Choking: Process, Duration, First Aid

Brief overview

• Sequence and Duration: Asphyxiation progresses to death in four stages and lasts about three to five minutes.
• Causes: Foreign body in the airways, smoke inhalation, swelling of the airways, drowning, etc.
• Treatment: First aid: Call emergency physician, calm patient, check breathing, if necessary clear airways (e.g. remove foreign body from mouth), assist with coughing, if necessary pat patient on back and use “Heimlich grip”, in case of respiratory arrest: resuscitation; oxygen administration, artificial respiration, aspiration of fluids, if necessary medications
• Diagnostics: examine for typical signs of choking, interview first responders for cause analysis
• Prevention: Do not keep certain foods and small objects near children, do not leave children unattended near swimming pools or open water, with difficulty breathing always see a doctor in time, etc.

What is suffocation?

During respiration, sufficient oxygen normally reaches the lungs and then the blood. Via the blood, the oxygen reaches the tissues, where it supplies the cells, which then produce carbon dioxide (cellular respiration). The oxygen-depleted blood then flows back to the lungs. Without oxygen, the cells (especially in the brain) die after a short time.

A person dies of asphyxiation (suffocation) if he or she breathes in too little oxygen, the oxygen transport in the body no longer functions or the cells cannot utilize the oxygen.

A distinction is made between external and internal suffocation:

In external suffocation, too little oxygen enters the lungs from the outside or there is a gas exchange disorder (lung disease).

What happens when you choke?

The process of choking consists of four phases (stages):

1. Carbon dioxide increase: increasing shortness of breath, rapid pulse, blue coloration of the skin (cyanosis), loss of consciousness
2. Oxygen deficiency: slow pulse, seizures (“suffocating spasms”), defecation and urination, ejaculatory discharge
3. Respiratory arrest: paralysis of the vagus (tenth cranial nerve), pulse increases, blood pressure drops
4. Last respiratory movements (gasping breaths).

How long does it take to suffocate?

How quickly one suffocates depends on the cause of the lack of oxygen. In the case of acute shortness of breath (for example, strangulation), choking takes about three to five minutes. By the way, heartbeats often last much longer (up to 20 minutes).

If oxygen is lacking more slowly or if affected persons can catch their breath in the meantime, the suffocation can last much longer.

This is how a choking attack manifests itself

Possible signs that someone is not getting enough air or is suffocating internally are:

• Shortness of breath, gasping for air
• Whistling breathing noise
• Strong urge to cough
• Coughing with frothy or bloody sputum
• Paleness, blue-violet coloration of face and lips
• Unconsciousness and cessation of breathing

In cases of respiratory distress due to poisoning (for example, carbon monoxide poisoning), headache, dizziness, vomiting, shortness of breath, rapid heartbeat, and weakness also occur.

Causes of suffocation

Several causes may lead to death from choking. The most common causes are:

• Foreign body in the airway (e.g., due to inhalation = aspiration).
• Covering of the airway (e.g., in infants)
• Crushing of the chest (thoracic compression)
• Lack of oxygen in the breathing air (also “atmospheric” suffocation)
• Drowning
• Anesthesia incident
• Poisoning (by carbon monoxide, hydrocyanic acid = hydrogen cyanide, medications, drugs, etc.)
• Bronchial asthma (in the absence of treatment or severe asthma attacks)
• Lung diseases (disturbed gas exchange)
• Blockage of the airways due to swelling (e.g. insect bites, allergies)
• Epiglottitis (inflammation of the epiglottis, mostly in children)
• Paralysis of the respiratory muscles, e.g. in polio (poliomyelitis)

First aid in case of impending suffocation

If choking is imminent, first aid is needed. The correct way to administer first aid for a choking attack depends on the cause of the shortness of breath. The following will tell you how to respond properly to the most common choking hazards.

Brain cells don’t survive long without oxygen. That’s why fast first aid is extremely important when choking is imminent. In case of severe or unclear shortness of breath, call the emergency physician immediately!

This emergency occurs mainly in young children, for example, when they inhale a peanut, a grape or a small toy part. Older people also often swallow. Particularly in people with swallowing difficulties (for example after a stroke), a bite of food often accidentally ends up in the windpipe. Death by suffocation may then be imminent.

Remove foreign bodies by hand: Is the object visibly stuck in your mouth or throat? Pull it out gently with your fingers. Be careful, however, that you do not inadvertently push it in deeper!

Back tapping: The object is stuck in the larynx or trachea? Support the affected person in coughing it out. Supportive back strokes will help. For older children and adults, proceed as follows:

• The affected person bends forward.

• Support his chest with one hand and hit him hard between the shoulder blades with the other (hit with the flat of your hand).
• Check in between to see if the object has come loose and slipped up into the mouth.

If an infant is involved, place him or her prone on your lap for the maneuver. If a baby has inhaled a foreign object, place him or her prone on your outstretched forearm for the backstroke. Support the small head in such a way that the neck is not constricted.

The baby’s head must not be thrown around by the back strokes, otherwise shaking trauma can easily occur.

Do not use the Heimlich grip on children under one year of age! There is a risk of injury! Instead, place the baby on its back and press on the center of the chest with two fingers.

Swollen airways

In some cases, an insect bite to the throat or a severe allergic reaction causes the airways to swell up. The affected person is in danger of suffocating. Provide first aid as follows:

• Call 911.

• Give the victim ice cream or ice cubes to suck on, if they are able to swallow.
• Make decongestant cold compresses around the neck (e.g., with a cold compress or ice cubes wrapped in a cloth).
• In the event of an allergic reaction, give the person an emergency shot if available (some allergy sufferers carry them with them at all times).

Drowning

Read more about drowning accidents in our article “Drowning and the forms of drowning”.

Smoke poisoning

Not only the fire, but also the smoke from it is life-threatening. As a rule, the gas carbon monoxide is produced. It binds to the red blood cells exactly where oxygen actually binds and is transported in this way. If the carbon monoxide displaces the oxygen, the affected person suffocates. Therefore, provide immediate first aid as follows:

• Alert the rescue services (fire department, emergency physician).
• Take the patient outdoors or provide fresh air if safe for you to do so.
• If the injured person is conscious, reassure him/her.
• Clear the airway if necessary.
• Position the person with the upper body elevated.
• If the casualty is unconscious but breathing on his own, place him in the recovery position.
• Check the patient’s heartbeat and breathing regularly until the emergency physician arrives.

In addition to carbon monoxide, other toxic gases can be produced, such as with cyanide (hydrogen cyanide). It is formed mainly when wool or fabrics from mattresses, upholstered furniture or carpets burn. The cyanide inhibits cell respiration, causing affected individuals to suffocate internally.

Keep your own safety in mind! Do not attempt rescue without breathing protection!

Medications or drugs

Medications and drugs may cause unconsciousness in case of an overdose and paralyze the respiratory center in the brain. If the person vomits, vomit sometimes enters the windpipe and blocks it. The tongue also obstructs the airway under certain circumstances: if someone becomes unconscious, the tongue becomes flaccid. In the supine position, it then falls backwards in some cases, cutting off the airflow.

In such cases of suffocation, administer first aid according to the ABC rule:

B for Ventilation: Ventilate the victim using mouth-to-nose or mouth-to-mouth ventilation, if you are confident in this first aid measure.

C for Circulation: Stimulate the victim’s heart and circulation by performing chest compressions. Even without ventilation, this may be sufficient to ensure the patient’s survival for a while.

If possible, hand over the remains of the consumed medication/drug to the emergency medical team. Knowing the exact cause of poisoning is very important for medical treatment.

What does the doctor do?

In case of severe or unclear respiratory distress, always call an emergency physician (rescue service)!

If possible, the rescue team interviews the first responders or relatives to obtain important information about the patient and the cause of the oxygen deficiency. They then take appropriate initial measures and take the affected person to a hospital as quickly as possible.

Treatment for inhaled foreign body

If a foreign body is stuck in the upper part of the larynx, the doctor often pulls it out using special forceps. If this is not possible, the foreign body can be removed in the hospital during a bronchoscopy or laryngoscopy. Surgical intervention such as a tracheotomy is rarely necessary.

Treatment of smoke inhalation

In the case of carbon monoxide poisoning of this kind, the patient is supplied with pure oxygen – either via a breathing mask fitted or via a breathing tube inserted into the trachea (intubation). Gradually, the oxygen supplied then displaces the carbon monoxide again. In severe cases of poisoning, patients receive oxygen therapy in a pressure chamber (hyperbaric oxygen therapy).

How to prevent choking accidents

Of course, choking emergencies can rarely be predicted. Nevertheless, it is advisable to take some preventive measures. Above all, prevent choking/drowning in children with these measures:

• Never leave babies alone in the bathtub (even if there is little water in the tub).
• Never leave children unsupervised near swimming pools, open water, or rain barrels
• Teach your child to swim as early as possible and practice regularly
• Use flotation devices for your child (water wings, life jackets)
• Keep the following foods out of reach of young children: Nuts, seeds, whole grapes, blueberries, raw vegetables, candy, gummy bears, chewing gum
• Also, keep small objects out of toddlers’ hands: Coins, marbles, button batteries, magnets, small toy parts.

Always have even mild shortness of breath (as in asthma or other lung diseases) checked by a doctor.

Vaccination against polio (poliomyelitis) usually prevents the onset of the disease and thus reduces the risk of suffocation.

You can prevent possible carbon monoxide poisoning by having gas heaters serviced regularly, ventilating frequently, and installing a carbon monoxide detector in the garage (running car), kitchen (gas stove), and bathroom (gas heater). Carbon monoxide detectors are not to be confused with fire and smoke detectors!