Guideline 4 outlines the recommended procedure for choking. This is a controversial area mainly as there is a lack of any scientific evidence for making strong clinical guideline recommendations. The Consensus of Resuscitation Science identified that the combination of back blows, chest thrusts and abdominal thrusts could be used to relieve complete foreign body airway obstruction. Where the patient is unconscious then CPR should be used.
It is the use of the chest thrust which appears to be causing some confusion. Chest thrusts are applied:
- At the same point on the chest that is used when providing chest compressions during CPR.
- They are delivered sharper and slower than chest compressions during CPR.
In order to do chest thrusts you need to have the back of the patient supported. This can be achieved by either:
- Placing your other hand on the patients back.
- If the patient is sitting use your other hand to support the back of the chair.
- Have someone stand behind to provide support.
- Stand against a firm surface like a wall.
- Lie the patient down.
It is very hard to state categorically on how to achieve back support when using chest thrusts but the overall principle remains the same. Support the back any way you can.
Remember if chest thrusts cannot be applied continue with back blows. If the patient becomes unconscious commence CPR. The ARC does not recommend the use of abdominal thrusts as there is considerable evidence of harm caused by this procedure.
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