuver (after Henry Heimlich, who first described the procedure in a June 1974 informal article entitled "Pop Goes the Cafe Coronary," published in the journal Emergency Medicine. Henry Jay Heimlich MD (born Henry Judah Heimlich, 3 February 1920 is an American Physician credited as the inventor of abdominal thrusts known as the Edward A. Patrick, MD, PhD, an associate of Heimlich, has claimed to be the uncredited co-developer of the procedure, and has been quoted calling it the Patrick maneuver. ^[4] Heimlich has objected to the name "abdominal thrusts" on the grounds that the vagueness of the term "abdomen" could cause the rescuer to exert force at the wrong site.

Performing abdominal thrusts involves a rescuer standing behind a patient and using their hands to exert pressure on the bottom of the diaphragm. For other types of diaphragm see Diaphragm. In the Anatomy of Mammals the thoracic diaphragm is a sheet of Muscle This compresses the lungs and exerts pressure on any object lodged in the trachea, hopefully expelling it. The traceartes, or windpipe, is a tube that has an inner diameter of about 20-25 mm and a length of about 10-16 cm in humans This amounts to an artificial cough. In Medicine, a cough ( Latin: tussis) is a sudden and often repetitively occurring defence Reflex which helps to clear the large breathing passages

Due to the forceful nature of the procedure, even when done correctly it can injure the person on whom it is performed. Bruising to the abdomen is highly likely and more serious injuries can occur, including fracture of the xiphoid process or ribs. In Vertebrates such as Mammals the abdomen (belly constitutes the part of the body between the Thorax (chest and Pelvis. The xiphoid process, also known as the xiphisternum is a small cartilaginous extension to the lower part of the Sternum which is usually In Vertebrate Anatomy, ribs ( Latin costae) are the long curved Bones which form the ribcage. ^[5]

Other uses of abdominal thrusts

Dr. Heimlich also advocates the use of the technique as a treatment for drowning^[6] and asthma^[7] attacks, but Heimlich's promotion to use the maneuver to treat these conditions resulted in marginal acceptance. Drowning is Death as caused by suffocation when a liquid causes interruption of the body's absorption of oxygen from the air leading to Asphyxia. Asthma is a chronic Condition involving the Respiratory system in which the airways occasionally constrict become inflamed, and are Criticism of these uses has been the subject of numerous print and television reports which resulted from an internet and media campaign by his son, Peter M. Heimlich, who alleges that in August 1974 his father published the first of a series of fraudulent case reports in order to promote the use of abdominal thrusts for near-drowning rescue. ^[8]

Modified chest thrusts

A modified version of the technique is sometimes taught for use with pregnant women and obese casualties. Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected The rescuer places their hand in the center of the chest to compress, rather than in the abdomen.

CPR

In most protocols, once the patient has become unconscious, the emphasis switches to performing CPR, involving both chest compressions and artificial respiration. Artificial respiration is the act of simulating respiration, which provides for the overall exchange of gases in the body by pulmonary ventilation external respiration and internal These actions are often enough to dislodge the item sufficiently for air to pass it, allowing gaseous exchange in the lungs.

Finger sweeping

Some protocols advocate the use of the rescuer's finger to 'sweep' foreign objects away once they have reached the mouth. However, many modern protocols recommend against the use of the finger sweep as if the patient is conscious, they will be able to remove themselves, or if they are unconscious the rescuer should simply place them in the recovery position (where the object should fall out due to gravity). There is also a risk of causing further damage (for instance inducing vomiting) by using a finger sweep technique.

Direct vision removal

The advanced medical procedure to remove such objects is inspection of the airway with a laryngoscope or bronchoscope, and removal of the object under direct vision, followed by CPR if the patient does not start breathing on their own. A laryngoscope ( Larynx + Scope) is a medical instrument that is used to obtain a view of the vocal folds and the glottis which is the space between the cords Bronchoscopy is a technique of visualising the inside of the Airways An instrument Bronchoscope is inserted into the Airways usually through Severe cases where there is an inability to remove the object may require cricothyrotomy. A cricothyrotomy (also called thyrocricotomy, cricothyroidotomy, inferior laryngotomy, intercricothyrotomy, coniotomy or

Notable victims

• United States President George W. Bush survived choking on a pretzel on January 13, 2002, receiving major media coverage. The President of the United States is the Head of state and Head of government of the United States and is the highest political official in United States by George Walker Bush ( born July 6 1946 is the forty-third and current President of the United States. A pretzel is a bread pastry of German origin that has the shape of a three looped Knot or twisted braid Events 532 - Nika riots in Constantinople. 888 - Odo Count of Paris becomes King of the Franks See also 2002 (disambiguation Year 2002 ( MMII) was a Common year starting on Tuesday of the Gregorian calendar. ^[9]
• Jimmie Foxx, a famous major league baseball player, died by choking on a bone. James Emory "Jimmie" Foxx ( October 22 - July 21) ( nicknamed Double X and The Beast) was an American First ^[10]
• Tennessee Williams, died after choking on a bottle cap. Thomas Lanier Williams III (March 26 1911 &ndash February 25 1983 better known as Tennessee Williams, was a major American playwright who received many of the top theatrical ^[11]
• An urban legend states that Mama Cass choked to death on a ham sandwich. Cass Elliot ( September 19 1941 – July 29 1974) born Ellen Naomi Cohen, was a noted American Singer, best This was borne out of a quickly discarded speculation by the coroner, who noted a partly eaten ham sandwich and figured she may have choked to death. A coroner is an official responsible for investigating deaths particularly some of those happening under unusual circumstances and determining the cause of death In fact, she died of heart failure. Heart failure is a Cardiac condition that occurs when a problem with the structure or function of the Heart impairs its ability to supply ^[12]

References

External links

• Choking. (PDF Format). Contains further information on preventing choking in small children.
• Choking. Contains information on procedures to alleviate choking in different cases.
• [1][2]
• Emedicinehealth. Choking. www. emedicinehealth. com. URL last accessed March 6, 2005. Events 1079 - Omar Khayyám completes the Iranian calendar. 1454 - Thirteen Years' War: Delegates of Year 2005 ( MMV) was a Common year starting on Saturday (link displays full calendar of the Gregorian calendar.
• UK Resuscitation Council. Adult Basic Life Support. www. resus. org. URL last accessed February 28, 2005. Events 202 BC - coronation ceremony of Liu Bang as Emperor Gaozu of Han takes place initiating four centuries of the Han Dynasty 's rule Year 2005 ( MMV) was a Common year starting on Saturday (link displays full calendar of the Gregorian calendar.
• The Heimlich Institute
• Articles and information about Dr. Henry Heimlich's use of fraudulent case reports to promote the Heimlich maneuver for drowning rescue and asthma.

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