Airway Obstruction During Cancer Care

MedlinePlus is blunt about this one. Airway obstruction is often an emergency. Call 911, or your local emergency number, for medical help. Then follow the instructions you are given to keep the person breathing until help arrives.

This is one of the few cancer situations where the emergency number comes before the oncology number.

These are the signs MedlinePlus lists for a blocked upper airway:

• Choking.
• Difficulty breathing, or gasping for air, leading to panic.
• Wheezing, crowing, whistling, or other unusual breathing noises.
• A bluish colour of the skin.
• Agitation or fidgeting.
• Confusion, or a change in how awake the person is.
• Unconsciousness.

Agitation is on that list for a reason. Someone who cannot get enough air usually looks frightened and restless before they look blue.

No clinician has reviewed this page yet. In an airway emergency, do what the dispatcher tells you.

MedlinePlus gives a first-aid script. Ask: "Are you choking? Can you speak?"

The answer splits the situation in two.

If they can cough forcefully and can speak, do not do first aid. A strong cough can shift the object by itself. Encourage them to keep coughing.

If they cannot speak, or are having a hard time breathing, act now. A choking person will often grab their throat with one or both hands. MedlinePlus calls that the sign worth learning.

The clock is short. On its abdominal thrusts page, MedlinePlus says that without oxygen, brain damage can occur in as little as 4 to 6 minutes.

MedlinePlus describes repeated cycles of 5 back blows followed by 5 abdominal thrusts. Keep going until the object comes out, or until the person becomes unconscious.

If they do lose consciousness, MedlinePlus changes the instruction. Shout for help and have someone call 911, and put the call on speaker: the dispatcher will talk you through each step, and their instructions come before anything written here. What follows is the shape of it, not a substitute for current certified first aid training. Lay the person on a firm flat surface and begin CPR, checking the mouth for the object before each set of breaths. Chest compressions may themselves shift it. Abdominal thrusts are for a conscious choking person; chest compressions are for an unconscious one. If you can see a loose object in the mouth, take it out, but do not go grasping for one lodged in the throat, because that can push it further in.

For back blows, stand behind the person. Wrap one arm around to support their upper body. Lean them forward until the chest is roughly parallel to the ground. Then strike firmly between the shoulder blades with the heel of your other hand.

For pregnant or obese people, MedlinePlus says to use chest thrusts rather than abdominal thrusts.

This is the one part of an airway emergency a bystander can sometimes fix outright. It only works when there is something to move.

MedlinePlus lists throat cancer among the causes of a blocked upper airway. So are infections of the upper airway area, injury to the area, allergic reactions that swell the throat, and vocal cord problems.

That changes two things.

First, it can build slowly. A voice that has gone hoarse, a new noise when breathing in, or swallowing that has quietly got harder can be the early part of the same problem. None of that looks like choking.

Second, back blows will not help. There is nothing to dislodge.

NCI's page on cardiopulmonary syndromes lists laser therapy and cauterization among the treatments used for tumors inside the large airways. Both are hospital procedures, not something to wait out at home.

They will be working out how to get air in. What helps most is knowing what is in the way.

• Any tumor in the neck, throat, chest or airway.
• A tracheostomy, and how long it has been there.
• Radiation to the neck or chest, and roughly when.
• Any recent surgery or procedure on the mouth, throat or neck.
• Known allergies.

MedlinePlus lists what a hospital can do: remove an object with special instruments, pass a tube into the airway to help with breathing, or make an opening through the neck into the airway. It also says prompt treatment is often successful, while warning that the condition is dangerous and can be fatal even when treated.

MedlinePlus names some groups at higher risk of an airway blockage. They include people with swallowing difficulty after a stroke or head injury, people who have lost teeth, and older adults.

Its prevention advice is ordinary and worth taking seriously if swallowing has changed:

• Eat slowly and chew food completely.
• Do not drink too much alcohol before or while eating.
• Make sure dentures fit properly.
• Learn the universal sign for a blocked airway: grabbing the neck with one or both hands.

If swallowing has changed since treatment, ask whether it is still safe to take pills whole, and whether the texture of food needs to change.

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• MedlinePlus (National Library of Medicine) — Blockage of upper airway
• MedlinePlus (National Library of Medicine) — Choking - adult or child over 1 year
• MedlinePlus (National Library of Medicine) — Abdominal thrusts
• National Cancer Institute — Cardiopulmonary Syndromes (PDQ) - Patient Version