An airway obstruction in an unconscious person is a time-sensitive medical emergency. The lack of oxygen delivery to the brain requires immediate action to dislodge the foreign body and restore breathing. When a choking person becomes unresponsive, standard first-aid maneuvers are abandoned in favor of a modified resuscitation protocol. This urgent transition requires a clear, step-by-step approach to maximize the chance of survival.
Recognizing Unconsciousness and Activating Emergency Services
The first step is to confirm the victim’s unresponsiveness and inability to breathe effectively. Gently tap the person’s shoulder and shout loudly to check for a response. If the person is limp, does not respond to stimuli, and is not breathing normally, they are considered unconscious.
The rescuer must immediately activate emergency medical services (EMS) by calling 911 or the local emergency number. If a second person is present, one rescuer should call for help while the other begins care. When alone with an adult victim, the guideline is to “call first,” contacting EMS before starting any physical intervention.
Once help has been summoned, the victim should be carefully lowered to a firm, flat surface, such as the floor. This ensures the chest compressions that follow are effective and allows the rescuer to apply the necessary force to dislodge the object. Irreversible brain damage can begin within minutes of oxygen deprivation.
The Unconscious Choking Protocol (Modified Resuscitation)
The core intervention for an unconscious choking victim is a modified form of Cardiopulmonary Resuscitation (CPR). This protocol utilizes chest compressions as the primary mechanism to increase pressure inside the chest cavity, creating an artificial cough that may expel the object. The standard sequence begins with 30 chest compressions.
The rescuer should kneel beside the victim and place the heel of one hand on the center of the chest, right between the nipples, with the other hand interlaced on top. Compressions must be delivered hard and fast, at a rate of 100 to 120 per minute, pushing down at least 2 inches, but no more than 2.4 inches, into the chest. Allow the chest to fully recoil after each compression; this allows the heart to refill with blood and is necessary for effective resuscitation.
Following the 30 compressions, the rescuer must attempt to deliver two rescue breaths. Before the first breath, the rescuer must open the airway using the head-tilt/chin-lift maneuver and visually inspect the mouth for the obstructing object. If the first breath does not cause the chest to visibly rise, the rescuer should quickly reposition the head and attempt a second breath.
If the chest still does not rise after the second attempt, the rescuer should immediately return to chest compressions. This cycle of 30 compressions, followed by a check for the object and two attempted breaths, must be repeated continuously. The compressions are designed to move the foreign object into a location where it can be seen or coughed out.
Foreign Body Check and Manual Removal
A visual check for the foreign body occurs between the compression and ventilation phases of the modified resuscitation protocol. After the 30 chest compressions, the rescuer opens the victim’s mouth to look for anything forced up by the internal pressure. The head-tilt/chin-lift maneuver is used to align the airway and provide a clear view into the throat.
Manual removal of the object, often called a finger sweep, must only be performed if the foreign body is clearly visualized. If the object is seen, the rescuer should use a finger to scoop or sweep it out of the mouth. This action avoids pushing the object deeper into the airway, which can worsen the obstruction.
Under no circumstances should the rescuer perform a “blind” finger sweep, where a finger is inserted into the mouth without seeing the object. A blind sweep carries a high risk of pushing the obstruction further down the throat, making it impossible to remove and completely blocking the airway. If no object is seen, the rescuer proceeds directly to the attempted rescue breaths. The check and removal process is a quick interruption, ensuring chest compressions are resumed with minimal delay.
Post-Intervention Care and Recovery Position
The continuous cycle of compressions and attempted breaths should be maintained until the obstruction is cleared, EMS arrives, or the victim begins to breathe normally. Once the foreign body is removed, the rescuer must immediately reassess the victim’s breathing. If the person is not breathing normally or is only gasping, the rescuer should transition to standard CPR, continuing the 30 compressions to 2 breaths sequence.
If the victim remains unconscious but is breathing effectively, the priority shifts to maintaining the airway and preventing aspiration. The victim should be carefully placed into the recovery position. This position involves rolling the person onto their side to keep the airway open and allow fluids, such as vomit, to drain from the mouth.
To safely position the victim, the arm nearest the rescuer is placed at a right angle. The far arm is placed across the chest with the hand against the cheek, and the far leg is bent at the knee. The rescuer then gently pulls on the bent knee to roll the person onto their side. This stable side-lying posture prevents the tongue from falling back and blocking the airway. The rescuer must remain with the victim, continuously monitoring breathing until professional medical help arrives.