Choking (Cafe Coronary)

What is a "cafe coronary?"

"Cafe coronary" is poorly named because it has nothing to do with a heart attack. This condition got its name because onlookers may think they are witnessing a heart attack when a diner is really choking to death. "Cafe coronary" is blockage in the upper airway, usually caused by food or vomit stuck in the throat. The blockage causes choking and makes it hard to breathe. It can be life threatening.

How does choking occur?

Choking occurs when a piece of food or some other object gets stuck in the airway. Chicken, fish bones, and pieces of meat that have not been chewed properly get stuck in the throat easily. If you have been drinking alcohol, your risk of choking is greater because you may be careless about chewing food well.

What are the symptoms?

Symptoms of choking may include:

• trouble talking or inability to talk
• high-pitched breathing, wheezing, or not breathing at all
• forceful coughing or inability to cough
• clutching the throat or chest as a sign of distress
• fainting.

How can I help someone who is choking?

If someone is choking but still able to breathe and cough and is not turning a bluish color, let them try to cough up the object. If they are having trouble breathing and turning blue, have someone call 911 while you do the following to help:

1. Ask the person if they are choking. If they cannot answer you, or they grab their throat, they need help right away.
2. Give 5 back blows.
   • Stand behind the person and wrap one arm around their chest.
   • Firmly strike the person on the back between the shoulder blades 5 times.
3. If the back blows do not cause the object to come up (be expelled), give 5 abdominal thrusts.
   • Wrap both of your arms around the person's abdomen.
   • Make a fist with one of your hands and place it with the thumb side in the center of the person's abdomen.
   • Grasp your fist with your other hand and give 5 abdominal thrusts by making a quick, hard movement inward and upward 5 times.
4. Repeat this series of 5 back blows and then 5 abdominal thrusts several times until the object is removed or the person becomes unresponsive.

If the choking person is pregnant or obese, use chest thrusts instead of abdominal thrusts after the back blows. To do chest thrusts:

1. Standing behind the person, wrap your arms around their chest.
2. Make a fist with one hand against the middle of the person's breastbone, between the nipples, thumb side in.
3. Grasp your fist with your other hand and pull straight inward 5 times (do not pull inward and upward as in the abdominal thrusts).
4. Repeat the series of back blows and chest thrusts until the object is removed or the person becomes unresponsive.

If the person loses consciousness, lower the person to the floor, call for help, and begin CPR (cardiopulmonary resuscitation). When no one else is available, stop to call for emergency help (EMS or 911), and then go back to rescue efforts. If something can be seen blocking the airway, try to remove it by using 1 finger to sweep the mouth.

If the airway cannot be cleared and the windpipe is completely blocked, the person may need an emergency operation called a tracheotomy. This is a procedure in which the emergency medical technician (EMT) or healthcare provider makes a cut through the skin of the throat and into the windpipe. A tube is then put into the windpipe through the cut to let air into the lungs.

How long will the effects last?

The choking will last as long as the food or object remains stuck in the airway. After a minute or so of being unable to breathe or cough, the person may faint (become unconscious).

After the object is removed, the throat may be sore if it was scratched by the object.

What can be done to help prevent choking?

Take these steps to prevent choking:

• Cut food into small pieces. Do not try to swallow large pieces of food.
• Eat slowly and be careful to chew foods thoroughly, especially when you are drinking alcoholic beverages.
• Avoid drinking too much alcohol before or during meals. Alcohol dulls your judgment as well as the nerves that help swallowing.
• Don't eat when you are talking, laughing, walking, running, or playing. This reduces the chance that you will inhale a piece of food that can get stuck in your throat.
• Make sure dentures fit properly. Loose-fitting dentures may make it hard to chew and to feel objects in your mouth.