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                                  CHOKING
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   This normally occurs when the airway is partially or totally obstructed
   by a large, swallowed object or when something goes down the windpipe
   rather than the food passage. However, choking can also be caused by
   muscular spasm.
     
   Adults may choke on peices of food which have been inadequately chewed
   and hurriedly swallowed. Children are at risk because they like putting
   objects into their mouths.

   It is imperative that any obstruction be removed as quickly as possible.
   Encourage a conscious choking casualty to cough the obstruction out. If
   this does not work, first attempt to dislodge it by using gravity and a
   "jolting" effect ( back slapping ). 

   Then, and ONLY if this fails, should you try to force the remaining air
   out of the lungs by Abdominal Thrust. ( See Next Page ).

   Always treat the casualty in the position found. If the casualty 
   becomes unconscious, you will have to perform Artificial Ventilation in
   order to try and blow air past the obstruction and into the lungs.
   In an unconscious casualty the throat usually relaxes sufficiently 
   enough to allow air to pass the obstruction.

   TREATMENT ( ADULTS )
   ---------------------

   1: Remove any debris or false teeth from the casualty's mouth and 
      encourage the casualty to cough.

   2: Help the casualty to bend over with the head lower than the lungs.
      Slap the casualty smartly between the shoulder blades with the heel
      of the hand up to four times; each slap should be hard enough to 
      remove the obstruction by itself.

   3: Check the mouth to see if the obstruction has been dislodged. If it
      has not, you may have to attempt Abdominal Thrust.

   4: Check the mouth again. If the obstruction is visible but not
      coughed out, hook it out with your fingers.

   5: If choking is not relieved, repeat back slaps - upto four times. If
      the casualty becomes unconscious, treat as described below.

 N.B. The casualty may begin breathing at any stage. When this happens,
      advise the casualty to sit quietly and give SIPS of water as
      necessary.

    TREATMENT ( FOR THE UNCONSCIOUS CHOKING CASUALTY )
    --------------------------------------------------

   1: Turn the casualty onto the back, open the airway and begin Mouth
      To Mouth. ( See Resusitation ).

   2: If this is not sucessful, roll the casualty onto the side facing
      you with the chest against your thigh and the head well back and
      perform four back slaps as described above.

   3: Check the mouth to see if the obstruction has been dislodged. If it
      has, hook it out with your finger. If it has not, turn the casualty
      on to the back with the head in the open airway position and perform
      Abdominal Thrust.

   4: Check the mouth again to see if the obstruction has been dislodged.

   5: If choking persists, reposition the casualty's head and attempt
      Artificial Ventilation. Then repeat steps 1 To 4 as necessary.

   6: When the obstruction has been removed and the casualty is breathing
      normally, place in the Recovery Position ( See Resusitation ) and
      remove to Hospital.


    TREATMENT ( FOR A CHILD )
    --------------------------

    Many children are comparable in height and build with small adults 
    and can be treated in the same way using slightly less pressure.
    However, some modifications HAVE to be made if you are treating a 
    small child.

    Follow the sequence described for adults but sit in a chair or kneel
    on one knee and lay the child over your knee, head down. Support the
    chest with one hand and slap the child smartly between the shoulder
    blades upto four times with the other hand. If this does not
    dislodge the obstruction, it may be necessary to perform Abdominal
    Thrust.
      
    If the child is or becomes unconscious, place on a firm surface and
    follow the sequence described for unconscious adults.

    
    TREATMENT ( FOR AN INFANT )
    ----------------------------

    The order of treatment for an infant is the same as for children but
    much lighter pressure is used and the positions for back slapping and
    Abdominal Thrust are different.

    Lay the infants head downwards with the chest and the abdomen lying
    along your forearm and use your arm to support the head and the chest.
    Slap the infant smartly, between the shoulders upto four times. If
    this does not dislodge the obstruction it maybe necessary to perform
    Abdominal Thrust.

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