Choking vs. CPR: Correlation to Code Status

As seen in the Consultant Connection July 2015 Issue
By Mary Burkart, RN
The 2010 American Heart Association guidelines indicate chest compressions & rescue breathing are given to a choking victim when that person becomes unresponsive.  How do these guidelines correspond with a resident’s selected code status?
Choking & sudden cardiac arrest are two very different events with VERY different causes!  It’s important to determine the cause of the unresponsiveness.
Choking indicates a foreign body is in the airway leading to coughing, gasping, the universal choking sign (hands around the neck), inability to speak and a panicked expression.  The person starts off conscious & very aware of what’s happening.  If abdominal thrusts (AKA ‘the Heimlich Maneuver”) are ineffective, the person will collapse and become unresponsive. It’s at this stage that chest compressions start.  The pressure provided by chest compressions is the same as during abdominal thrusts.  The purpose continues to be dislodging the foreign body.  Sometimes the very act of becoming unresponsive relaxes the throat muscles enough the foreign body can easily be seen & removed.  
Activate emergency services now!  Anyone who has been unresponsive during a choking episode should be seen by a physician. 
The heart usually continues to beat when the choking victim becomes unresponsive, at least for a while. Performing chest compressions until emergency assistance arrives gives the victim a chance to regain consciousness, the foreign body be dislodged, etc.  Once at the hospital, special instruments can be used to help dislodge the foreign body.
A sudden cardiac arrest is just that; the heart itself stops beating normally.  The most common arrhythmia is ventricular fibrillation, where the heart quivers instead of beats. The victim is pulseless & is not breathing or is not breathing normally.  
A ‘Do Not Resuscitate’ (DNR) order comes into play in this event. If the person has chosen a DNR-Comfort Care (DNR-CC) or DNR Comfort Care Arrest (DNR-CCA), nothing extraordinary or invasive will be done.  
If the person has chosen to be a ‘Full Code’, chest compressions, rescue breathing, & notification of emergency services commence.
Chest compressions provided to a cardiac arrest victim are a way to keep blood circulating and to buy time until more advanced care can be provided by the squad/emergency department.
When performing chest compressions, it’s important to remember our objective.  Is it a respiratory issue or a cardiac issue?  What was occurring immediately before the incident?  What is the victim doing? Are there any witnesses?
While the actual technique for performing chest compressions is the same for both choking and cardiac arrest, it’s the sequence of events and desired outcome that determine what we do.  DNR status does not mean we do not treat a choking episode as a medical emergency!

Back to Articles