Choking occurs when a foreign object, typically food, lodges in the throat or windpipe, preventing the flow of oxygen to the lungs. It is important to distinguish between a partial airway obstruction, where the person can still cough forcefully or speak, and a complete obstruction. If the victim cannot cough, speak, or breathe, the situation is life-threatening and requires immediate action. The first step is to immediately call emergency services, such as 911, or designate a bystander to do so while you begin intervention.
Performing Abdominal Thrusts on a Responsive Adult or Child
The goal of abdominal thrusts, commonly known as the Heimlich maneuver, is to use the residual air in the victim’s lungs to create an artificial cough that expels the obstruction. To begin, stand directly behind the person and wrap your arms around their waist. For a small child, you may need to kneel down to be at an appropriate height.
Place one foot slightly in front of the other for balance, which helps stabilize you. Locate the person’s navel, then place your fist (thumb side against the abdomen) just above that point and well below the breastbone. This placement targets the diaphragm to maximize upward pressure.
Grasp your fist firmly with your other hand. The motion must be a quick, powerful jerk directed simultaneously inward and upward, compressing the lungs and forcing air out. This movement is designed to pop the blockage free from the windpipe.
Deliver five abdominal thrusts in rapid succession, checking after each set to see if the object has been dislodged. The thrusts must be forceful enough to generate necessary pressure but not aggressive enough to cause internal injury. Continue alternating sets of five thrusts until the object is expelled and the person can breathe or cough on their own, or until they become unresponsive.
If the person loses consciousness, the procedure must immediately transition to the steps for an unresponsive victim. The standard abdominal thrust is effective for most adults and children, but the technique must be modified for certain body types or conditions.
Adapting the Technique for Special Circumstances
When performing the maneuver on a victim who is noticeably pregnant or significantly overweight, abdominal thrusts carry a risk of causing internal injury or trauma to the fetus. In these situations, the pressure must be applied to the chest instead of the abdomen, using a modified technique called chest thrusts. Position yourself behind the person and place your hands directly on the center of the breastbone, avoiding the lower ribs.
Deliver sharp, inward-directed thrusts to the chest until the airway is cleared or the person becomes unresponsive. This modification utilizes the same principle of air compression while avoiding pressure on the abdomen. If the victim becomes unresponsive, gently lower them to the floor, call for medical help, and begin cardiopulmonary resuscitation (CPR).
When performing CPR on an unconscious choking victim, look inside the mouth each time you open the airway for rescue breaths. Only attempt a finger sweep if you can clearly see the object; blind finger sweeps can push the object further down the airway. For a small child over the age of one, use the same inward and upward thrusts, but apply a less powerful force appropriate for the child’s size.
Clearing an Airway Obstruction in Infants
The standard abdominal thrust technique is never performed on an infant (under one year of age) due to the high risk of damaging the liver or other abdominal organs. The recommended procedure is a cycle of back blows and chest thrusts. Support the infant face-down on your forearm, resting your arm on your thigh, ensuring the head is lower than the trunk so gravity assists in dislodging the object.
Deliver five firm but gentle back blows with the heel of your hand between the infant’s shoulder blades. If the object is not expelled, turn the infant face-up, supporting the head and neck, and keeping the head lower than the body. Place two fingers on the center of the breastbone, just below the nipple line.
Apply five quick chest thrusts, compressing the chest about one-third of the depth (approximately 1.5 inches). Continue alternating between five back blows and five chest thrusts until the object is expelled or the infant becomes unresponsive.
How to Perform the Heimlich Maneuver on Yourself
If you are choking while alone, you can perform a modified Heimlich maneuver on yourself. Form a fist with one hand and place the thumb side just above your navel and below the ribcage, grasping the fist with your other hand. Deliver a rapid, inward and upward thrust into your own abdomen using your hands.
A more effective method often involves utilizing a stationary, rigid object to apply the necessary force. Bend forward over a stable surface, such as the back of a chair, a railing, or a countertop. Position your upper abdomen over the edge of the object, ensuring it is below your ribcage.
Shove your body sharply against the object, applying strong inward and upward pressure to simulate the abdominal thrust. Repeat this self-administered thrust until the object is expelled and you can breathe normally. Remember to call emergency services first, even if you cannot speak, as the open line will alert the operator to an emergency in progress.