When a person is choking, the inability to breathe means air cannot reach the lungs, and the brain is quickly deprived of oxygen. Unresponsiveness signals that initial efforts to clear the airway have failed and the body is collapsing from lack of oxygen. This shift from conscious choking to unresponsiveness demands an immediate response, moving from standard choking maneuvers to cardiopulmonary resuscitation (CPR) protocols. Irreversible brain damage can begin in minutes without intervention. This transition requires a modified approach to CPR to address the foreign body obstruction directly.
Immediate Steps Before Starting CPR
The first step upon recognizing an unresponsive victim is to activate the emergency medical system. If others are present, direct a bystander to call 911 and retrieve an automated external defibrillator (AED) if one is nearby. A lone rescuer must call for help before beginning physical intervention on an adult victim.
The victim must be lowered to the ground to establish a flat surface necessary for effective chest compressions. The goal is to initiate chest compressions with minimal delay. Before starting the sequence, the victim should be positioned lying face-up on their back. Proper positioning ensures compressions generate the required force to circulate blood and potentially dislodge the obstruction.
The Sequence of Compressions and Rescue Breaths
Once the victim is positioned, the rescuer immediately initiates the cycle of chest compressions and rescue breaths, which differs slightly from standard CPR. The cycle begins with 30 compressions delivered at a rate between 100 and 120 beats per minute. Compressions should be approximately two inches deep, allowing the chest to fully recoil after each push. Chest compressions circulate remaining oxygenated blood and create a sudden increase in pressure within the chest cavity.
After completing the 30 compressions, open the airway using the head-tilt, chin-lift maneuver. A visual check of the mouth must be performed before attempting to give breaths. Look for the foreign object at the back of the throat or in the mouth. If a solid object is clearly visible and within easy reach, carefully remove it using a finger.
If no object is seen or if it is too deep to retrieve, administer two rescue breaths. Pinch the victim’s nose and form a complete seal over the mouth, delivering a breath that lasts about one second while watching for the chest to rise. If the first breath fails to cause the chest to rise, reposition the head and attempt the second breath. Failure of the chest to rise after the second attempt confirms the airway remains blocked, and the rescuer must immediately return to another cycle of 30 chest compressions. This modified CPR sequence continues until the object is removed, the victim responds, or medical personnel arrive.
Rationale for Airway Checks and Breaths
Giving rescue breaths to a choking victim may seem counterintuitive, but the preceding compressions are designed to change the situation. Chest compressions forcefully increase pressure in the lungs, similar to the Heimlich maneuver, which can help move or dislodge the foreign object. This pressure change means the airway may be partially or completely clear when the rescuer attempts ventilation.
The rescue breaths serve as a direct test of whether the compressions were successful. If a breath causes the chest to rise, it confirms air is able to pass, providing needed oxygen to the victim’s lungs and brain. This oxygen delivery is the ultimate goal, even if the obstruction is only partially relieved.
The instruction to only remove a clearly visible object safeguards against the “blind finger sweep.” Attempting to sweep a non-visible object can inadvertently push it further down the throat, worsening the obstruction. The compressions are intended to move the object into a position where it can be safely removed, making the visual check a necessary part of the protocol.
Protocol Adjustments for Infants and Children
The technique is adjusted significantly for infants and children up to the age of puberty, though the principle of compressions followed by attempted breaths remains. For an infant (birth to one year), compressions are performed using only two fingers placed on the breastbone, just below the nipple line. The depth is shallower, aiming for about one-third the depth of the chest, or approximately 1.5 inches.
For a child over one year, compressions are typically delivered with the heel of one hand, compressing to about one-third the depth of the chest, or approximately two inches. Rescue breaths also differ for infants; the rescuer must cover both the infant’s nose and mouth to create an effective seal. The breath force is gentler than for an adult, using only a puff of air from the cheeks.
A lone rescuer with an infant or child must adjust the timing of calling emergency services. Because respiratory arrest is often the cause of collapse in children, the lone rescuer should perform five cycles of CPR first before pausing to call 911. This prioritizes the immediate delivery of oxygen. The rule against blind finger sweeps is strictly applied due to smaller, more fragile airways, where the risk of pushing the object deeper is greater.