Head-down self-treatment of choking.

It is estimated that choking can result in tens of thousands of eaths each year (incidence of 0.66 per 100,000 population).1 For onscious adults showing signs of severe airway obstruction, the uropean Resuscitation Council recommends applying back blows ollowed by abdominal thrusts. One important limitation of curent recommendations for FBAO treatment is that it requires the ssistance of another person, and in approximately 30–40% of FBAO ases, the victim is alone.2 Surprisingly, even if other people are resent during FBAO, in only 5–13% of these cases are the observers r medical personnel able to make a correct diagnosis and initiate he appropriate treatment.2 These statistics underscore the imporance of developing an alternative method of treatment which ould be self-applied without relying on the presence or knowledge f other people. Multiple evidence suggest, that one of promising approaches o improve FBAO treatment in adults could be by applying the ead-down (inversed) position (Fig. 1). The head-down position is lready recommended during choking incidents that occur in chilren below one year of age.3 Similarly, it is suggested that in older hildren that back blows are more effective if the child is positioned ead down.3 There is also evidence that combining the inverse posiion with other treatment methods improves its effectiveness in dults. One of the most rigorous studies supporting this was conucted by Ruben and Macnaughton.4 They studied FBAO in artificial arynxes attached to the endotracheal tubes of intubated voluneers. They reported that successful removal of the obstructing food ould be achieved only when maneuvers were aided by gravity. One ther advantage of the head-down position is that it could help emove saliva and other fluids which may further obstruct airflow uring choking; particularly during partial obstruction or when a oreign object is semisolid. Moreover, I also experienced food chokng, and using the upside-down position helped me to remove the