From the Guidelines
For relieving choking obstruction, immediately encourage coughing in a conscious individual, as this is a normal physiological response that may be effective and is unlikely to cause harm, as suggested by the 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations 1. If the individual is unable to cough, the Heimlich maneuver (abdominal thrusts) can be applied in rapid sequence until the obstruction is relieved. For an unconscious victim, begin CPR with chest compressions, checking the mouth for visible obstructions before rescue breaths. Back blows alternated with abdominal thrusts can be used for infants. For pregnant or obese individuals, perform chest thrusts instead. The initial response to foreign-body airway obstruction in a conscious individual should be to encourage coughing because this is a normal physiological response that may be effective and is unlikely to cause harm 1. The sequence of interventions in individuals without an effective cough suggested in treatment recommendations seeks to balance the benefits of early removal of the foreign-body airway obstruction with the potential harms of interventions, such as abdominal thrusts 1.
CTA Head and Neck Rules
CTA of the head and neck should be used when evaluating patients with suspected vascular injuries, stroke symptoms, severe headache with suspected aneurysm, or neck trauma with potential arterial damage, as it is particularly valuable in emergency settings for rapid assessment of blood vessels and surrounding structures 1. CTA is preferred over standard CT because it uses contrast to visualize blood vessels clearly, allowing detection of dissections, aneurysms, occlusions, or active bleeding. The procedure requires intravenous contrast administration and should be avoided in patients with severe contrast allergies or significant kidney dysfunction unless benefits outweigh risks. High-velocity maxillofacial trauma and penetrating neck trauma are the most common causes of traumatic vascular injuries, and identification and treatment of these injuries should be swift because irreversible neurologic damage or death may occur 1. CTA has been recommended over digital subtraction angiography for initial vascular evaluation because of its short acquisition time and low complication rate 1. CTA detects almost all clinically relevant blunt cervical arterial injuries, and the excellent negative predictive value and high sensitivity of the revised Denver criteria make them an excellent screening tool for BCVI 1.
Some key points to consider when using CTA head and neck include:
- CTA may logically follow identification of specific bony or soft-tissue injuries but is not useful as the initial imaging modality to identify midface injury 1.
- Guidance on the imaging of vascular injuries in various clinical scenarios is provided by other ACR Appropriateness Criteria topics 1.
- Suspected intracranial arterial injury due to clinical risk factors or positive findings on prior imaging is found in the ACR Appropriateness Criteria topic on “Head Trauma” 1.
- Penetrating neck injury imaging guidance is found in the ACR Appropriateness Criteria topic on “Penetrating Neck Injury” 1.
- Additional imaging recommendations and scenarios addressing vascular injury are found in the ACR Appropriateness Criteria topics on “Cerebrovascular Disease” and “Cerebrovascular Diseases-Aneurysm, Vascular Malformation, and Subarachnoid Hemorrhage” 1.
Overall, CTA head and neck is a valuable tool in the evaluation of patients with suspected vascular injuries, stroke symptoms, severe headache with suspected aneurysm, or neck trauma with potential arterial damage, and its use should be guided by the principles outlined in the ACR Appropriateness Criteria topics 1.
From the Research
Immediate Recommendations for Relieving Choking Obstruction
- For a conscious adult with a severe obstruction, back blows and/or abdominal thrusts (Heimlich maneuver) may be necessary to remove the obstruction from the airway 2.
- The American Red Cross and the American Heart Association have recommended the use of back blows, abdominal thrusts (Heimlich maneuver), or chest thrusts (or both) and finger probes until definitive therapy by trained medical and paramedical personnel becomes available 3.
- For infants under 1 year of age, a combination of back blows and chest thrusts is recommended to relieve foreign body airway obstruction 4.
Use of CTA Head and Neck
- There is no direct evidence in the provided studies regarding the use of CTA (Computed Tomography Angiography) head and neck for relieving choking obstruction.
- The studies focus on the immediate first-aid techniques for relieving choking obstruction, such as back blows, abdominal thrusts, and chest thrusts 5, 3, 2, 4.
Additional Techniques
- The "table maneuver" has been described as a potentially life-saving technique for relieving foreign-body airway obstruction in unconscious elderly patients who fail to respond to the Heimlich maneuver and other conventional treatments 6.
- This technique involves laying the patient down on a table in a prone position with the head facing downwards and giving sharp blows between the scapulas with the heel of the hand.