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Choking in the hospital and care home setting really should never happen. And it only tends to happen when we take our eye off the ball when we have got other things on our mind, or we are not following basic procedures. First of all, a patient that is lying flat in bed should never be fed in that position because it is so, so difficult to manage an airway whilst somebody is lying down. You try drinking a glass of water whilst lying on your back or try drinking soup. It is not only impossible, but you will also nearly always choke. So first of all, the patient needs to be sat up. If we cannot sit the patient up then the patient will normally be PEG-fed or drip-fed or fed in a different way because it is not safe to put solids or even thick liquids into a patient that is lying down. We cannot use funnels or anything like that, it just is not safe.

So make sure the patient is sitting upright, first of all, so they can breathe, they can chew, they can swallow effectively and efficiently. When the patient is sitting up, pillows behind them, and then we gradually feed them. If we try and rush this process, again, we encourage and we induce the choking reaction. If the patient is sitting on the side of the bed, again, we can feed the patient, but we have got to make sure that they cannot fall off the bed, and we have got to make sure that the patient is safe in that position. Because again, we are moving the patient to feed them into a position that is potentially more dangerous than not giving them the food in the first place.

So as we say, the first thing we need to do is to make sure that the bed is in an upright position so that the patient is in a position that is conducive with eating, okay? So, far, far less risk if the patient is in the right position first off. So if we have a patient that is in the prone position, and the airways start to become a problem due to choking, and it can be on as simple as mucus, it could be false teeth that come loose, it could be absolutely anything. But if they start to choke in that position, what we are going to do is to drop the sides of the cot down very quickly, so as we can get to the patient. We are going to bring the hand across the side of the face into the halo position, outside of the leg, roll the patient over, and we can gently pat the back, we can clear the airway, we can manage the airway to the best of our abilities.

But remember, we have also got things like suction, Magill's forceps, there are all sorts of different tools and techniques that we have got in the hospital environment to make sure the airway is clear. But very, very quickly, recovery position, open the airway, pat the back, and make sure we can clear that airway to the best of our abilities until the rest of the equipment can get to us quickly. If we have a patient that is sitting up, whether on the side of the bed or on a chair, again, we can have the choking risk, and if they start to choke, and cough, and splutter, then we can again encourage them to cough. Coughing is one of the best ways to clear the airway because the brain and the body's natural instinct is to actually try and draw air in, which pulls the blockage further.

If we can encourage them to cough, then that expels air and tends to pressurize the blockage and force it forward. We can also, in this position, use the back slaps. So with the patient lying forward coughing, we can gently put the blows between the shoulder blades, and hopefully, the shockwave of the actual back blow and the coughing will expel the blockage out onto the floor. Always, again, beware that if I let go of this patient in a poor position they can fall to the floor, and we can end up with a worst situation than we actually started off with. So safety always comes first, the patient safety. Make sure they cannot fall off, we have got total control, hand on the front to stop them falling forward, hand on the back to use as the back blows, but you are in control of this patient. They will be panicking, they will be in a distressed state.

If the back blows and the coughing have not worked, we can perform the abdominal thrust on a bed, whether they are in the normal position on the bed, lying on the bed, we can take the headboard off, and come from the back of the bed, and pull the patient towards us, or on the side of the bed. We can draw the patient back towards us using hands underneath the abdomen. Just gently draw the patient back across the bed and you can do your abdominal thrusts from this side of the bed, whilst you are in the control of the patient. So your inward and upward compression of the diaphragm forces air out of the lungs and hopefully expels the blockage. And we can also do the back blows from this position as well. So we can do both whilst the patient is totally in our control. But again, remember safety, a patient must be in your control at all times.