Choking is a life-threatening emergency that occurs when a foreign object, most commonly food, partially or completely blocks the airway, preventing air from reaching the lungs. This obstruction quickly leads to oxygen deprivation in the brain, making immediate action necessary. While this information provides guidance on emergency response, it is not a substitute for formal, hands-on training in CPR and first aid. Learning these techniques in a certified course is the best way to ensure preparedness.
Recognizing Choking and Initial Response
Recognizing the signs of choking is the first step toward saving a life. The universal sign of severe airway obstruction is a person clutching their throat, often accompanied by panic. If the airway is completely blocked, the person will be unable to speak, cough, or breathe, and their skin or lips may begin to turn blue or gray.
It is important to distinguish between a partial and a complete obstruction. If the person can still cough forcefully or speak, encourage them to continue coughing to clear the obstruction naturally. If the person cannot make any sound, or their cough is silent and ineffective, the obstruction is complete and requires immediate intervention. The first action, regardless of the victim’s age, is to immediately call or designate someone to call emergency medical services.
Clearing Obstructions in Conscious Adults and Children
For conscious adults and children aged one year and older who cannot cough or speak, the recommended sequence is an alternating cycle of five back blows and five abdominal thrusts. This combination creates a forceful, artificial cough to dislodge the foreign object. Back blows are delivered with the heel of your hand to the person’s back, directly between the shoulder blades.
Following the back blows, quickly transition to five abdominal thrusts (the Heimlich maneuver). Stand behind the person and wrap your arms around their waist, placing one foot slightly in front of the other for balance. Make a fist with one hand and place the thumb side against the person’s abdomen, just above the navel and below the breastbone. Grasp your fist with your other hand.
Deliver five quick, inward and upward thrusts, using a strong “J” motion to compress the lungs and expel the trapped air. Each thrust should be forceful and separate. The cycle of five back blows and five abdominal thrusts must be repeated continuously. Continue this alternating sequence until the object is expelled, the person can breathe or cough effectively, or the person becomes unresponsive. The goal is to generate enough subdiaphragmatic pressure to force the object out of the trachea.
Specialized Techniques for Infants
The technique for clearing an obstruction in an infant (under one year old) is significantly different, and abdominal thrusts must never be used. The procedure begins by carefully positioning the infant face down along your forearm, supporting the head and neck with your hand. The infant’s head should be positioned lower than their chest to utilize gravity in dislodging the object.
Deliver five firm but controlled back blows using the heel of your hand between the infant’s shoulder blades. After the back blows, sandwich the infant between your forearms and turn them face up, ensuring the head remains lower than the chest. Then administer five chest thrusts using two fingers placed on the center of the breastbone, just below the nipple line.
These chest thrusts should be quick, downward compressions, approximately one-third the depth of the chest. The sequence of five back blows followed by five chest thrusts is repeated until the object is expelled or the infant becomes unresponsive. After each cycle, look inside the infant’s mouth, removing the object only if it is clearly visible.
Managing Unresponsive Victims and Special Circumstances
If a conscious choking victim loses consciousness, the immediate response must change. Carefully lower the person to the ground on a firm, flat surface, and immediately begin cardiopulmonary resuscitation (CPR), starting with chest compressions. The compressions act as a mechanical tool to help dislodge the obstruction.
After completing the first cycle of 30 chest compressions, open the person’s mouth and check for a visible foreign object before attempting rescue breaths. If the object is seen, carefully remove it with a finger sweep only if it is within reach. If the object is not visible or cannot be removed, attempt two rescue breaths.
If the chest does not visibly rise with the first rescue breath, reposition the head and attempt the second breath. If the chest still does not rise, continue compressions and do not attempt further breaths. For special circumstances, such as pregnant or morbidly obese victims, standard abdominal thrusts must be replaced with chest thrusts to avoid injury. To perform a chest thrust, the rescuer stands behind the person, places a fist on the center of the breastbone, and pulls straight back forcefully until the object is expelled or the person becomes unresponsive.