How Nurses Handled Choking on Phlegm/Mucus in Elderly

Dementia

While being hospitalized, my mother had a choking episode. In this post, I would share what the nurses did to help my mother. They also provided me advice on how to manage the situation if I am at home with her.

It was about 2 hours after her meal. I was on the sofa next to my mom when she was breathing normally. I was on the phone with my brother and updating him of my mom’s situation. Then something seemed to block her lung passageway and she started wheezing and struggling for breath.

Her lips quickly turned greyish.

I rushed out to get the nurses. They rushed in, immediately, got her seated at an incline of 45 degrees. One immediately perform phlegm suction (the phlegm suction machine and the suction catheter were already in the room, ready to be used anytime. They also lightly hit on her chest (lung area) to help dislodge the mucus in her throat.

Another nurse rushed out to get an oxygen cannula and proceed to administer oxygen to my mother.

Suction performed by the nurse

As nurses have been medically trained, they are familiar with phlegm suction. At least the nurses in Thailand are because nasogastric tube feeding is a common form of treatment. At first, the nurse thought that there was something solid blocking her airway. With a guedel airway 80mm, she passed a suction catheter size 12 fr deep towards her lungs. She then move the catheter up and down movement position to try to break off any solid particles, if any. However she mentioned she was not able to detect any solid thing that is blocking her passageway.

The nurse continued phlegm suction, aiming deep into her trachea.

After a short while, my mom stopped struggling for breath and her lips turned back to pinkish colour. The nurse then stop the suction but continued giving her oxygen. Usually my mother is irritated by the cannula which connects the oxygen to her nose but the struggle for breath must have tired her out hence she did not try to push off the cannula like she normally did.

How I handle when I was at home

My mother had a few choking episodes while we were at home. These choking episodes were often unpredictable. But the risk of choking can be reduced substantially if phlegm suction is being done and the mouth is constantly checked and cleaned of any solidified phlegm or mucus.

This is the health hazard that comes with dysphagia. In ALS (Lou Gehrig disease) discussion groups, the choking is a recurring theme in ALS loved ones who have developed dysphagia from the motor neuron degeneration. Sometimes Alzheimer’s persons can still swallow a little but in the case of ALS, when the dysphagia progresses, they could not swallow nor spit out anything at all.

When my mom have a choking episode, I would quickly get her in a seated position (adjusting her bed) and then use my curved palm to hit on her back. Usually I would get help from someone to help raise her up as she tend to become very heavy, tense and uncooperative as she struggled to breathe. If I raise her up on my own, she would keep trying to go back to the position of lying down.

I would then immediately turn on the oxygen concentrator and phlegm suction machines in the room. Both machines are ready and can be used immediately after turning on the switch. The oxygen is turned to 3.0 but sometimes up to 3.5 to 4.0 until she stop struggling to breathe.

I would also do phlegm suction immediately. Previously I have asked the nurses as I expressed my concern that I do not dare to pass the tube too deep into my mother’s trachea. The nurses told me it is actually alright to pass till the base on the trachea but if I am afraid, just focus on clearing off the phlegm and secretions that is in her mouth and the upper opening of the throat.

Hence for me, basically my suction covers the top area and slightly lower in my mother’s throat. I do not go down deep as I am afraid of hurting her.

As a person continued to cough or choke, a lot of phlegm or secretions that are deep in their lungs would be pushed upwards which make suction easier. Often, the phlegm and secretions that we have problem getting out during normal phlegm suction would  be pushed out and up during coughing and choking. In cases of those with ALS that lose the complete ability to cough, I understand they would use a cough assist machine to help the cough.

IMPORTANT: The method above does not apply to someone who is choking due to food. The process to manage choking from food is different compared to choking on secretions.

We can only do our best

The above is what we have tried when encountering someone who is choking on phlegm and saliva. To minimize the risk, we always need to keep their body position upright, hit their back to dislodge the phlegm, and perform phlegm suction as well as administering oxygen.

There are 2 cases of persons who is on nasogastric tube feeding who have died due to choking. Both were fitted with nasogastric tube as they lost the ability to swallow following a stroke. Both the families did not know nor understand about phlegm suction. As stroke patients, unlike Alzheimer’s patients still have intact cognitive functions, they were expected to spit out their phlegm and mucus.

However problem occur when the mucus or phlegm is thick and sticky. With their compromised swallowing function as well as weakened throat muscles, they cannot use their muscles to pull out the phlegm to swallow it to the stomach. Hence, if we notice they have thick phlegm, we have to help them by doing suction. Taking Fluimucil and Mucinex as prescribed by doctors do help but even with that, we need to do suction or else the phlegm and mucus will still harden and become a choking hazard.

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