Editing Choking (section)

==== Unconscious victims ====

A choking victim who becomes unconscious<ref name=":22" /><ref>{{Cite web |last=Mayo Foundation for Medical Education and Research (MFMER) |date=2024-05-31 |title=Choking: First aid |url=http://mayoclinic.org/first-aid/first-aid-choking/basics/art-20056637 |access-date=2024-07-01 |website=Mayo Clinic|archive-url=https://web.archive.org/web/20240531120521/http://mayoclinic.org/first-aid/first-aid-choking/basics/art-20056637 |archive-date=2024-05-31 }}</ref><ref>{{Cite book |last=American Red Cross |title=CPR/AED and First Aid |pages=22 |chapter=Unconscious Choking}}</ref> must be gently caught before falling and placed lying face-up on a surface.<ref><!--useless ref?-->{{Cite journal |last=Herbert |first=Henry |year=1981 |title=Book review: The American Medical Association's Handbook of First Aid and Emergency Care |url=http://dx.doi.org/10.1097/00043764-198102000-00004 |journal=Journal of Occupational and Environmental Medicine |volume=23 |issue=2 |pages=74 |doi=10.1097/00043764-198102000-00004 |issn=1076-2752}}</ref> That surface should be firm enough (it is recommended placing a layer of something on the floor and laying the victim above).

A rescuer can then ask for any of the known anti-choking devices that is available, and use it on the unconscious victim. After that, the obstruction would be dislodged, but it could remain into the mouth, which needs a manual removal. If the unconscious victim cannot breath then, or stays in a cardiac arrest, it will require to perform a normal cardiopulmonary resuscitation (CPR), as described below, but only alternating the 30 compressions and the two rescue breaths.

[[List of emergency telephone numbers|Emergency medical services]] must be called, if this has not already been done.

It can be also convenient that any rescuer asks for a defibrillator around (an AED, as those devices are very common today), just in case it can be necessary to treat the victim's heart.

Anyway, a choking victim that is already unconscious needs to receive (even<ref name=":9">{{Cite web |last=Sarver Heart Center. University of Arizona. |date=2024-01-27 |title=Frequently Asked Questions about CPR |url=https://heart.arizona.edu/heart-health/learn-cpr/frequently-asked-questions-about-chest-compression-only-cpr |access-date=2024-07-03 |website=heart.arizona.edu|archive-url=https://web.archive.org/web/20240127072004/https://heart.arizona.edu/heart-health/learn-cpr/frequently-asked-questions-about-chest-compression-only-cpr |archive-date=2024-01-27 }}</ref><ref name=":11">{{Cite web |last=American Heart Association |title=Guidelines for CPR and ECC |url=https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf?la=en |page=12|archive-url=https://web.archive.org/web/20211220204935/https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf?la=en |archive-date=2021-12-20 }}</ref> with no more delay) an anti-choking cardiopulmonary resuscitation (CPR) for unconscious adults and children. It is not valid for infants less than one year old, who require a special [[#Unconscious infants|adaptated CPR for unconscious babies]] (described further below). [[File:Chest compressions.gif|thumb|Chest compressions of cardiopulmonary resuscitation (CPR), proper rhythm.|250x250px]]

The anti-choking cardiopulmonary resuscitation (CPR) for unconscious adults and children is quite similar to any other CPR, but with some modifications:

In a first step, a series of 30 ''chest'' ''compressions'' are applied on the lower half of the [[sternum]] (the bone that is along the middle of the chest from the neck to the belly) at an approximate rhythm of nearly 2 per second.

After that series, the rescuer looks for the obstructing object and, if it is already visible, the rescuer makes a ''try to extract'' it, usually by using a finger sweeping (hopefully from the mouth). Normally, the object would be a food bolus (and not the epiglottis, a cartilaginous flap of the throat). It is also possible to try to extract it when it is deeper and not visible, always carefully: using the fingers to take it, or lifting the victim's chin to form a straight way to the throat while the victim is face up (face down in case of the victim's tongue obstructs too much, or on a side with a base under the head) and then grasping or sweeping the stuck object with tools: thin kitchen tweezers, scissors (these used with care), forks and spoons (in a reverse position: introducing their handle) or even a toothpick (if other instruments were too much big for the case); but, anyway, the current protocols do not recommend extracting the obstructing object if it is not visible (a blind extraction), because of the risk to sink it deeper by accident, and because the compressions could move the object outside by themselves (in some cases). Moreover, if any removal is tried and is taking too much time, it may require alternating it with the chest compressions at some moments, without hindering to the extraction. And, whether the object has been found and removed in this step or not, the CPR procedure must pass to the next step and continue until the victims can breathe by themselves or emergency medical services arrive.[[File:Insulfation2.jpg|thumb|Rescue breaths of cardiopulmonary resuscitation (CPR).|250x250px]]

In the next step of the CPR, the rescuer applies ''a'' ''rescue breath'', pinching the victim's nose and puffing air inside of the mouth. Rescue breaths would usually fail while the obstructing object is blocking the entrance of air. Anyway, it is recommended, additionally, ''tilting the victim's head'' up and down, to reposition it trying to open an entrance for the air, and then giving ''another rescue breath''. After the rescue breaths, this resuscitation returns to the 30 initial compressions, in a cycle that repeats continually, until the victim regains consciousness and breathes,<ref>American Red Cross Training Services. Choking. In: First Aid/CPR/AED Participant's Manual. The American Red Cross; 2021. https://www.redcross.org/store/first-aid-cpr-aed-participants-manual/754100.html .</ref> or until the object is extracted but a defibrillation is needed to solve a cardiac arrest (read below).

''Defibrillation'' can also be needed, because an unconscious victim of choking can suffer a cardiac arrest at any moment, due to several possible causes.<ref name=":13">{{Cite web |date=2024-07-03 |title=First aid - To perform CPR on a baby 4 weeks old, or older - such as from choking - get the AED |url=http://mayoclinic.org/first-aid/first-aid-cpr/basics/art-20056600 |access-date=2024-07-04 |website=Mayo Clinic|archive-url=https://web.archive.org/web/20240703122615/http://mayoclinic.org/first-aid/first-aid-cpr/basics/art-20056600 |archive-date=2024-07-03 }}</ref> So it is convenient to ask around for a defibrillator (AED device), for trying a defibrillation on a victim that remains in cardiac arrest after having extracted the stuck object (if it has been extracted, and only after that). Those defibrillators are easy to use, as they emit their instructions with voice messages.

===== Finger sweeping =====
It is crucial to avoid blindingly sweeping the airway unless there is direct visualization of the airway – in fact, these procedures are advised only to be performed in more controlled environments such as an operating room.<ref>{{Cite journal |last=Sarper Erikci |first=Volkan |date=2022-06-27 |title=Airway Foreign Bodies in Children: A Review Article |journal=Journal of Clinical Research and Reports |volume=11 |issue=3 |pages=01–04 |doi=10.31579/2690-1919/250 |s2cid=250541892 |issn=2690-1919|doi-access=free }}</ref> In unconscious choking victims, the American Medical Association has previously advocated sweeping the fingers across the back of the throat to attempt to dislodge airway obstructions.<ref name="AMA">{{Cite book |url=https://archive.org/details/handbookoffirsta00amer |title=American Medical Association Handbook of First Aid and Emergency Care |date=2009-05-05 |publisher=[[Random House]] |isbn=978-1-4000-0712-7 |page=70 |quote=dislodge the object. |url-access=registration}}</ref> Many modern protocols suggest other treatment modalities are superior. Red Cross procedures also advise rescuers not to perform a finger sweep unless an object can be clearly seen in the victim's mouth to prevent driving the obstruction deeper into the victim's airway. Other protocols suggest that if the patient is conscious they will be able to remove the foreign object themselves, or if they are unconscious, the rescuer should place them in the [[recovery position]] to allow the drainage of fluids out of the mouth instead of down the trachea due to gravity. There is also a risk of causing further damage (inducing vomiting, for instance) by using a finger sweep technique. There are no studies that have examined the usefulness of the finger sweep technique when there is no visible object in the airway. Recommendations for the use of the finger sweep have been based on anecdotal evidence.<ref name=":2" />