Awareness and First Aid

Here’s what to do when someone goes from enjoying a meal to choking on it or having an allergic reaction.

What if you’re sitting around a table when someone swallows their food wrong or has an allergic reaction that causes a complete airway obstruction, or severe choking? Two ER24 paramedics tell you how to handle a food-related emergency.

Severe choking incident: Adults

The most common signs of an adult choking are that they’ll clutch their neck, stand up, and cough and struggle for air, says ER24 Johannesburg South Branch Manager Raeesah Boomgaard. But the best way to confirm this is to ask the person if they’re choking, “They’ll react with a nod,” she says, “and need immediate help”. In the absence of this, the patient’s face will turn red, and then blue as they use the last of their reserve oxygen.

Once you’ve established that they’re choking, the first thing to do is call for help on 084 124, and then ask the patient to cough. This may dislodge the obstruction in the throat, but if it doesn’t, your next move is to apply blows to the back. Lean the patient forward and use the heel of your hand to perform blows on their back. Five of these should suffice. If back blows don’t work, then it’s time to perform abdominal thrusts, otherwise known as the Heimlich manoeuvre.

 How to do a Heimlich manoeuvre

  • Get the person to stand up
  • Position yourself behind them
  • Place your arms around their waist
  • Make a fist and place it just above the navel, thumb side in
  • Grab the fist with your other hand and push it inward and upward at the same time; perform five of these abdominal thrusts
  • Repeat until the object is expelled and the person can breathe or cough on their own.

Once the item has been dislodged and the patient is breathing again, you need to monitor their heart rate and breathing. If you requested medics, they would check if the obstruction has been completely dislodged and for any trauma to the throat.

Choking in babies

With babies, a gentler procedure is required to avoid doing damage. ER24 Advanced Life Support (ALS) Practitioner Kurt Maske describes what to do:

Back blows

  • Place the infant with head downwards on your forearm. Support the head and shoulders on your hand
  • Hold the infant’s mouth open with your fingers
  • Give up to five back blows with the heel of one hand between the shoulders, checking if the airway obstruction is relieved after each back blow
  • Turn the infant onto their back, open mouth and remove any loose foreign material with your little finger.

If you’re unsuccessful after five back blows, move on to modified chest thrusts.

Modified chest thrusts

  • Place the infant on their back on a firm surface
  • Place two fingers in the cardiopulmonary resuscitation (CPR) compression position just below the nipples
  • Give 5 chest thrusts – slower but sharper than compressions
  • Check if the obstruction has been removed after each chest thrust

If the child becomes unconscious during this procedure, drop the chest thrusts and commence CPR.

“If the infant was struggling for just a short period, monitor their consciousness, if they’re still having difficulty breathing, and whether they’re lethargic,” says Maske. If any of these signs are present, call medics or get the baby to a doctor urgently.

Allergic reaction to food

There are several foods that can cause an allergic reaction, the most common being fish, shellfish, peanuts, and eggs. Alarmingly, there’s not much a bystander can do if the allergic reaction causes the airway to swell closed – known as anaphylaxis. “The best you can do is find out if the patient or anyone else nearby has an EpiPen.”

This should be administered by the person suffering the reaction, and even then, they’re not completely out of the woods. They still need to get to the hospital, because once the adrenalin of the EpiPen wears off, the anaphylaxis could start up again. Maske also points out that you sometimes won’t notice any allergic symptoms like a rash, watery eyes, or heavy breathing, but you will notice that the patient is anxious, and may start acting out in what he calls “panic of impending doom”. When this happens it’s important to stay calm and call ER24 on 084 124 for real help, real fast.