NCM 109

HEALTH
ASSESSMENT
Laboratory Class

Romina O. Berganio, RN, MAN

Professor/Clinical Instructor
 Learning Objectives
After the laboratory activities, you are expected to:
• Define the Heimlich maneuver and its
importance in emergency situations.
• Identify the signs of choking in adults, children,
and infants.
• Demonstrate the correct technique for
performing the Heimlich maneuver on conscious
and unconscious individuals.
• Understand modifications for special populations
(e.g., pregnant women, obese patients, infants).
RELEVANT ANATOMY OF CHOKING

● The epiglottis usually protects the airway from aspiration of foreign objects
● Aspirated objects may be above or below the vocal cords.
WHAT IS CHOKING?
• occurs when the airway becomes either
partially or completely blocked
• by a foreign object,
• by swelling in the mouth or throat;
• or by fluids, such as vomit or blood.
• is especially common in young children,
but a person of any age can choke.
• A person who is choking can quickly
become unresponsive and die, so it is
important to act quickly.
RISK FACTORS OF CHOKING

• talking or laughing with the mouth full or eating too

fast.
• Medical conditions (such as a neurological or
muscular condition that affects the person’s ability
to chew, swallow or both)
• dental problems or poorly fitting dentures that affect
the person’s ability to chew food properly.
Signs and Symptoms of Choking
• One or both hands clutched to the
throat.(universal sign of choking)
• A look of panic, shock or confusion.
• Inability to talk.
• Strained or noisy breathing.
• Squeaky sounds when trying to breathe.
• Cough, which may either be weak or
forceful.
• Skin, lips and nails that change color
turning blue or gray.
• Loss of consciousness.
The Heimlich Maneuver
(Abdominal Thrust)
• is a rapid first-aid procedure to treat
choking due to upper airway
obstruction by a foreign object
• should be used only when the airway
obstruction is severe and life is
endangered.
• If the choking person can speak, cough
forcefully, or breathe adequately, no
intervention is required.
Contraindications for HEIMLICH
MANEUVER
Absolute contraindications
• Age < 1 year is a contraindication to the Heimlich
maneuver

Relative contraindications
• Children < 20 kg (45 lb; typically < 5 years) should
receive only moderate pressure thrusts and back
blows.
• Obese patients and women in late pregnancy
should receive chest thrusts instead of abdominal
thrusts.
 Step-by-Step Description of TREATING A
CONSCIOUS CHOKING ADULT OR CHILD

• Determine if there is severe airway obstruction

• Look for signs such as inability to speak, cough, or breathe
adequately.
• Look for hands clutching the throat, which is the universal
distress signal of severe airway obstruction.
• Ask: “Are you choking?”
• If the person can speak and breathe, encourage them to
cough but do not initiate airway clearance maneuvers;
instead, arrange medical evaluation.
• If the choking person nods yes or cannot speak, cough, or
breathe adequately, that suggests severe airway
obstruction and the need for airway clearance maneuvers.
d slightly behind the choking

need to kneel behind them rather

o strike between the shoulder

he person stand up straight.

bend your knees slightly for

ch time.
ws and 5 abdominal thrusts.
can cough, cry or speak or
• If the person becomes unresponsive, lower
them to a firm, flat surface and begin CPR
(starting with compressions) according to
your level of training.
• Trained responders: After each set of
compressions and before attempting
breaths:
• Open the person's mouth.
• Look for an object.
• If seen, remove it using your finger. NEVER
do a finger sweep unless you actually see an
object.
 How to give back blows?
• Position yourself to the side and
slightly behind the person. For a
small child, you may need to kneel
behind them.
• Place one arm diagonally across their
chest.
• Bend them forward at the waist so
the upper body is parallel to the
ground.
• Firmly strike them between the
shoulder blades 5 times with the
heel of the hand.
How to give back blows?
How to give abdominal thrusts?
• Have the person stand up straight.
• Find their navel with two fingers.
• Move behind them; place your front foot in between their
feet, bending your knees slightly. For a small child, you may
need to kneel behind them.
• Make a fist with your other hand.
• Place the thumb side against their stomach, above your
fingers.
• Take your first hand and cover your fist with it.
• Pull inward and upward 5 times.
• Make each abdominal thrust forceful and separate from the
other.
• If the person is able to cough, cry or speak, encourage the
person to keep coughing, but continue to observe them. Do
not leave them alone and be prepared to act if their
condition changes.
How to give abdominal thrusts?
Treating a Choking Infant
ABDOMINAL THRUST FOR
UNCONSCIOUS PATIENT
Special Considerations in
Managing Choking
• If a person is too large to wrap your arms around to give abdominal
thrusts, give chest thrusts instead of abdominal thrusts.
• If a person is obviously pregnant or known to be pregnant, give chest
thrusts instead of abdominal thrusts.
• If a person is in a wheelchair, give abdominal thrusts as usual but you may
need to kneel behind the wheelchair. If abdominal thrusts are difficult,
give chest thrusts.
• Remove the armrests, if necessary, to give abdominal or chest thrusts.
• As a last resort, remove the person from the wheelchair.
•
 Giving Yourself Abdominal
Thrust
• If you are choking and alone, call 9-1-1 using a landline
or a GPS-enabled mobile phone. Even if you are not able
to speak, the open line will cause the dispatcher to send
help.
• Give yourself abdominal thrusts, using your hands, just
as if you were giving abdominal thrusts to another
person.
• Alternatively, bend over and press your abdomen
against any firm object, such as the back of a chair or a
railing.
• Do not bend over anything with a sharp edge or corner
that might hurt you, and be careful when leaning on a
railing that is elevated.
Giving Chest Thrust to
PREGNANT/Obese Client
FIRST AID FOR A CHOKING
ADULT
https://youtu.be/8R3RWC-xx1I?si=cB0SG5zJgODfUC
0U
FIRST AID for a CHOKING CHILD

https://youtu.be/FhZtQwayP1g?si=5aht0MeMs8i-F_
pB
FIRST AID FOR A CHOKING
INFANT
https://youtu.be/tsjik2xpDQs?si=KKgMylmL2it189pr
• “Nursing is an art; and if it is to be made an art, it
requires as exclusive a devotion, as hard a
preparation, as any painters or sculptors work; for
what is the having to do with dead canvas or cold
marble, compared with having to do with the living
body - the temple of Gods spirit? It is one of the
Fine Arts; I had almost said the finest of the Fine
Arts.” - Florence Nightingale