Choking occurs when a foreign object, typically food or a small item, lodges in the throat or windpipe, blocking the flow of air. This obstruction can be partial, allowing some air to pass, or complete, which stops breathing entirely. Because the brain can suffer damage from a lack of oxygen in as little as four to six minutes, prompt intervention is necessary to save a life. Knowing the correct, immediate actions to take can prevent a fatal outcome.
Recognizing the Emergency and Calling for Help
The most recognized sign of choking is the victim instinctively grabbing their throat with one or both hands, known as the universal distress signal. A victim with a completely blocked airway will be unable to speak, cry, or cough forcefully. Other physical signs include a look of panic or silent coughing.
The skin, lips, or fingernail beds may begin to turn blue or gray (cyanosis), indicating a severe lack of oxygen. If the person is conscious but cannot breathe, the immediate priority is to activate the emergency response system. If another person is present, delegate the task of calling 911 or the local emergency number while you begin first aid measures. If you are alone with the victim, begin the rescue sequence immediately and call for help after two minutes of attempting to dislodge the object.
Techniques for Conscious Adults and Older Children
For conscious adults and children over the age of one, the recommended procedure involves a cycle of five back blows followed by five abdominal thrusts, commonly known as the Heimlich maneuver. This technique compresses the lungs, forcing air out to expel the blockage. The cycle should be repeated until the obstruction is cleared or the person loses consciousness.
To administer back blows, stand to the side and slightly behind the victim, supporting the chest with one arm. Bend the person over at the waist so their upper body is parallel to the ground. Use the heel of your other hand to deliver five firm blows directly between the shoulder blades.
If the object remains lodged, proceed immediately to five abdominal thrusts. Stand directly behind the person and wrap your arms around their waist. Make a fist with one hand and place the thumb-side just above the navel and below the rib cage. Grasp your fist with your other hand and deliver five quick, inward and upward thrusts into the abdomen.
If the victim is pregnant or too large for your arms to wrap around their abdomen, administer chest thrusts instead of abdominal thrusts. For self-aid when alone, place a fist above your navel, grasp it with your other hand, and thrust inward and upward forcefully. Alternatively, you can lean over a firm, fixed object like a chair back or a counter edge and shove your upper abdomen against it to create the necessary force.
Specialized Care for Infants and Toddlers
Infants (less than one year old) require a distinct rescue technique because abdominal thrusts can cause internal injury to their developing organs. The procedure involves alternating between five back blows and five chest thrusts, with the goal of generating pressure to dislodge the object. The infant must be kept in a position where the head is consistently lower than the chest to use gravity’s assistance.
To begin, sit and place the infant face-down along your forearm, resting your arm on your thigh for support. Use your hand to support the infant’s head and neck, keeping the jaw steady. Deliver five gentle but firm back blows with the heel of your hand between the shoulder blades.
If the obstruction is not cleared, turn the infant face-up onto your other forearm, keeping the head lower than the rest of the body. Place two fingers in the center of the chest, just below the nipple line. Deliver five quick chest thrusts, pushing down about one and a half inches. Repeat the cycle of back blows and chest thrusts until the infant begins to cough or cry.
What to Do If the Victim Becomes Unresponsive
If a conscious choking victim loses consciousness during the rescue attempts, the priority shifts immediately to modified cardiopulmonary resuscitation (CPR). Gently lower the victim onto a firm, flat surface on their back. If you have not already done so, call emergency services immediately.
Begin chest compressions, following the standard rate of 30 compressions. After the first set, open the victim’s mouth to check for the foreign object. If you can clearly see the object and easily sweep it out, remove it; however, do not perform a blind finger sweep, as this may push the object deeper.
Attempt two rescue breaths after checking the mouth. If the chest does not rise with the first breath, reposition the head and try the second breath. If both breaths fail, continue the cycle of 30 compressions, checking the mouth, and attempting two breaths until the object is dislodged, the victim recovers, or professional help arrives.