When a person becomes unresponsive while choking, the situation immediately escalates to a severe, life-threatening emergency. The sudden loss of consciousness causes the muscles supporting the airway to relax, adding the risk of the tongue blocking the throat to the pre-existing foreign body obstruction. Time is extremely limited, as brain damage can begin within four to six minutes without oxygen. The procedures for an unresponsive, choking person require an immediate transition to modified cardiopulmonary resuscitation (CPR). This information provides a framework for immediate response, but it is not a replacement for formal, hands-on training and certification in CPR.
Initial Assessment and Emergency Activation
The first step upon encountering a person is to quickly assess their responsiveness by shouting and tapping their shoulders. If there is no reaction, an unresponsive state is confirmed, and the emergency response system must be activated immediately. If you are alone with an adult, the recommendation is to “Call First”: call 911 or your local emergency number and put the phone on speaker before beginning intervention.
If a bystander is present, instruct them to call for help and locate an Automated External Defibrillator (AED) while you begin care. The person must be on their back on a firm, flat surface, such as the floor, to ensure that chest compressions are effective.
Airway Maneuvers for the Unresponsive Person
Before starting compressions, you must attempt to open the airway to see if the obstruction is accessible. The standard technique for an unresponsive person is the Head-Tilt/Chin-Lift maneuver. This involves placing one hand on the person’s forehead and two fingers under the chin, then gently tilting the head back while lifting the chin. This action physically moves the tongue away from the back of the throat.
If you suspect a neck or spinal injury, the Jaw-Thrust maneuver should be used instead. This involves placing your fingers under the angles of the person’s jaw and lifting with both hands, moving the jaw forward without tilting the head back. After performing either maneuver, open the mouth and look inside, carefully removing any foreign object only if it is clearly visible and within easy reach. Never attempt a blind finger sweep, as this can inadvertently push the object deeper into the airway.
Removing the Obstruction Using Chest Compressions
Once unresponsiveness is confirmed, the procedure shifts from the conscious choking response (like abdominal thrusts) to a modified CPR sequence designed to dislodge the object. Chest compressions are the primary tool for forcing air out of the lungs to create an artificial cough.
You should begin a cycle of 30 chest compressions. Place the heel of one hand on the center of the person’s chest, just below the nipple line, with the other hand interlaced on top. The compressions must be delivered hard and fast, at a rate of 100 to 120 compressions per minute, pushing down at least 2 inches, but not more than 2.4 inches, for an adult. This force circulates blood while generating pressure within the chest cavity to potentially expel the foreign body.
After the 30 compressions, immediately open the airway again using the head-tilt/chin-lift and check the mouth for the object. If no object is seen, attempt to give two rescue breaths, each lasting about one second, watching to see if the chest rises. If the chest does not rise after the first breath, reposition the head and try the second breath. If the second breath is also unsuccessful, indicating the airway remains blocked, return immediately to another cycle of 30 compressions. This continuous cycle is repeated until the object is cleared, the person begins to move or breathe normally, or emergency medical services arrive.
Ongoing Care and Transition to Professional Help
As soon as the foreign object is expelled, or if the person begins to breathe normally, the focus shifts to monitoring and preparing for professional help. Immediately check for normal breathing and a pulse, maintaining the airway with the Head-Tilt/Chin-Lift if they remain unresponsive. If the object is removed, but the person is still not breathing normally, transition to standard CPR (30 compressions followed by two breaths).
If the person remains unconscious but is breathing normally and has a pulse, they should be carefully placed into the recovery position. This involves turning the person onto their side to help keep the airway open and allow any fluids, such as vomit or saliva, to drain freely from the mouth, preventing aspiration. Even if the person appears recovered, a comprehensive medical evaluation is necessary to assess for internal injuries from the compressions and ensure no remaining complications exist.