Choking is a form of asphyxia (impaired or impeded breathing) caused by an obstruction within the air-passages. Food or small objects can cause choking if they get caught in your throat and block your airway. This keeps oxygen from getting to your lungs and brain. If your brain goes without oxygen for more than four minutes, you could have brain damage or die. Acting like a little door, it closes off the entrance to your trachea so that food is sent down your esophagus into your stomach instead of into your lungs.

Peanuts and popcorn, hot dogs, candy, carrots, and sunflower seeds. Ayal Willner, M.D., has seen them all stuck in children's throats--and sometimes their lungs. The pediatric ear, nose, and throat specialist in Long Beach, Calif., spends a lot of time in emergency rooms removing food and small objects from children's air passages. "I see about 20 to 30 kids a year from all over southern California because of choking," he says.

Research released by Asthma UK Cymru shows that traffic pollution is one of the most commonly reported asthma triggers for people with asthma across Wales, with more than three out of five (65%) claiming it leaves them gasping for breath.

In 2001, more than 17,000 children ages 14 years or younger were treated for choking episodes in U.S. emergency departments, according to the Centers for Disease Control and Prevention (CDC). About 60 percent of these episodes were related to food items. Coins were involved in 18% of all choking-related emergency department visits for children ages 1 to 4 years.

Signs and symptoms:

The universal sign for choking is hands clutched to the throat. If the person doesn't give the signal, look for these indications:

• Inability to talk
• Difficulty breathing or noisy breathing
• Inability to cough forcefully
• Skin, lips and nails turning blue or dusky
• Loss of consciousness

Causes with different types of Choking:

Accidental Choking: Choking is almost always accidental. Choking from objects being lodged in the throat is commonly seen in the very young, elderly, psychiatric patients or in the infirm, acute alcohol intoxication, particularly where the ability to swallow or masticate is severely impaired. Choking commonly occurs during a meal when food is accidentally inhaled, especially when the victim is laughing or crying. Vomited matter may be inhaled by a person under the influence of drink or of an anesthetic, during a fit of epilepsy, or while in a state of insensibility from other causes. Infants usually regurgitate clotted milk after a meal, and this may fall into the larynx.

Choking may occur due to inhalation of blood from facial injuries, such as a broken nose, or dislodged teeth, and laceration of the lips and gums inflicted during fight, if the victim becomes unconscious and lies on his back. Impaction of solid bodies, such as a large bolus of food, piece of meat, fruit stone, onion, potato, corn, button, coin, rag, rubber teat, seeds, live fish, mud, leaves, cotton, or a set of false teeth, extracted teeth in dentistry, blood and cloth after ENT operation, such as tonsillectomy may cause asphyxia.

Gauze packs inserted during an operation can be inhaled and cause death. Children often place objects like marbles or coins in their mouths, which may pass into larynx or trachea during a sudden deep inspiration. Objects like rubber balloons may be inhaled by children during play. Choking due to regurgitation of food may occur during rape or violent sexual intercourse.

In head injury, irritation of the brain causes vomiting, which may be inhaled. The foreign body becomes arrested at, or just below the vocal cords and may produce an inflammatory reaction with edema. Food aspiration following suppression of the gag reflex by tranquillizing drugs is sometimes seen in lunatic asylums. If there is struggle to breathe and attempts to remove the occluding object are unsuccessful, asphyxial changes are, well marked. When a foreign body is inhaled, there is immediate acute respiratory distress, but once this has passed, the victim has little subsequent distress. Complications may develop after a latent interval.

Sixty percent of infant suffocation occurs in the sleeping environment. Infants can suffocate when their faces become wedged against or buried in a mattress, pillow, infant cushion or other soft bedding or when someone in the same bed rolls over onto them. Infants can also suffocate when their mouths and noses are covered by or pressed against a plastic bag.

Suffocation

Suffocation may occur from diseases, such as diphtheria, infectious mononucleosis, H. influenza infection in children, rupture of aortic aneurysm in air-passages, haemoptysis in pulmonary tuberculosis, a tuberculous gland eroding into a bronchus and prolapsing into its lumen, acute edema of the larynx due to inhalation of steam or ingestion of irritant substances, pharyngeal abscess, laryngeal and bronchial growths, hemorrhage into the trachea, etc., and from the effects of certain poisons.

Insect bites especially those of bees, wasps and hornets, and drug reaction from penicillin, etc,, can cause swelling of the lining membranes of the larynx and death within a few minutes due to an allergic reaction. A blow to the front of the neck may cause severe swelling of the mucosa of the airway due to edema and hemorrhage. Death may occur due to reflex vagal inhibition.

Choking from external causes may occur from impaction of a relatively large foreign body, a bolus of food, or a denture in the oesophagus, compressing the trachea.

Suicidal Choking: It is rare. The victims are usually mental patients (dementia or psychoses) or prisoners. For this a foreign body is thrust into the throat.

Homicidal Choking: Choking as a mode of infanticide may be caused by stuffing a wad of paper or cloth into the pharynx or larynx. It is very rare and is practicable only when the victim is suffering from disability or disease.

Cause of Death: (1) Asphyxia. (2) Cardiac inhibition is the common cause. (3) Laryngeal spasm. (4) Delayed death may result from pneumonia, lung abscess or bronchiectasis (an abnormal stretching and enlarging of the respiratory passages caused by mucus blockage).

Mechanism of Death: Large foreign bodies may be impacted in the pharynx and cover the opening of the larynx. By completely obstructing the airway, such impacted bodies may cause death from hypoxic hypoxia or anoxic anoxia. A small object partially blocking the lumen of larynx may cause death by laryngeal spasm. Usually laryngeal spasm passes off before the hypoxia becomes fatal.

Sudden reflex neurogenic cardiovascular failure is probably produced by reflex parasympathetic cardiac inhibition. Impaction of a foreign body at the bifurcation of trie trachea may cause death by asphyxia, but irritation m this region usually causes parasympathetic cardiac inhibition. A foreign body impacted in a bronchus may produce reflex cardiac inhibition.

CAFE CORONARY: This is a condition in which a healthy but grossly intoxicated person (restaurant patron), who begins a meal, suddenly turns blue, coughs violently, then collapses and dies, without much fuss. Death appears to be due to sudden heart attack. At autopsy, a large piece of poorly chewed food (bolus or a piece of meat) may be found obstructing the larynx. The clinical signs of choking are absent, because of the high blood alcohol content which anaesthetizes the gag reflex.

Autopsy: The foreign body which caused the occlusion of air- passages will be found in the mouth, larynx or trachea. When food or vomited matter has been inhaled, particles of food material may be observed embedded in thick mucus in the trachea and bronchi, and particles may be drawn into the bronchioles which distinguishes the condition from those cases in which food is forced up the esophagus and falls into the larynx after death.

Traumatic asphyxia results from respiratory arrest due to mechanical fixation of the chest, so that the normal movements of the chest wall are prevented. Fatal cases are only due to accident. Usually, there is a gross compression of the chest by a powerful force. Multiple deaths are likely to occur when there is an outbreak of fire in a theater or whenever large crowds gather in an enclosed place. Some are crushed by the weight of the crowd, the chest being pressed violently, or may even get trampled on and crushed-under feet (riot crush or human pile deaths). Another common cause is crushing by falls of earth or stone usually in a coal mine or during tunneling or in a building collapse.

Sometimes, the victim is pressed to the ground by some heavy weight as by a motor vehicle or other machinery. A person repairing a car may be crushed when the jack slips and the vehicle falls on top of him. It may occur in assault cases, where the victim is jumped or stamped upon and crushed by one or more assailants. Occasionally, it results from indirect compression, when the body is subjected to force in such a manner that his thighs and the knees are driven against his chest, the so-called "jack-knife" position.

Prevention and first aid treatment:

Parents should supervise young children during mealtime, says the AAP, and should teach children to chew their food well. Children should be sitting--not lying down or in motion--while eating. Eating "on the run" increases the risk of choking. When picking out toys, take a few extra minutes to make sure that the toy is safe for the child that it is intended for. Most toys have an age-appropriate label on them. This should be a good starting point to make sure that this toy is a good fit. Many times parents and grandparents like to buy older toys for kids because they think the child is “more advanced” than their age-level. These labels are there for the child’s safety and adults need to pay attention to them.

The CDC and other experts recommend the following that advice will help prevent choking:

• Keep a watchful eye on children who are eating and playing. Don't leave small objects, such as buttons, coins and beads within an infant's reach.
• Keep dangerous toys, foods, and household items out of reach. Do not let children eat too fast.
• Learn how to provide early treatment for children who are choking.
• Sit down, take small bites, and don't talk with your mouth full. There's more than good manners at stake.
• Remove all wrapping papers, bags, paper, ribbons and bows from tree and fireplace areas after gifts are opened. These items can pose suffocation and choking hazards to a small child or can cause a fire if near flame.
• Use Mylar balloons instead of latex balloons. Children under age 8 can choke or suffocate on uninflated or broken balloons. If you must use latex balloons, store them out of reach of children, do not allow children to inflate them, and deflate and discard balloons and balloon pieces after use.

The AAP recommends that children younger than 4 not be fed any round, firm food unless it is cut into small pieces no larger than one-half inch. Children under 4 do not have a full set of teeth and cannot chew as well as older children, so large chunks of foods may lodge in the throat and cause choking. And caregivers should be aware of older children's actions. Many choking incidents occur when older brothers or sisters give dangerous foods, toys, or small objects to a younger child. Make sure that toys have no small parts that could be pulled off. Cut foods a chld can choke on easily such as hot dogs, into small pieces.

People who are choking should first be asked to bend forward and cough. If this fails the following action should be taken:

• Stand behind the person
• Put your arms around the abdomen
• Make a fist with one hand with the thumb against the abdomen - the other hand should grasp the fist of the first hand
• With a sharp movement of the hands press up and into the abdomen to dislodge the foreign body.
• A blow on the back or on the sternum may cause coughing and expel the foreign body. If this is not successful, the foreign body should be removed from the hypopharynx or laryngopharynx )bottom part of the pharynx, and is the part of the throat that connects to the esophagus with the middle and index fingers or with forceps).
• Perform an abdominal thrust (Heimlich Maneuver) repeatedly until the foreign body is expelled. If the object does not come out after five back blows, turn the infant onto his or her back and give up to five chest thrusts, supporting the head and neck. Hold the infant with one hand and arm. Use two or three fingers of your free hand to push on the breastbone just as you press for chest compressions during CPR. Stop chest thrusts if the object is forced out.

If choking is occurring, the Red Cross recommends a "five-and-five" approach to delivering first aid:

• First, deliver five back blows between the person's shoulder blades with the heel of your hand.
• Next, perform five abdominal thrusts (also known as the Heimlich maneuver).
• Alternate between five back blows and five abdominal thrusts until the blockage is dislodged.

If you're the only rescuer, perform back blows and abdominal thrusts before calling 911 (or your local emergency number) for help. If another person is available, have that person call for help while you perform first aid.

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