DON’T DANCE TO THE TUNE OF DEATH

Have you ever witnessed anybody dying where you were a hapless onlooker? Wished not and never! But the friends  and onlookers of these famous personalities were mute witnesses to their tragic ends. From Alexander Alekhine  to  Subroto  Mukherjee, the first Indian Air force Chief,  from Jimmie Foxx to Raymond Griffith  is a list of notable people who had one thing common to them.Similarly,  former American President George W. Bush and Queen Elizabeth The Queen Mother have /had one thing common to them too.You may be surprised to know that the first group of celebrities died of Choking and the second group were the lucky survivors, that too Queen Elizabeth ; not once but three times !!!

Choking,  also known as foreign body airway obstruction is a life-threatening medical emergency characterized by the blockage of air passage into the lungs secondary to the inhalation or ingestion of food or another object. It is caused by a mechanical obstruction of the airway that prevents normal breathing and was the fourth most common cause of unintentional injury-related death in the US in 2011.

Witnessing  a choking victim the onlookers get panic and in the process  they forget grandma’s cure .Let us start from that. As mentioned in Google book:

“If something has ‘gone down the wrong way' the universal solution is a swift slap on the back to dislodge the blockage.However, when the choking is caused by fish bones or small,pointed objects sticking in the throat a more subtle approach may be needed. Fluids should not be given, but a dry diet of bread, thick porridge, pudding or mashed potatoes, which will carry the object through the food passage. To remove a fish bone from the throat, suck a lemon which dissolves parts of the bone, and makes it quite fexible. Another way is to swallow a raw egg immediately.”

These methods do definitely help, but have got limitations. The first aid method of choking management is described here in the language the laymen and the public can understand. These are featured in Wiki How and their formal permission is obtained to use it in this article .It is purely for Educational purposes. There are so many variations and modifications of the first aid technique, but the universally accepted one is   Heimlich manoeuvre.

                             Performing the Heimlich on a Standing Person

                                              Heimlich Manoeuvre Step 1

Determine if the person is truly choking. A choking victim will often have their hands around their throat. If you notice someone making this gesture, look for other choking signals. You should only perform the Heimlich on a choking person. Look for the following:

 •Cannot breathe or experiencing loud, difficult breathing

•Cannot speak

•Inability to cough effectively

•Blue or gray color to lips and fingernail beds

•Loss of consciousness                                                              

                                                 Heimlich Manoeuvre Step 2

Let the person know you're going to perform the Heimlich. Tell the choking person you want to help them. Let them know you know the Heimlich Manoeuvre and are going to perform it on them.

                                         Heimlich Manoeuvre Step 3

   Wrap your arms around the person's waist. Stand with your legs separated to best support your body. Gently wrap both arms around their waist. Lean them forward slightly.   

Position your hands. With one hand, make a fist. Which hand you use does not matter. Position your fist below the ribcage, but above the navel. Then, wrap your other hand around your fist.

                                            Heimlich Manoeuvre Step 4

.  Make a series of thrusts. To make a thrust, press hard and quick into the abdomen. Pull inward and upward as you press. It should feel like you're trying to lift the person off the ground:

 •Make the thrusts quick and forceful

 •Perform five abdominal thrusts in quick succession. If the object is still not dislodged, repeat with five additional thrusts                                 

Heimlich Manoeuvre Step 5                  

Perform back blows. If the object is not dislodged with the Heimlich manoeuvre, do back blows. Deliver five blows to the person's back with the heel of your hand. Aim for the area between the shoulder blades , Press down hard, as you need to use enough force to dislodge the object.However, keep the force confined to your hands. Do not squeeze the area surrounding the person's ribcage or abdomen.

When a victim of choking is the only one in the scene of occurrence  and no one else is around who is able to assist the victim, the victim can save himself  by following a few simple steps  “how to perform the Heimlich Manoeuvre on yourself”

Try to cough out the foreign object. If you feel like you have something caught in your throat, you should try to cough it out. If you can cough forcefully enough to get it out, then you should not have to perform the Heimlich manoeuvre. If you cannot get the object out by coughing and are struggling for air, you need to act quickly, especially if you are alone.

 •You need to expel the obstruction before you lose consciousness.

•Even through the Heimlich manoeuvre, continue to intentionally cough

Make a fist. To start getting ready to perform the Heimlich manoeuvre on yourself, you need to get your hands positioned correctly first. Make a fist with your strongest hand. Place it on your abdomen just above your navel and below your ribcage.

You need to make sure that your hand is in the right place so you can ensure that you don't hurt your ribs and are at the most opportune place for expelling the object.

Hold the fist with your other hand. Once you have your fist in place, you need to add your other hand for leverage. Open your other hand and place it over the fist you have on your stomach. You need to make sure that the fist is in the center of your hand.

This will allow you to push harder when you start the Heimlich manoeuvre.

Drive your fist in and up. To try to get the foreign object dislodged, you need to push your fist and hand into your diaphragm or stomach area. Use a quick j-shaped motion, in and then up. Repeat multiple times.

If this does not dislodge the foreign object very quickly, you need to try to add more force with a stable object .

Add force with a stable object. In your immediate area, you need to find a stable object that is about waist high that you can bend over. A chair, a table, or a counter top will work . With your hands still clasped in front of you, bend over the chair, table, counter, or other solid object. Brace your fists between the chair and your abdomen and drive your body against the solid object.

This will greatly increase the force you apply to your diaphragm, which will be more effective to help dislodge seriously stuck foreign objects.

Repeat. You may not be able to dislodge the object during the first try. You need to quickly repeat pushing yourself onto the stable object until the object is removed. You should return to normal breathing once it is removed. Although it is very scary, it is better if you stay calm. Panicking will only increase your heart rate and need for air, which will make it worse.

Once you have it dislodged, sit down and catch your breath and remember Leo Tolstoy:

“I sit on a man's back, choking him and making him carry me, and yet assure myself and others that I am very sorry for him and wish to ease his lot by all possible means - except by getting off his back.”

[Dr. (Major) B. C. Nayak is an Anaesthetist who did his MBBS from MKCG Medical College, Berhampur, Odisha. He is an MD from the Armed Forces Medical College, Pune and an FCCP from the College of Chest Physicians New Delhi. He served in Indian Army for ten years (1975-1985) and had a stint of five years in the Royal Army of Muscat. Since 1993 he is working as the Chief Consultant Anaesthetist, Emergency and Critical Care Medicine at the Indira Gandhi Cooperative Hospital, Cochin]