A blocked airway from choking is a life-threatening medical emergency requiring immediate and decisive action. When an object lodges in the throat, it prevents oxygen from reaching the lungs, and brain damage can begin in as little as four to six minutes without intervention. If you are with a choking victim, your primary response must be to delegate a bystander to call 911 or the local emergency number immediately. If you are alone, you should begin the rescue procedure first, especially for an adult, and then call for help as soon as possible. The goal of any rescue technique is to generate a sudden, forceful pressure in the lungs to expel the obstruction, using the air already trapped below the blockage.
Identifying the Need for Intervention
Recognizing the signs of a blocked airway is the first step in providing aid, and it requires distinguishing between a partial and a complete obstruction. A person experiencing a partial airway obstruction can still move air, which is often indicated by a forceful, effective cough, wheezing, or the ability to speak. In this scenario, intervention is generally limited to encouraging the person to keep coughing, as their own body is attempting to clear the airway. A partial blockage is only cause for concern if the cough becomes weak or silent, signaling a transition to a complete obstruction.
A complete airway obstruction means the person cannot breathe, speak, or cough effectively. Signs include the universal distress signal—clutching the throat with one or both hands—a panicked appearance, and high-pitched sounds or no sound at all when attempting to breathe. As oxygen levels drop, the skin, lips, or nail beds may begin to turn blue or pale. If the person cannot force a cough, you must begin rescue procedures immediately to prevent unconsciousness.
Standard Procedure: Abdominal Thrusts
The standard procedure for a conscious, choking adult or older child involves a combination of back blows and abdominal thrusts. Begin by positioning yourself slightly to the side of the victim and having them lean forward at the waist. Deliver five firm blows with the heel of your hand between the person’s shoulder blades, pausing between each one to see if the obstruction has cleared.
If the back blows are unsuccessful, transition immediately to five abdominal thrusts. Stand directly behind the person and wrap your arms around their waist, placing one foot between their feet for stability. Locate the spot just above the navel and well below the breastbone, and make a fist with one hand. Place the thumb-side of your fist against the person’s abdomen.
Grasp your fist with your other hand, ensuring your elbows are out and away from the person’s ribs. Deliver five quick, forceful thrusts in an inward and upward direction, aiming to compress the diaphragm and force air from the lungs. Continue alternating the cycle of five back blows and five abdominal thrusts until the object is expelled or the person loses consciousness.
Specialized Rescue Techniques
Infants
For infants under one year old, abdominal thrusts are avoided due to the risk of damaging internal organs. Instead, the conscious infant is given a sequence of five back blows followed by five chest thrusts. Place the baby face-down along your forearm, supporting their head and neck with their head lower than their chest. Deliver five quick, firm back blows between the shoulder blades using the heel of your hand. If the object is not cleared, turn the infant face-up on your other forearm, keeping the head low. Use two fingers to deliver five quick chest thrusts to the center of the chest, just below the nipple line, repeating the cycle until the baby coughs or cries.
Pregnant or Large Individuals
For individuals who are pregnant or too large for you to wrap your arms fully around their abdomen, chest thrusts are used instead of abdominal thrusts. Stand behind the person and place your arms under their armpits, wrapping them around the chest. Place the thumb-side of your fist against the center of the breastbone, just above the lower tip. Grasp the fist with your other hand and deliver five firm, quick inward thrusts.
Self-Rescue
If you are alone and choking, place your fist, thumb-side in, against your abdomen just above the navel and below the rib cage. Grasp your fist with your other hand and press your fist forcibly into your upper abdomen with a quick inward and upward movement. An alternative method involves leaning over a firm surface, such as the back of a chair, a railing, or a countertop. Position the upper abdomen against the edge and forcefully thrust your body down and inward onto the object.
Managing an Unconscious Choking Victim
If the choking victim becomes unresponsive, the procedure changes immediately. Gently lower the person to the floor, ensuring they are lying flat on their back on a firm surface. If another person is present, instruct them to call 911 immediately. The next step is to begin cardiopulmonary resuscitation, starting with 30 chest compressions at a rate of 100 to 120 per minute in the center of the chest.
After the compressions, open the person’s mouth and look for the foreign object. If you can clearly see the object and it is easily accessible, attempt to remove it. Never perform a blind finger sweep, as this risks pushing the object deeper into the airway.
Attempt to give two rescue breaths, repositioning the head and chin if the chest does not rise. If the breaths are unsuccessful, immediately resume chest compressions, repeating the cycle of 30 compressions, checking the mouth, and giving two breaths.
Even after the object is dislodged and the person is breathing, they should seek medical attention. A medical evaluation is necessary to check for potential internal injuries, such as bruised ribs or damage to the throat or abdomen resulting from the forceful thrusts.