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So now in this segment, we're going to cover unresponsive choking patient for the healthcare professional. This adult either was choking, conscious and went unconscious, either we witnessed it or bystanders witnessed it or through our assessment, they had a pulse but were not breathing and we tried to give a rescue breath and it wouldn't go in, even after repositioning the head. Any way we find this person when we don't have an open airway and we can't get air in, we're going to treat the as if they're an unresponsive choking patient. So our gloves are on, our rescue mask is available and our scene is safe. I'm still going to make sure that the patient is not breathing normally and we assess the patient for movement. And there isn't any. Whether they are going from conscious to unconscious or we find them unresponsive, if EMS or a code has not been called yet, it's at this point that we need to make sure EMS is called. So you in the plaid shirt, go call 911 and come back. If you can find an AED, bring it with you. Or, call a code. At this point in time, I am going to go ahead and give my 30 chest compressions. One and two and three and four and five and six and seven and eight, nine and ten. 11 and 12, 13, 14, 15, 16, 17, 18, 19, 20. 22, 23, 24, 25, 26, 27, 28, 29, 30. Now make note that these chest compressions are just like CPR. They are 2 to 2.4 inches deep and they're at a rate of between 100 and 120 times a minute. And we're still giving those chest compressions right on the sternum on the lower third of the sternum. Now something to keep in mind if this person was pregnant, if they were a female who is pregnant, we would still do these chest compressions and it would basically stay away from the baby in the womb so we wouldn't have any complications. So that question gets asked from time to time and I just wanted to make that clarification. We do the chest compressions the same exact way whether it's a non pregnant or a pregnant patient. Now, I go from there to a head tilt chin lift. I look in the mouth. Did any product come out with my compressions? If I don't see it, I'm not doing a blind finger sweep. If I do see it, I'm going to sweep it out. In this case I do not see anything but I'm going to try two breaths. I try my first breath. It doesn't go in. So I reposition the head down and back up again. I try a second breath but it doesn't go in. So I go right back to my chest compressions and do 30 more chest compressions. After the 30 compressions I go back into the mouth. I look. If I see an object, I'm going to sweep it out and I'm going to try a rescue breath. This time the rescue breath went in. So I give another one. It went in again. So now as a healthcare provider, I'm going to check for a carotid pulse for no more than ten seconds. If the pulse is present but there's no breathing normally, I'm going to continue rescue breathing at a rate of one breath every five seconds for two minutes. After two minutes I'm going to reassess a pulse, check for normal breathing, check for a carotid pulse. If the pulse is still there, I'm going to continue rescue breathing. If the pulse is gone, I'm going to go straight into full CPR and continue my 30 compressions with two rescue breaths until EMS arrives, an AED arrives or my patient revives.
This unconscious adult choking lesson is for situations where you find a person who is unconscious, and you suspect they became unresponsive due to an airway obstruction.
Ideally, either you or a bystander witnessed the victim choking before they went unconscious. Through further assessment, you find that the patient has a pulse but isn't breathing normally. Any attempts to deliver a rescue breath have failed, most likely due to an obstruction.
In this scenario, you would treat this patient as an unconscious adult choking victim. The method of care will closely resemble performing CPR, however there are subtle differences to pay attention to.
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy.
Pro Tip #1: To maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm.
Remember to make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart.
Warning: Once you perform a chest compression, make sure you allow for full recoil of the chest cavity. You want to allow the chest to come all the way back to the neutral position before performing another compression.
Pro Tip #2: There are no complications when performing chest compressions on a pregnant woman, as you're not near the womb and baby when doing them. Proceed as you would for any other adult patient.
It's important to understand what constitutes high quality CPR, as performing CPR correctly will give the victim the best chance of survival.
Warning: Once you begin CPR, it's important not to stop. If you must stop, do so for no more than 10 seconds. Reasons to discontinue CPR include more advanced medical personnel taking over for you, seeing obvious signs of life and the patient breathing normally again, an AED being available and ready to use, or being too exhausted to continue.