20 Sep 2024

Is Marshmallow a Choking Hazard?

– The information has been reviewed by Nursing Officer of the Outpatient Department, Phoebe Lai

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Marshmallow is one of the confections enjoyed by both adults and children alike. However, this seemingly harmless food item has tragically become the 'weapon' that led to the death of an adult. In October 2023, a rugby club in the United Kingdom hosted a fundraising party for a youth rugby team. The event was designed to include family-friendly activities to encourage parental participation. One such activity was a competition to see who could fit the most marshmallow into their mouth within 60 seconds. One mother successfully swallowed dozens of pieces of marshmallow, but immediately after leaving the stage, she suddenly collapsed and choked. Despite the immediate assistance rendered by medical personnel on-site, she unfortunately succumbed to choking.

Choking can lead to hypoxic unconsciousness, and if it persists for more than four minutes, it can cause irreversible damage to the brain, significantly increasing the risk of death. Upon noticing anyone in this distressing situation, the observer should remain calm and take advantage of the critical moments for emergency intervention. Immediate first aid should be administered, and assistance should be sought from those nearby to call for an ambulance. The following information will provide insights into the symptoms of choking, methods for administering first aid, and prevention strategies.

Five major symptoms of choking

Pointing to the throat or grasping the neck with both hands to indicate discomfort
Inability to speak
Inability to cough
Inability to breathe
Facial flushing and redness, progressing to a bluish-purple discoloration

Choking First Aid Methods

If the patient is conscious and able to cough forcefully, the rescuer should encourage the sufferer to continue coughing and closely monitor their condition. Conversely, if the patient is unable to cough due to a complete obstruction of the airway, the rescuer should immediately administer the "Abdominal thrusts" or "Heimlich maneuver" first aid technique from behind the sufferer. Simultaneously, please ask someone to call 999 for an ambulance and to bring an Automated External Defibrillator (AED) to the location to assist.

The Heimlich Maneuver is a first aid technique invented in 1974 by American physician Dr. Henry Heimlich, aimed at clearing obstructions from the upper airway. The principle involves the rescuer standing behind the patient and applying pressure to the diaphragm, thereby compressing the lungs and expelling the foreign object from the trachea.

To perform the maneuver, the rescuer should first stabilize themselves behind the patient and wrap their arms around the patient's waist.
One hand should be made into a fist, with the thumb facing towards the patient and the palm facing inward.
Next, place the fist at the midline of the patient's abdomen, just above the navel (approximately 2.5 centimeters above the navel) but well below the xiphoid process of the sternum.
The other hand should then grasp the fist.
With appropriate force, the rescuer should thrust both hands upward and inward against the patient's abdomen, applying pressure to the diaphragm.
The above action may be repeated up to five times, with each thrust being distinct, until the patient expels the foreign object.
If the patient is pregnant, abdominal pressure should not be applied. Instead, pressure should be exerted on the center of the sternum, followed by inward thrusts performed five times without applying pressure to the xiphoid process.

Recommendations for Preventing Choking

Chew thoroughly and swallow slowly

When eating, it is important to chew food thoroughly and swallow slowly. Take only one bite-sized portion at a time and ensure that food is well chewed before swallowing.

Avoid eating during activities

Refrain from eating while engaged in activities such as talking, laughing, walking, exercising, or driving, as these actions may increase the risk of choking.

Be mindful of dietary considerations for specific groups

Avoid allowing children and the elderly to consume foods that are prone to cause choking, such as whole grapes, hot dogs, and nuts. Whenever possible, cut food into smaller pieces.

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