Editing Choking (section)

== Signs and symptoms ==
Choking victims may present very subtly, especially in the setting of long term foreign body aspiration. Cough is seen in 80% of foreign body aspiration cases, and shortness of breath is seen in 25%.<ref name=":83">{{Cite web |title=UpToDate - Airway foreign bodies in adults |url=https://www.uptodate.com/contents/airway-foreign-bodies-in-adults |access-date=2022-09-12 |website=UptoDate}}</ref> People may be [[Muteness|unable to speak]], attempt to use hand signals to indicate they are choking, attempt to force vomiting, or clutch at their throat.

=== History of episode ===
An observed or recalled episode of choking, with sudden onset of any of the below respiratory and skin signs and symptoms while eating or handling small objects, is seen in around 90% of choking episodes.<ref>{{Cite journal |last1=Blazer |first1=S. |last2=Naveh |first2=Y. |last3=Friedman |first3=A. |date=January 1980 |title=Foreign body in the airway. A review of 200 cases |url=https://pubmed.ncbi.nlm.nih.gov/7350789/ |journal=American Journal of Diseases of Children |volume=134 |issue=1 |pages=68–71 |doi=10.1001/archpedi.1980.02130130050015 |issn=0002-922X |pmid=7350789}}</ref> Initial episodes typically last seconds to several minutes, but can be followed by symptom improvement that can be mistaken as resolution.<ref name=":12">{{Cite web |title=UpToDate - Airway foreign bodies in children |url=https://www.uptodate.com/contents/airway-foreign-bodies-in-children |access-date=2023-11-08 |website=UptoDate}}</ref>

=== Respiratory ===
Initial respiratory symptoms can include involuntary cough, gurgling, gagging, shortness of breath, labored breathing, or wheezing.<ref>{{Cite web |title=Choking Definition, Symptoms, Causes, First Aid, Heimlich Maneuver |url=https://www.emedicinehealth.com/choking/article_em.htm |access-date=2022-09-12 |website=eMedicineHealth |language=en}}</ref> Children often present with excessive drooling and [[stridor]] (high pitched breathing sounds).<ref name=":22"/> Classic triad of choking symptoms in children is coughing, wheezing, and diminished breath sounds, however, a 10-year review showed that this grouping of symptoms was present together in only about 60% of patients.<ref>{{Cite journal |last1=Tan |first1=H. K. |last2=Brown |first2=K. |last3=McGill |first3=T. |last4=Kenna |first4=M. A. |last5=Lund |first5=D. P. |last6=Healy |first6=G. B. |date=2000-12-01 |title=Airway foreign bodies (FB): a 10-year review |url=https://pubmed.ncbi.nlm.nih.gov/11115682/ |journal=International Journal of Pediatric Otorhinolaryngology |volume=56 |issue=2 |pages=91–99 |doi=10.1016/s0165-5876(00)00391-8 |issn=0165-5876 |pmid=11115682}}</ref>

Loss of consciousness may occur if breathing is not restored. In the setting of lower airway aspiration, patients may develop pneumonia like symptoms such as fever, chest pain, foul smelling sputum, or blood in sputum (hemoptysis). In the case of long term foreign body aspiration, patients may present with signs of lobar pneumonia or pleural effusion.<ref name=":83" />

The time a choking victim is still alive without [[Brain injury|brain damage]]<ref>{{Cite web |date=2021-04-06 |title=How Long Can the Brain Be without Oxygen before Brain Damage? |url=https://infobloom.com/how-long-can-the-brain-be-without-oxygen-before-brain-damage.htm |archive-url=https://web.archive.org/web/20210406211957/https://infobloom.com/how-long-can-the-brain-be-without-oxygen-before-brain-damage.htm |archive-date=2021-04-06 |access-date=2021-05-22}}</ref> can vary, but typically brain damage can occur when the patient remains without air for approximately three minutes (it is variable). Death can occur if breathing is not restored in six to ten minutes (varies depending on the person). However, life can be extended by using [[#Unconscious victims|cardiopulmonary resuscitation for unconscious victims of choking]] (see more details further below).

=== Skin ===
The face could turn blue ([[cyanosis]]) from lack of oxygen if breathing is not restored. Cyanosis may also be seen on the fingertips. In a healthy child or adult, this sign is highly [[Sensitivity and specificity|sensitive]], but is only observed in 15-20% of choking episodes.<ref name=":12"/><ref>{{Cite journal |last1=Pinto |first1=A. |last2=Scaglione |first2=M. |last3=Pinto |first3=F. |last4=Guidi |first4=G. |last5=Pepe |first5=M. |last6=Del Prato |first6=B. |last7=Grassi |first7=R. |last8=Romano |first8=L. |date=June 2006 |title=Tracheobronchial aspiration of foreign bodies: current indications for emergency plain chest radiography |url=https://pubmed.ncbi.nlm.nih.gov/16779536/ |journal=La Radiologia Medica |volume=111 |issue=4 |pages=497–506 |doi=10.1007/s11547-006-0045-0 |issn=0033-8362 |pmid=16779536|s2cid=25901127 }}</ref>