When it goes down wrong: The president's choking incident gave us something to chew on. Let's do it right.
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Now that the late-night comics have had plenty of time to kick the Pretzel Incident to death, here are some easily digestible facts on choking.
First off, for the record, once and for all, here's what happened to the commander-in-chief during Pretzelgate: President Bush suffered from vasovagal syncope, or vasovagal fainting. That’s a mouthful for saying he had a brief fainting spell from choking while he was eating. It’s a common occurrence. Food gets caught in your throat, you cough or can't breathe, your blood pressure drops, circulation to your brain lowers and it's Lights Out. Whether it's permanent lights out depends on whether the object in question is dislodged.
But Bush may have been more prone than average to fainting under those circumstances, because his high level of physical fitness makes his resting heart rate lower than average. So it could have taken less for his blood pressure to drop to the Lights Out point.
Dr. Henry Heimlich, creator of the Heimlich Maneuver, says he's answered plenty of inquiries since the incident. "The question is, did he fall unconscious because he was lacking oxygen due to the blockage of the airway? Or did the piece of the pretzel irritate the vagus nerve, which can cause fainting?"
The president’s doctor says the latter. But the question is moot. "Whichever it was, the solution was to get the pretzel out of there. So the real solution would be to do the Heimlich maneuver. It doesn't matter which condition exists," Heimlich says.
Speaking from the Heimlich Institute in Cincinnati, Ohio, the 81-year-old doctor says, "The incident with President Bush points out one thing very specifically: When you are alone, you can do the Heimlich maneuver on yourself."
(It's just like performing it on another person: Put your fist — with the thumb pointing inward — below your ribcage and above your belly button, then quickly press inward and upward. Or you can use the back of a chair, pressing the top of it against yourself in the same spot.)
"That's what the president, if he knew it, he could have done," Heimlich says.
But enough pretzel prattling. Heimlich, whose procedure has saved an estimated 100,000 lives in this country since the mid-1970s, adds that unconsciousness from choking isn't instantaneous. "You can always do something in time. You have up to, say three minutes. The point is, you know immediately when you start choking."
And a hand to the throat is the signal to someone else that you're choking.
Seeing someone turning blue is another warning sign. And if you see someone fall unconscious in a restaurant, Heimlich says there's a "98 ½ percent" probability that the person has choked on food.
Brief fainting spells from choking are common, but deaths from it aren't.
The American Red Cross reports 2,800 choking deaths a year.
"It doesn't come up that often," says emergency-room doctor Terry Mengert, at the University of Washington Medical Center. "That's probably because most people have it relieved in the field and don't come subsequently into the hospital. But that's not many for 5,500 emergency rooms around the country with 92 million patients per year."
Why people choke
Here are the main reasons people choke:
• Obstruction (i.e., swallowing something too big or inhaling something instead of swallowing it).
• Tissue swelling (i.e., throat closure from an allergy).
• Crushing of the throat (e.g., getting strangled).
• Watching the new "Orange County" film (all right, we made that one up).
But for most of us, it's an obstruction from food — such as a big piece of steak. Food accounts for nearly 70 percent of nonfatal choking incidents, according to the Center for Disease Control.
For children age 3 and younger, though, about 70 percent of those who choke to death do so on toys and other children's products.
Experts at the University of Washington's Otolaryngology Clinic say the majority of people who have choking incidents experience something similar to the president's. The important thing is to act quickly. For severe breathing problems or allergic reactions, call 911, because the longer the brain goes without oxygen, the greater the chance of brain damage and death.
What if you or someone else is choking?
• Heimlich 'em. (See our diagram.)
• Don't waste time. Lack of oxygen can cause permanent brain damage if not death.
• Call the paramedics if you can't immediately solve the problem.
• Don't slap a choking child on the back. That can cause an object to go further down the throat.
• For smaller children, a Heimlich maneuver should be done more gently than with an adult, using the index and middle fingers of both hands rather than a full fist, with the child either sitting on your lap or lying face up, on a flat surface.
Mark Rahner: 206-464-8259 or mrahner@seattletimes.com.