Choking occurs when a foreign object, such as food or a small item, becomes lodged in the throat or windpipe, preventing the person from breathing normally. This blockage quickly stops the flow of oxygen to the lungs and brain, creating a medical emergency that requires immediate intervention. Without oxygen, permanent brain damage can begin in as little as four minutes, highlighting the need for prompt action. Knowing the correct first aid procedures for different age groups can make the difference between life and death.
Identifying Choking and Calling for Help
The most widely recognized indication of severe airway obstruction is the universal choking sign, where the victim clutches their throat with one or both hands. This signals that the person is in distress and cannot breathe, speak, or cough effectively. If the airway is completely blocked, the person will be unable to make sounds, and any cough will be silent or weak.
Lack of oxygen can cause the skin, lips, and fingernails to turn blue or gray, a condition known as cyanosis. If you observe these signs, immediately ask, “Are you choking?” If the person nods or cannot speak, call 911 or your local emergency number, or instruct a bystander to do so. For a conscious adult, seek consent before beginning intervention, though distress usually implies permission.
Steps for a Conscious Adult or Child
The primary technique for dislodging an object from a conscious adult or child (over one year old) is abdominal thrusts, commonly known as the Heimlich maneuver. Stand behind the person and wrap your arms around their waist, leaning them slightly forward. This technique uses residual air in the lungs to create an artificial cough that can expel the blockage.
To perform the thrusts, make a fist with one hand and place the thumb side against the person’s abdomen, positioning it just above the navel and below the breastbone. Grasp your fist with your other hand, then deliver five quick, inward and upward thrusts. Repeat the cycle of five thrusts until the object is dislodged or the person begins to cough forcefully.
If the victim is pregnant or significantly obese, standard abdominal thrusts must be modified to chest thrusts. Stand behind the person and wrap your arms under their armpits, placing your hands on the center of the breastbone. Deliver five quick inward thrusts directly to the chest instead of the abdomen. Continue this technique until the obstruction is cleared or the person loses consciousness. Professional medical evaluation is necessary afterward.
Steps for a Choking Infant (Under 1 Year)
Rescuing an infant under one year old requires a modified approach, as abdominal thrusts risk internal organ damage. The procedure involves alternating five back blows and five chest thrusts until the obstruction is relieved. Position the infant face-down along your forearm, using your thigh for support, ensuring the head is lower than the chest to utilize gravity.
Deliver five firm back blows with the heel of your hand between the infant’s shoulder blades to loosen the foreign object. If the object remains, carefully turn the infant face-up on your other forearm, keeping the head lower than the chest. Place two fingers in the center of the chest just below the nipple line.
Perform five quick chest thrusts, pushing down about one and a half inches. Continue alternating between five back blows and five chest thrusts until the infant is able to breathe, cough, or cry, or until they become unresponsive. If you are alone, begin the cycle immediately and call for emergency help after approximately one minute of intervention.
Managing the Unconscious Victim
If the victim loses consciousness while choking, the procedure must immediately shift to modified cardiopulmonary resuscitation (CPR). Lay the victim flat on their back on a firm surface, and call 911 or instruct a bystander to do so. Unlike standard CPR, the first step is to check the mouth for a visible foreign object before attempting rescue breaths.
If you see the object, remove it with a finger sweep, but never perform a blind finger sweep, as this risks pushing the object deeper. If no object is visible, begin chest compressions, following the standard cycle of 30 compressions. After the compressions, open the airway and attempt two rescue breaths, checking the mouth for obstruction again before each attempt.
If the first rescue breath does not cause the chest to rise, reposition the head and attempt the second breath; if neither breath works, continue compressions. The act of chest compression helps maintain blood flow while also creating pressure changes in the chest that may help dislodge the blockage. Continue the cycle of 30 compressions, mouth check, and two rescue breaths until the object is expelled, the victim recovers, or emergency medical services arrive to take over.