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We're now going to look at choking and in particular, we're going to look at what's classified as the older child and adult choking. Now, the reason we're calling it older child and adult choking is it's exactly the same. Now, on the course, you're going to see how to do infant, which is nought to one year old; child, which would be one to puberty type ages, and then anything above that is where we're looking at the older child and the adults. Now, the actual rules are pretty much exactly the same as for children. We're going to run you through this video, so we can show you the basics on how to do the exercise and show you how simple it is to save a child or an adult's life.

We're dealing here with obstructions, and there are two key types of obstruction. We have partial airway obstruction. This could be something like a fish bone. It's caught in the throat, it's causing a lot of discomfort, pain, the person's coughing, they're getting very distressed, their face is becoming very red, they're getting very upset, they can't eat anything more but they are making a noise, they are breathing. So with this person, we will go up to anyone who's choking and really ask them the most obvious question, "Are you choking?" If they can answer yes to it or they respond in any way to that, they're not choking in the sense of a complete airway obstruction. So this person with the partial airway obstruction, we need to allow them to cough, try and calm them as much as we can, and hopefully, they'll clear the obstruction themselves fairly well. But the important thing is this person is breathing. There's nothing more blocking their throat.

Now, if they were to maybe eat something else on top, then that may well cause a complete airway obstruction. A complete airway obstruction might be someone's eating a lump of steak, swallows that, and it's now got completely stuck in their throat. When someone's got a complete airway obstruction, that's where we're doing the manoeuvres we're talking about, which are back slaps, and abdominal thrusts. Once the item is blocked in the throat, there's not a lot this person can do to actually get air past it. So they're going to do what's called the universal sign of choking. They'll take their hands to their throat and they'll gasp. They can't make any noise. They're going to look very panicked, very wide-eyed. They can look very scared. Sometimes they'll start to look blue as the oxygen levels start to drop. Sometimes what they'll also do is they'll be embarrassed. What could happen then is the person may leave the room, maybe go in to the toilets or go outside. So if you see someone who's choking has left the room, follow them. They need some help because once they get to a point when they collapse, they could collapse and then die.

So with choking, as a complete airway obstruction, this is a life-threatening condition. So you approach an older child and to start with, this child is eating and then you see that they've got this that's stuck in their throat, they're starting to panic, they're holding their hands to their throat, they're turning blue, go up to them and say, "Are you choking?" You're asking permission also at this stage, and then we're doing some quick procedures. So talk to them the whole time and try and stay calm yourself. What we're doing is we go up to them and we turn them 'round and we just lean them over our arm. In this example, just showing you here on the mannequin, and what we're doing is leaning over so that we're holding them tight just against us so we can support them.

We can also feel a little bit if there are any breaths on the inside of our arm. We're then taking the heel of the hand and we're doing five back slaps on the section in the back between shoulder blades. Now, the idea of these back slaps is hopefully to dislodge the item so that then they can expel the air out of their lungs and the item will come out. Whenever you're doing the back slaps, always look forward to see whether something is coming through. To deliver these, you just take the hand, and we go one and check, and check, check, check, and check. So we've done five back blows, nothing's come out, we move around the person, and then we can come through and do an abdominal thrust. Now, the old name for abdominal thrust was the Heimlich manoeuvre. This went away many years ago, but a lot of people still know the Heimlich manoeuvre, but it's just it's called abdominal thrust. The word "abdominal thrust" is much easier because we're talking about the abdomen and the thrust. Heimlich manoeuvre is a very much more difficult word for people to learn.

To do this, we're taking the thumb side of the first and we're bringing it in just above the belly button. From there, we take the other hand round and then we're pulling inwards and upwards, and we're doing it five times. So as we pull in, what's actually happening is your fist is almost going in this action. It's forcing against the diaphragm, against the base of the lungs, and the idea is we're forcing the air that's trapped in the lungs against the obstruction to hopefully expel it out. So around and you get close to the person, and with inwards and upwards, that'll be one, check, two, check, three, check, four, check, five, check. If that hasn't worked, we would bring them around and then we'd deliver five back blows again, followed by five abdominal thrusts, five back blows. We just keep on repeating that until the obstruction comes out or until they pass out.

If they do pass out, allow them to fall to the floor. Be careful that you don't hurt yourself. If it is just an older child, it wouldn't be so difficult, but an adult definitely you can hurt yourself because they'll literally just become lifeless. You now go up to them. You know they're not breathing, so we've got an unconscious non-breathing patient and if we have that, we would then start CPR. Remember, if you're on your own and you haven't called the emergency services at this stage, then we're going to need to call them. Now, with the emergency services, there's different people who say different things but if someone says, "Leave them after so many cycles." But if you've got other people there and someone's got a complete airway obstruction, you can phone the emergency services, get them to call them, keep them on the line, you can tell them what's going on.

Now, if you've gone through a few cycles of this and the obstruction's come out, we should get this person checked over by a doctor because the act of pushing into the stomach is like someone punching you really, really hard in the stomach, but because they're not breathing, the stomach's not protecting itself, so it's like a very hard punch to the stomach where your muscles are very slack. You can do a lot of internal damage and you could cause internal bleeding, which again, would lead on to shock and all sorts of other conditions. So, call the emergency services when you can. If you're on your own, you wouldn't want to leave this patient to go and call the emergency services. You'd really keep going until you can get this obstruction out. It's going to be very distressing for them.

Now, this is very successful but we need to do it quickly and we need to do it effectively, so try and stay calm the whole time you're delivering the back slaps and the abdominal thrust. Keep talking to the patient, get the emergency services there as quick as possible, and when the obstruction's come out, sit them down, they're going to be very, very tired, they're going to be coughing, they're going to need to get a lot of air. Sit them down and relax, loosen their clothing, maybe open the window if needed, just so we can calm them down. Most importantly, get medical help after you've done this because you could well have damaged their insides very badly.