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First Aid Rescue Story

Monday, 10 March 2008

Réitseal Nic Dhonncha (pronounced 'Rachel')is a bubbly 5 year old from Galway who, having choked on a coin, was saved by her mum, who had seen Anthea Savage's First Aid segment on The Afternoon Show. Today we meet with Sandra and Réitseal to hear their story.

Who are our guests?
Sandra Shaw and her daughter Réitseal Nic Dhonncha (5)- Is Gaeilgeoirí iad.
Sheila Graham and her son Mark (17 months)

Sandra's Story:
11.15am Sunday 17th Feb

Two kids Liadh and Reitseal in their car seats heading out for a drive to collect Jessica. Pulled up at my housekeepers house and hopped out to drop off large drinking water containers. Was standing just inside the door when  approx one minute later, Reitseal came out of the car in the drive clutching her throat, very strange color and while gasping said the 'money is gone down my throat'.  Immediately realised this was serious as she said it was "the big silver coin".  Taking this to be 2 euro, and understanding the fact that in comparison to her anatomy, that this was potentially a life threatening situation.. Quickly I dialed 999. The phone operator responded immediately and an ambulance was en route.  Being in Athenry and understanding that this meant at least 25mins wait, I knew it was up to me in the mean time. 
At this stage I could not see the coin and her face was starting to swell under her cheeks.  (I feel quite shaky going through this.)  She started to vomit profusely and was making gulps like she was struggling for air.  The paramedic was still on the line, I told her I thought her airway was getting compromised and when she proceeded to tell me what to do, I realised that this was what I had seen Anthea doing two weeks previous.
Prior to this, probably from watching medical dramas, I knew that you look for ABC airway breathing and color. But would not have had a clue how to put it into practice.  With what I had seen on your show and that although I might not have remembered every detail, I knew that I could keep her alive until help came.  I cannot explain how that felt.  Without wanting to sound heroic or melodramatic, it was the most important time in my life that I knew that Knowledge is Power. 
Auto pilot took over at this stage, by now only 3 or 4 minutes had passed.  The paramedic had started to explain that I was to turn her upside down, as Anthea had demonstrated with the baby, only I did this sitting down, Reitseal head down over my leg and proceeded to percuss her between the shoulder blade and with her feet up.  checking every 10 blows if she still had an airway.  Somewhere in the middle of this Paraic arrived and took over as I needed to concentrate on keeping her conscious as her level of shock was very high.  She was gulping for air and I was afraid that she would inhale it into her windpipe. Fearing it would cap it and prevent her breathing or inhaling it into her lung was my fear at this stage.  I later learned from a Peadiatric Nurse, that this was indeed highly possible. I did try the heimleich manover but she was too young and was more terrified so we went back to what was working.  
27 minutes passed before the ambulance arrived, at this stage her face was very swollen and her eyes badly bloodshot, her pain level was severe.  As you can see from the x ray, the position it was in was extremly painful, her stats were not great and was immediately taken to the ambulance and we were at the hospital 20 mins later. 
Resuss were alerted and I understood that a team were waiting to assess her.  Not so. One registrar was available immediately and after initial assessment An ENT doctor had to come in from home.  UCHG has not got cover at the weekend. So between the x ray and first surgery nearly two hours ha passed, so what was promised by the anaesthetist to be a 30 second job, after I had held her and let them put her to sleep in theatre turned out to be 45 mins with no result.  The coin had travelled in the intervening time and now she was a general surgical case.  In pain, frightened and confused she came to in recovery, I have to point out that for a 5 year old child she handled everything that happened with amazing grace as long as "Dukey" (toy dog) mum and dad were there.
We went back to the Paediatric Ward and sat with her while she recovered.  The following day the Surgical Consultant Mr. Courtney assessed her and decided that as the scan now showed the coin in her stomach since the first surgery, he wanted her to eat normally and wait 24 hours.  He said he would then take her back to theatre and use an endoscopy method to get purchase on the coin a take it out through her throat.  We asked him would he take it out abdominally at this stage as we were against her having to have a third anaesthetic.  He said that was absolutely not going to happen.  He would try again in four days if today was not successful.  We were not happy with this, but had to accept his decision. 
This was approx 11am Monday.  As the coin had moved, she was now in no pain. She had a normal day and was in good form, considering what had happened the previous day. Kids! .......
At approx 6am the following morning, Paraic was with her when Mr, Courtney decided to take her for x ray and to theatre, I was not long gone home and did not make it in before she went to theatre.  By the time I got to the hospital at 9.30 she was already over an hour in theatre and the Consultant had come out and explained to Paraic that there was no way because of its position in the stomach ceiling that he could retrieve it today or any other day.  Reluctantly he had no option but to do full abdominal surgery.  This took most of another hour to complete and she looked pretty rough in recovery,   Having been through several surgeries myself, its a tough gig for a  adult, she stayed in recovery until the afternoon and I sat with her as her pain and stats were hard to control.
It was a one euro coin in the end, and is preserved for her Gold and Silver when she gets married!
She was a week in hospital; the first three days were difficult.  Pain management, lack of sleep, post shock nightmares etc, by the time we got home, she was in fairly good shape, the local celebrity, lapping up the attention getting better by the hour, leaving Paraic and I completely knackered in her wake!
This is the moral in the tale:
I have been a parent for almost 17 years.  During that time I have bought cars, washing machines, toys etc etc etc.  Almost everything we bring into our home has a breakdown manual.  What to do in an emergency.  We give birth to the most precious thing in our lives, and all we learn is how to bathe and feed and change it.  As a parent I am embarrassed but willing to admit that I have talked, thought and procrastinated about taking first aid classes.  I, like every other parent, leave my most precious possession with babysitters, and often my older daughter Jessica and never have I checked if they would know what to do in a similar situation.  I know I might sound like a first aid crusader, but if my story makes one more mum or dad get themselves trained, it will be worth it.  As parents we have a right to know that the teachers looking after our kids are trained.  I would urge parents on Parent Councils to ask themselves and their teachers what they can do as a community to get together and get trained.  You don't know when it could be you.  I surely didn't.

Sheila's Story:
Sheila (Balbriggan) was with her husband when their 17 month old son began to choke on a piece of biscuit. He was sitting in his buggy at the time and although Mark's dad began to panic, Sheila remembered what she had seen on The Afternoon show and began to put it into practice. She turned Mark upside down and gave a number of sharp blows to his back, dislodging the biscuit from his airway.

"On Wednesday 27th February just after dinner I gave my 17mth old boy Mark a biscuit and he wanted another piece before he had finished the bit that was in his mouth and I told him he lost his temper and threw his head back in the buggy screaming and my husband and myself saw in slow motion the piece he already had in his mouth sliding down in throat. This was when he started husband and I whipped him out of his buggy and I threw him over my arm and started thumping his back....after which we sat him up to see if we could see the offending biscuit but couldn't see anything so I put him back over my arm and again thumped his back at this stage we could hear he was able to get more air. And eventually after what seemed like a lifetime out popped the biscuit.....
So I would like to thank all at the afternoon show for the brilliant advice given in the first aid section".
**Sheila also has a 6 year old boy, James.

Useful websites and for info on First Aid courses:

. Choking
Choking occurs when a foreign object becomes lodged in the windpipe, blocking the flow of air. In adults, this is normally a piece of food; in children it can be any small object that they have put in their mouth.

The person may be clutching their hands to the throat and:
Have difficulty breathing
Have difficulty speaking or coughing
Have blue lips and skin
Lose consciousness.

Adult / Child
1. If coughing - stay beside them
  Make sure they don't get into further difficulty
2. If they start to have difficulty breathing, can no longer cough or speak and make the universal choking sign
- Ask are they choking and if they nod their head give abdominal thrusts until the object becomes dislodged
Abdonminal Thrusts (Heimlich manoeuvre):
. Stand behind the person and put your arms around their waist.
. Make a fist with one hand and place it between the navel (belly button) and bottom of the breastbone - grasp it with the other hand.
. Lean the person slightly forward and pull sharply into the abdomen, with a quick upwards thrust. Repeat until the obstruction is dislodged.
Anthea will demo all of this and describe how they look, universal choking sign etc
3. If they don't cough it up, collapse and become unresponsive
- Lay them gently onto the floor
- Call for help
-  Start the steps of CPR as seen last week but each time you go to give a breath, look into the mouth before hand to see if there is anything there. Only put your finger into remove the object if you can see it.
Anthea will demo this on a child manikin, giving more information on looking in the mouth etc.

There are some differences between managing choking in a child and infant.
1. If coughing - Lift them up and keep a close eye on them
   Make sure they don't get into further difficulty
2. If they start to get into difficulty where they can no longer cough effectively, breath or make high pitched noises do the following
- Lay then along your arm with their head facing downwards
- Give 5 back blows before turning them over to give 5 abdominal thrusts.
- Continue this alternating between back blows and thrusts until the object is coughed up.
3. If they don't cough it up and become unresponsive
 Lay them onto a hard surface
- Call for help
-  Start the steps of CPR as seen last week but each time you go to give a breath, look into the mouth before hand to see if there is anything there. Only put your finger in to remove the object if you can see it and safely remove it. At all times you must be careful not to push it further down.

Again, Anthea will demo where to give the blows and how to position the body etc. Anthea will also go through the steps of CPR for the infant as it's slightly different to the adult.

How can I lower my child's risk of choking?
Don't give children younger than four foods or small objects likely to lodge in the windpipe. Troublesome foods include nuts of any kind, sunflower seeds, cherries (unless you remove the pits and slice up the fruit), chewing gum, hard sweets, popcorn, raw carrots, raw peas, raw celery, watermelon with seeds, and spoonfuls of peanut butter. Hot dogs, sausages, cheese, and grapes also frequently cause choking, so be sure to chop them into pieces before serving. In fact, all foods should be cut into small pieces.

Always supervise mealtime, and make sure babysitters, other carers, and older siblings know which foods are off-limits for small children. Also, make it a rule that your toddler must sit down while eating (eating while walking, running, or playing increases the risk of choking) and must never eat while riding in a car seat (you or another driver might not be able to respond quickly if your child chokes).

Small toys can pose a danger, too. For children, rubber balloons are a leading cause of death from choking, so warn your child never to chew on a piece of a rubber balloon or put his mouth on an inflated balloon. Other risky objects include coins, marbles, small batteries, pen or marker caps, and toys that can fit in your child's mouth.


In the event of any emergency call 999 or 112