Question

SCENARIO: Rachel and her family are enjoying a great home-cooked dinner. At one point Rachel's brother (who they weren't expecting) sneaks in and comes into the room tapping Rachel on the shoulder from behind and surprises everyone. Unfortunately for Rachel, she inhales a small piece of food (wrong tube situation). She struggles to breathe, gags, and coughs a few times, and eventually (nearly a minute has passed) dislodges the food and begins breathing normally again. Think about this scenario, there may even be a few different phases in this scenario, focus on the physiology of Rachel, and tell me what is happening in her body. Name structures/systems,  talk about what is and isn't in homeostasis, describe how one failure leads to another. Be sure to provide details and use the correct terminology.

Answer 1

In this scenario Rachel has underwent Choking which might have been dangerous and even cause death to Rachel.

Choking is caused when a piece of food or other object gets stuck in the upper airway. In the back of the mouth are two openings. One is the esophagus, which leads to the stomach; food goes down this pathway. The other is the trachea, which is the opening air must pass through to get to the lungs.

The process of swallowing food involves a number of involuntary muscle movements. Most of the time, these muscle movements prevent food from becoming stuck in the throat.

First, the tongue pushes food to the back of the throat. This is where the openings of the esophagus (food pipe) and windpipe are located. As a person swallows, a flap of cartilage called the epiglottis closes off the windpipe. This temporarily stops breathing and prevents food from entering the airways.

At the same time, a muscle called the upper esophageal sphincter relaxes, allowing food to move into the esophagus.

Sometimes, however, food get can stuck in the esophagus, creating an uncomfortable sensation in the throat or chest. At other times, the epiglottis does not close sufficiently during swallowing, which allows food to enter the airways. This can result in choking.

Both types of blockage can cause pain and discomfort. However, a blockage in the windpipe can be a medical emergency.

When food enters the windpipe, it can partially or completely block the airways.

Sometimes, persistent or forceful coughing can dislodge the food. At other times, a blockage that occurs in the windpipe or voice box can result in choking.

Choking refers to breathing difficulties resulting from acute obstruction of the airways. A person who is choking is unable to inhale or exhale enough air to cough.

The following symptoms may indicate that a person is choking:

• silent coughing or gagging
• wheezing
• clutching the throat
• an inability to speak or breathe
• a blue tint to the skin, called cyanosis

A person who cannot speak, cough, or breathe may require the Heimlich maneuver. This procedure, also known as abdominal thrusts, involves forcefully applying pressure to the abdomen to dislodge a blockage in the windpipe.

The Heimlich maneuver

The Heimlich maneuver is only required in emergency situations. A person should only perform the Heimlich maneuver on someone who is choking.

The procedure is not suitable for children under 1 year of age or women in the late stages of pregnancy. These people may require different variations of the maneuver.

To perform the Heimlich maneuver:

• Step 1: Stand behind the person and reach both arms around their waist.
• Step 2: Clench one fist and position it so that it is above the person’s navel and below their ribcage.
• Step 3: Clasp the clenched fist with the other hand.
• Step 4: Quickly thrust the clenched fist backward and upward under their ribcage. Do this 6–10 times in quick succession.
• Step 5: Continue to perform abdominal thrusts until the obstruction dislodges from the airways or until the emergency services arrive.
• Step 6: Ensure that the person receives medical attention as soon as possible, even if they have stopped choking.

If the person stops breathing and becomes unresponsive, they should receive cardiopulmonary resuscitation (CPR).

A person who is alone while choking may need to perform the Heimlich maneuver on themselves. If a chair is available, they can lean over the back of the chair while performing the maneuver. This should help dislodge blockages from the airways.

Sometimes, the obstruction occurs in the esophagus. This is called a food bolus impaction (FBI). Although uncomfortable, medical professionals do not consider an esophageal FBI to be as significant a medical emergency as choking.

People who have food stuck in the esophagus can try the following tips to help dislodge it:

• Swallowing fluids or soft foods: This can help lubricate the food or push it downward.
• Taking effervescent tablets: These over-the-counter tablets cause carbon dioxide gas to form, which helps relieve food blockages by pushing them downward.
• Drinking carbonated drinks: These may work in a similar way to effervescent tablets.
• Taking simethicone: This drug helps bring gas bubbles together in a larger density. This causes pressure in the esophagus that may help release food blockages.