Wednesday, February 12, 2014

Choking on Valentine's Chocolates--How to Write It

My character receives a box of chocolates for Valentine’s Day. When he eats the first one, he chokes. His roommate thinks the chocolates are poisoned, but the guy is only choking. How can I write the choking?

Choking happens when something blocks the airway—the trachea. Food and air share the same route until dividing into the esophagus (passage to the stomach) and
trachea (airway). A specialized flap called the epiglottis covers and protects the airway during swallowing. Anything that makes it past the epiglottis—food or object—can get stuck and cut off the air supply. Drugs, alcohol, and some medical conditions increase the risk of choking.

The victim usually grabs their throat—universal choking sign—and becomes agitated.

The blockage can be partial or complete.

With partial obstruction, there may be gagging, wheezing, coughing, or other sounds. It requires air movement to make sound.

With complete obstruction, the victim can’t talk or make noise. Because of lack of oxygen, he may begin to turn blue (cyanosis) from low blood oxygen.

Treatment on the Scene

Airway obstruction is a medical emergency. Have a bystander call 911. Even if the victim is fine by the time the paramedics get there, it’s vital to call immediately. If there is no one else around, do the following before calling 911.

The Five and Five method:

--Five back blows: using the heel of your hand, strike the victim between the shoulder blades five times. This may dislodge the obstructing object.

--Five abdominal thrusts (Heimlich maneuver): Stand behind victim; wrap your arms around their waist and tip them forward a bit. With one hand, make a fist and place it just above the belly button. Grip the fist with your other hand. Press hard with a quick upward motion—a thrust—the way you’d try to pick someone up. This generates an artificial “cough,” or rush of air from the lungs to “blow loose” the blockage.

If the victim is obese or pregnant, place the fist in the middle of the chest.

NOTE: If YOU are the victim, make the fist and position the same way, and lean on a hard surface. Forcibly push your fist in/up.

Repeat the five and five until effective or help arrives.

If the victim loses consciousness (passes out) position them on their back. Position hands just beneath the ribcage and gently thrust upward.

If there is no response and the victim has no pulse, Begin CPR until help arrives. Do NOT try to drive the victim to the ED yourself.

Treatment in the ED

In the Emergency Department, a needle in the trachea can be used to restore air flow until the obstruction is relieved and/ or a larger more permanent airway can be placed in the trachea. A small cut is made in the skin slightly below the Adam’s apple, and a needle is inserted to make a temporary detour for air.

I don’t recommend a layman try this needle maneuver in real life, but in fiction it’s potentially useable.

In the field, this might be done without the cut. There are blood vessels in this area, so I don’t recommend using a hunting knife to make a big hole—no matter what you’ve seen in the movies. A small pocket knife would be believable.

Yes, you could use any hollow object instead of a needle. A heavy duty drinking straw, a pen casing, etc. would work. Just be sure it doesn’t disappear down the hole and make things worse.

No matter what, call 911 beforehand.

Hope this helps!

Comments? Questions?
elly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.
Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous. Find Kelly’s fiction at
Epiglottis pic:; Abdominal thrust pic: ADAM (Mayo Clinic)