Choking First Aid in Residential Aged Care
Published: 20 June 2024
Published: 20 June 2024
Choking is the second most common cause of preventable death in residential aged care (Ibrahim et al. 2015).
Knowing how to prevent choking and correctly perform first aid for this life-threatening emergency is an essential skill.
Note that the first aid procedure detailed in this article should be used for adults only.
The trachea (windpipe) is a tube-like structure in the respiratory system enabling the passage of air from the larynx to the bronchi and finally to the lungs (Encyclopaedia Britannica 2024).
Choking occurs when the trachea is completely or partially blocked by a foreign body (food, liquid or another object), obstructing airflow (Queensland Government 2019; Gonzalez & Kahn 2019).
Choking can be gradual or sudden, and it may only take a few seconds for the airway to become completely blocked. The specific symptoms experienced by a choking person will depend on the foreign body causing the obstruction and the severity of the blockage (ANZCOR 2024).
If airflow is completely blocked, the brain will be deprived of oxygen. It only takes four minutes without oxygen for brain damage to occur (Headway 2018).
A person who is choking may be conscious or unconscious. Conscious patients and unconscious patients must be managed differently (ANZCOR 2024).
While choking is a prevalent cause of injury-related death in infants (Queensland Government 2019), did you know that older adults over the age of 65 are seven times more likely to choke on food than children aged 1 to 4 (Cichero 2018)?
Loss of muscle mass and strength - which is a natural part of the ageing process - affects muscles related to chewing and swallowing, increasing the risk of choking (Cichero 2018). Dysphagia (swallowing difficulty) is also common among older adults (Healthdirect 2022).
Pathological factors such as dementia, stroke, functional decline, and medicines may further increase the risk (Health.vic 2023).
Read: Dysphagia and Swallowing
Standard 5: Clinical Care - Outcome 5.5: Clinical Safety (Action 5.5.2) under the strengthened Aged Care Quality Standards requires aged care organisations to establish processes for ensuring safe chewing and swallowing during:
(ACQSC 2024)
(Queensland Government 2019)
It is important to identify residents who may be at risk of choking. These may include:
(Health.vic 2023)
Residents with an established risk of choking should be referred to an appropriate specialist, such as a speech pathologist, dietitian or dentist. It is important that the results of a risk assessment, and any subsequent recommendations that have been made, are appropriately recorded, communicated and put into practice (Health.vic 2023).
If the resident is conscious, they may show some of the following signs:
(ANZCOR 2024; Queensland Government 2019; Better Health Channel 2014)
If there is partial airway obstruction, the resident will still be able to breathe, speak and cough to some extent (Better Health Channel 2014). Other indications of partial obstruction include:
(ANZCOR 2024; Better Health Channel 2014)
Indications for complete airway obstruction include:
(ANZCOR 2024; Better Health Channel 2014)
Note that airway obstruction in a resident who is unresponsive and non-breathing may not be apparent until rescue breathing has commenced (ANZCOR 2024).
(Adapted from ANZCOR 2024; Health.vic 2023)
If the resident is conscious, remember to tell them what you are doing and why.
The first step in managing choking is to assess the severity of the airway obstruction. This can be done by determining whether the resident/patient is able to cough effectively (ANZCOR 2024).
If the resident is able to effectively cough, this indicates a mild airway obstruction. You should:
(ANZCOR 2024)
An ineffective cough indicates a severe airway obstruction (ANZCOR 2024).
First aid for severe airway obstruction in a conscious resident/patient requires the use of two techniques: back blows and chest thrusts.
In order to perform a back blow, keep the resident standing unless they are already seated. Bend the resident forward, and using the heel of your hand, give a sharp blow to their back between their shoulder blades (Healthdirect 2023). Back blows aim to completely or partially dislodge, or loosen, the foreign object by creating an increase in pressure in the obstructed airway. If the foreign object is loosened, the resident may be able to cough (British Red Cross 2018).
When delivering a chest thrust, place one hand on the middle of the resident’s back for support. Using the heel of your hand, give a short, sharp upward thrust to the resident’s lower sternum. Chest thrusts should be performed sharper and at a slower rate than CPR compressions (St John Ambulance Australia 2022).
Note: The use of abdominal thrusts (aka the Heimlich manoeuvre) is no longer recommended due to evidence of life-threatening complications (ANZCOR 2024).
The procedure for a conscious patient with an ineffective cough is to:
(Health.vic 2023)
If the resident/patient becomes unresponsive:
(Health.vic 2023; ANZCOR 2024)
Read: Adult Basic Life Support (BLS) Using DRSABCD
After a choking incident has occurred:
(Health.vic 2023)
For residents who have been identified at risk of choking:
For further information on meal assistance, read: Meal Assistance in Aged Care.
(Health.vic 2023)
Note that this is a written refresher on choking first aid and is not designed to be a substitute for comprehensive education and hands-on training. Always follow your organisation's policies and procedures.
Question 1 of 3
What is the first step in aiding a conscious resident who is choking and can cough effectively?