OBJECTIVES

At the end of presentation we will be able to

 Identify an airway emergency (air way obstruction
or choking).
 Discuss causes, signs and symptoms of choking
 Perform first aid for choking
 Formulate Nursing care plan for patient with airway

Obstruction or choking.
 AIRWAY EMERGENCIES
The airway is the passage through which the
air moves from the nose and mouth to the
lungs. If anything blocks the airway, the
person chokes and cannot get enough oxygen,
and life is threatened. This is an emergency,
and you must give first aid to clear the
airway.
 AIRWAY OBSTRUCTION

 An airway obstruction can occur if the

tongue or swollen tissues of the mouth block
the airway. Air way obstructions caused by:
1. An injury to the mouth or neck
2. A severe allergic reaction
3.The tongue dropping to the back of the
throat and blocked the airway.
 CHOKING
Any airway blockage caused by a foreign
object or fluid is called choking
1.Trying to swallow large pieces of food.
2.Excess alcohol, causing suppression of the
gag reflex, and then choking on food.
3.Wearing dentures.
4.Eating with talking excitedly or laughing or
eating too quickly.
5.Walking, playing or with food, small toys or
other objects in the mouth.
 SIGNS AND SYMPTOMS
OF CHOKING
A person who is choking may have a partial
or complete blockage of the airway. A
complete blockage will not allow breathing.
A partial blockage may be cleared by the
person coughing.
SIGNS AND SYMPTOMS OF
PARTIAL OBSTRUCTION
1. High pitched or wheezing sounds when
breathing in.
2. Coughing
3. Clutching at the throat with one or both
hands
 SIGNS AND SYMPTOMS OF
COMPLETE OBSTRUCTION
 A conscious adult can usually indicate they are choking.
 With an infant or small child who is conscious but not
able to breathe assume they are choking on something.
 1. May be conscious or unconscious
 2. Unable to breathe
 3. Unable to speak
 4. Unable to cough
 5. Face may appear bluish.
FIRST AID FOR CHOKING
For a patient with partial airway obstruction
do not interfere with their attempts to cough
up the object. If the patient is no longer able
to cough or speak, treat as for complete
obstruction.
CONSCIOUS ADULT CHOKING WITH
COMPLETE AIRWAY OBSTRUCTION
1. Ask“Are you choking?”
2. Summon someone to help you.
 3.Bend the casualty well forward at the waist
and give up to 5 sharp slaps between the
shoulder blades with the flat of your hand.
4.If back slaps fail, try up to 5 abdominal thrusts
(Heimlich maneuver)
ABDOMINAL THRUSTS;
5. stand behind the person and wrap your arms
around their waist.
6. Make a fist with one hand and place the thumb
side of the fist on the middle of the abdomen
slightly above the navel.
 CONSCIOUS ADULT CHOKING WITH
COMPLETE AIRWAY OBSTRUCTION
CHEST THRUSTS; Use chest thrusts when you
can’t reach far enough around the patient, or for
women in late pregnancy
 1.Place your arms under the patients armpits and
around the chest.
 2. Make a fist with one hand, place the thumb side
against the center of the patient’s breastbone.
 This is not to be the lower tip of the breast bone
and not on the ribs).
CONSCIOUS ADULT CHOKING WITH
COMPLETE AIRWAY OBSTRUCTION
 3. Grab you fist with the other hand and thrust
inward.
 4. Repeat until the object is dislodged or the
patient becomes conscious.
 WHEN TO STOP CHEST
THRUSTS, ABDOMINAL

THRUSTS AND BACK BLOWS
Stop immediately if the object is dislodged or if
the patient begins to breathe or cough. Make sure
the object comes out. The thrust can cause
internal injuries.
 The significant difference for treating a child over
the age of 1, is use less force to expel the object
Make sure you are sitting or stable before starting
Otherwise use the same method as an adult.
 CONSCIOUS INFANTS
CHOKING WITH COMPLETE
AIRWAY OBSTRUCTION
 First determine if the infant is choking by
observing if the infant can breathe, cough or cry
or is coughing weakly or making high pitched
sounds. Do not use abdominal thrusts.
 Turn the infant face down on your fore arm with
the head lower than the body, and with the heel
of your hand give five forceful back blows
between the infant’s shoulder blades. Then turn
the infant over, with its head lower than its body
 CONSCIOUS INFANTS
CHOKING WITH COMPLETE
AIRWAY OBSTRUCTION
 Give five chest thrusts using your middle and
index fingers on the breast bone one finger
below the nipple line. Repeat back blows and
chest thrusts until object is coughed up or infant
becomes conscious
CHEST THRUST IN INFANTS
 FIRST AID FOR CHOKING
ADULT WHO BECOMES
UNCONSCIOUS
 If the obstruction cannot be removed the casualty
may become unconscious.
 1. Lower the casualty to the floor on their back.
 2. Open the airway and look for an obstruction.
 3. If seen, lift the lower jaw, remove the object
by sweeping it out using a hooking action with
your finger.
 4. Be careful not to push the object deeper.
 FIRST AID FOR CHOKING
ADULT WHO BECOMES
UNCONSCIOUS
 5. Next try to open the airway using head tilt/
chin-lift method
 6. Assess for effective breathing for 10 seconds.
 7. If not breathing attempt to ventilate.
 8. If air does not go into the lungs, retitle the head
and try again.
 9. If air still does not go into the lungs, assume
the airway is still obstructed.
 FIRST AID FOR CHOKING
ADULT WHO BECOMES
UNCONSCIOUS
Start CPR sequence with 30 chest compressions.
 10. After those, open the airway and look in the
mouth.
 11. If you see an object, remove it.
 12. If you cannot get air into the casualty’s lungs
continue the CPR sequence, always looking in
the mouth before the ventilation attempt. Keep
trying to clear the airway.
 FIRST AID FOR CHOKING
ADULT WHO BECOMES
 13.If
UNCONSCIOUS
you see and change in the person’s
condition, stop CPR and reassess the ABCs.
 14.Once you can breathe air into the casualty’s
lungs, give two rescue breaths.
 15.Then complete the primary survey by
checking casualty for signs of circulation and
checking and caring for severe bleeding.
 16.If there are no signs of circulation, begin
CPR.
STEPS OF CPR
 FIRST AID FOR CHOKING
ADULT WHO BECOMES
UNCONSCIOUS
 7.If the casualty has signs of circulation but is
not breathing on their own, continue rescue
breathing. If the casualty starts breathing on their
own, monitor the breathing and circulation,
maintain an open airway, and get to EHS .Put the
casualty into the recovery position.
 FIRST AID FOR AN
UNCONSCIOUS CHOKING
ADULT
 1. Open the airway and place your ear close to
the person’s mouth, then look, listen and feel for
signs of breathing for 10 seconds.
 Look at chest and abdomen for movement Listen
for breathing sounds Feel for exhaled breath on
your cheek If none of these signs are present the
casualty is not breathing.
 FIRST AID FOR AN
UNCONSCIOUS CHOKING
ADULT
 2. Use the head tilt/ chin lift method to open the
airway.
 3. Attempt to ventilate.
 4. If air does not go into the lungs, re-tilt the
head and try again.
 5. If air still does not go into the lungs, assume
the airway is still obstructed and begin the CPR
sequence with 30 chest compressions.
 FIRST AID FOR AN
UNCONSCIOUS CHOKING
ADULT
 6. After those, open the airway and look in the
mouth.
 7. If you see an object, remove it.
 8. If you cannot get air into the casualty’s lungs
continue the CPR sequence, always looking in the
mouth before the ventilation attempt. Keep trying
to clear the airway.
 FIRST AID FOR AN
UNCONSCIOUS CHOKING
ADULT
 9. If you see and change in the person’s
condition, stop CPR and reassess the ABCs.
 10. Once you can breathe air into the casualty’s
lungs, give two rescue breaths.
 11. Then complete the primary survey by
checking casualty for signs of circulation and
checking and caring for severe bleeding.
 FIRST AID FOR AN
UNCONSCIOUS CHOKING
CHILD OR INFANT
 12. If there are no signs of circulation, begin
CPR.
 First aid for a child under 8 is the same as an
adult with 30 compressions, but only performed
with one hand. First aid for an infant is the same
but with two fingers.
 CHOKING EMERGENCIES
PROBLEM SIGNALS CARE
 Casualty conscious Coughing forcefully
Encourage casualty to partial obstruction Can
speak and breathe continue coughing Wheezing
If coughing persists, call EHS Casualty conscious
Coughing weakly Get help complete obstruction
Cannot speak or Begin abdominal thrusts breathe
(back blows and chest thrusts for infants)
 CHOKING EMERGENCIES
PROBLEM SIGNALS CARE
 Casualty unconscious No breathing Call EHS
complete obstruction Breaths won’t go in Begin
CPR Look in casualty’s mouth for an obstruction
after each cycle of compressions before
attempting to ventilate.
 HEAD TILT / CHIN LIFT
 This can be used to stop the tongue from
blocking the airway. If the airway is blocked by
swollen tissue, this may not work. If air goes in
from rescue breaths, the airway is clear.

Nursing Diagnosis:
Ineffective Airway Clearance
Possible Etiologies:(Related to)
 Bronchospasm
 Increased production of
secretions;
 Retained secretions; thick,
viscous secretions
 Decreased energy
“Fatigue
Defining characteristics :
( Evidenced by)
 Statement of difficulty In
breathing
 feeling of chest
constriction
 changes in depth" rate of
respiration ;tachypnea
 tachycardia
 use of accessory muscles
or marked respiratory
effort
 abnormal breath sound,
inspiratory and expiratory
wheezing
 cough (persistent),without
sputum production
 Prolonged expiration
Nursing care plan
Goals/ Objectives
 Short term goal:
 client will demonstrate
signs of patent airway and
adequate oxygen
exchange within 3 days
 long term goal:
 Client will demonstrate
behaviors to improve or
maintain airway clearance
and identify potential
complications and initiate
appropriate actions.
Nursing Intervention
 Nursing Actions
 1. Assess respiratory
status every hour during
acute phase: lung sounds,
respiratory rate and depth,
presence and severity of
wheezing, breathing
pattern, use of accessory
Muscles.
 2. Assist patient to assume
to comfortable position,
keep elevate head of bed,
have client lean on over
bed table or sit on the
edge of bed.
• 3. Keep environmental
pollution to a minimum
according to individual
situation.
 4.. Encourage and assist
abdominal and pursed lip
breathing exercises.
Rationale Outcome Criteria:
client will verbalize reduction
 1.Some degree in bronch
ospasm is present with or absence in difficulty in
obstruction in air way breathing and feeling of chest
constriction, respiration and
and may be manifested cardiac rate within normal
with wheezing or range, absence or reduction of
absent breath sounds in inspiratory and expiratory
severe asthma. wheezing, and ability to resume
Tachypnea is usually to activities
present to some degree
and respiratory
dysfunction is variable
depending on
underlying process such
as allergic reaction.
 2. Elevation of head of
the bed facilitates
respiratory function by
use of gravity, however
client in distress may
seek position that most
eases breathing.-.
3.Precipitators of allergic
type of respiratory
reactions that can trigger
or exacerbate onset of
acute episode.
 4.Provides some means
to cope with or control
dyspnea and reduce air
trapping.
 Nursing care plan
Nursing Diagnosis: Goals/ Objectives Nursing Intervention Rationale Outcome Criteria:

• 5. Increase fluid intake to-  5. Hydration helps thin  client will be able to
3000 ml/ day with in secretions, facilitating identify and avoid
cardiac tolerance. expectoration and using potential allergens or
warm liquids may stimuli that would trigger
 6. Provide warm liquids decrease bronco spasm. asthma attack and be
and recommend intake of able to handle symptoms
fluids between meals. if recurrence comes
 7. Administer  6. liquids during meals prompt follow up
medications as indicated. can increase gastric checkup and to always bring or
distension and pressure have the prescribed medications
 8. Monitor side effects of
on the diaphragm. on hand in case asthma occurs.
bronchodilator (tremors
“tachycardia).  7. Anticholinergic
 9. Provide supplemental medications are the first
humidification, e.g. line drugs for clients
Neutralizer in respiratory with this condition.
Treatments.  8. Humidity helps reduce
 10. Monitor ABGs, pulse viscosity of secretions,
oxymettery, chest X –ray facilitating expectoration
and may.
 9.Breathing exercises
help enhance
diffusion ,nebulizer
medications can reduce
bronchospasm and
stimulate expectoration.

• 10.Establishes baseline for

monitoring progression
"regression of disease
process
Nursing Diagnosis:
Ineffective Airway Clearance
Possible Etiologies:(Related to)
 Bronchospasm
 Increased production of secretions;
 Retained secretions; thick, viscous secretions
 Decreased energy “Fatigue
Defining characteristics :( as Evidenced by)
 Statement of difficulty In breathing
 feeling of chest constriction
 changes in depth" rate of respiration ;tachypnea
 Tachycardia
 use of accessory muscles or marked respiratory effort
 abnormal breath sound, inspiratory and expiratory wheezing
 cough (persistent),without sputum production
 Prolonged expiration
Goals/ Objectives
Short term goal:(adequate oxygen exchange)
client will demonstrate signs of patent airway and adequate oxygen exchange
within 3 days
long term goal:(Identify potential complication to improve or maintain
airway clearances )
Client will demonstrate behaviors to improve or maintain airway clearance
and identify potential complications and initiate appropriate actions.
Nursing Actions
1. Assess respiratory status every hour
during acute phase: lung sounds,
respiratory rate and depth, presence and
severity of wheezing, breathing pattern,
use of accessory Muscles.
2. Assist patient to assume to comfortable
position, keep elevate head of bed, have
client lean on over bed table or sit on the
edge of bed.
3. Keep environmental pollution to a
minimum according to individual
situation.
4.. Encourage and assist abdominal and
pursed lip breathing exercises.
Rationale
1.Some degree in bronchospasm is present
with obstruction in air way and may be
manifested with wheezing or absent breath
sounds in severe asthma. Tachypnea is
usually present to some degree and
respiratory dysfunction is variable
depending on underlying process such as
allergic reaction.
2. Elevation of head of the bed facilitates
respiratory function by use of gravity,
however client in distress may
seek position that most eases breathing.-.
3.Precipitators of allergic type of
respiratory reactions that can trigger or
exacerbate onset of acute episode.
4.Provides some means to cope with or
control dyspnea and reduce air trapping.
Nursing Actions
5. Increase fluid intake to-3000 ml/ day
with in cardiac tolerance.
6. Provide warm liquids and recommend
intake of fluids between meals.
7. Administer medications as indicated.
8. Monitor side effects of bronchodilator
(tremors “tachycardia).
9. Provide supplemental humidification,
e.g. Neutralizer in respiratory
Treatments.
10. Monitor ABGs, pulse oxymettery,
chest X –ray
Rationale
5. Hydration helps thin secretions,
facilitating expectoration and using warm
liquids may decrease bronco spasm.
6. liquids during meals can increase
gastric distension and pressure on the
diaphragm.
7. Anticholinergic medications are the first
line drugs for clients with this condition.
8. Humidity helps reduce viscosity of
secretions, facilitating expectoration and
may.
9.Breathing exercises help enhance
diffusion ,nebulizer medications can
reduce bronchospasm and stimulate
expectoration.
10.Establishes baseline for monitoring
progression "regression of disease process
Evaluation
Outcome Criteria:
client will verbalize reduction or absence in difficulty in breathing and feeling
of chest constriction, respiration and cardiac rate within normal range,
absence or reduction of inspiratory and expiratory wheezing, and ability to
resume to activities.
client will be able to identify and avoid potential allergens or stimuli that
would trigger asthma attack and be able to handle symptoms if recurrence
comes
prompt follow up checkup and to always bring or have the prescribed
medications on hand in case asthma occurs.