Managing an airway and choking

Airway assessment and management is the first element of casualty management because the inability to breath because of an obstructed airway is immediately life threatening. First aid for airway management is essentially all about clearing an individual’s airway in order to enable them to breath usually unaided.

Most airway management that the nurse will need to understand in order to provide first aid is about learning basic skills to clear and maintain a casualty’s airway until more specialised care can be provided.

Signs and symptoms of airway obstruction

There are some very basic indications that a casualty has an obstructed airway. These include:

• increased respiratory effort
• noisy breathing including gurgling
• rapid breathing
• intermittent breath sounds
• absent breath sounds (Cohen, 2016).

Causes of airway obstruction

There are a number of reasons someone may have an obstructed airway. If the nurse can diagnose these, they are at least part way to being able to manage the issue. Causes of an obstructed airway include:

• swelling of the tongue or glottis
• swallowing a foreign object
• aspiration on vomit

Relieving an airway obstruction

Choking in a conscious casualty will be covered later. Most airway management needs to take place in casualties who have also lost consciousness and requires:

• that the obstruction is removed or reduced
• that the patency of the airway is maintained

Clearing an airway in someone who is unconscious may be as simple as:

• rolling someone off of their back, or turning their head to one side, and pulling the underside cheek down to allow fluids, e.g. vomit and mucus, to drain from their mouth
• removing ill-fitting dentures

The nurse should not put their hands in the casualty’s mouth if they can avoid it and certainly never if the casualty’s mouth is clamped shut or they are experiencing a seizure of any kind.  

Maintaining a patent airway may be achieved by the nurse:

• placing a hand on the casualty’s forehead and the other under the bony

References

Cohen E. Upper airway obstruction in the critically ill. In: Webb A, Angus D, Finfer S, Gattinoni L, Singer M (eds.). Oxford Textbook of Critical Care. (2nd edn).  Oxford: Oxford University Press; 2016.

Manduchi B, Walshe M, Burke E, Carroll R, McCallion P, McCarron M. Prevalence and risk factors of choking in older adults with intellectual disability: Results from a national cross-sectional study. J Intell & Developmental Disability.  2021; 46(2): 126-137. https://doi.org/3109/13668250.2020.1763278.

Mulryan C. First Aid. In: Delves-Yates (ed.) Essentials of Nursing Practice. Sage; 2015 pp.465-490.

Resuscitation Council. Adult basic life support Guidelines. 2021.  https://www.resus.org.uk/library/2021-resuscitation-guidelines/adult-basic-life-support-guidelines (accessed 11 March 2022).

Simpson E. How to manage a choking adult. Nurs Stan. 2016; 31(3): 42-46. https://doi.org/10.7748/ns.2016.e10542.

St John’s Ambulance. Choking adult. 2021. https://www.sja.org.uk/get-advice/first-aid-advice/choking/adult-choking/ (accessed 11 March 2022).