When an individual experiences a severe choking incident, their airway becomes completely blocked, preventing air from reaching their lungs. If this obstruction is not cleared quickly, the person may lose consciousness and become unresponsive due to a lack of oxygen. This situation represents a medical emergency, demanding immediate and informed intervention to restore breathing and blood circulation. Understanding the appropriate sequence of actions in such a time-sensitive scenario can improve the outcome for the choking person.
Immediate Actions Upon Unresponsiveness
Upon recognizing that a choking person has become unresponsive, the first step involves carefully lowering them to a firm, flat surface, such as the ground. This provides a stable base for subsequent life-saving interventions. Simultaneously, it is important to activate the emergency medical system by calling 911 or the local emergency number, or by directing someone nearby to make the call. This ensures professional medical assistance is en route.
After positioning the person, the next action is to open their airway using the head-tilt, chin-lift maneuver. This involves gently tilting the head back while lifting the chin, which helps to move the tongue away from the back of the throat. Once the airway is open, visually check inside the mouth for the obstructing object. Only attempt to remove the object if it is clearly visible and can be easily grasped, avoiding blind finger sweeps that could push the object further down the airway.
Administering CPR for Choking
Once the airway is assessed and any visible obstruction is addressed, if the person remains unresponsive and not breathing, initiate cardiopulmonary resuscitation (CPR). Begin with chest compressions, positioning the heel of one hand on the lower half of the person’s breastbone, with the other hand placed on top. For adults, compress the chest at least 2 inches (approximately 5 centimeters) deep, but no more than 2.4 inches (6 cm). For children, compress about 2 inches (5 cm) or one-third the depth of the chest. For infants, compress about 1.5 inches (approximately 4 centimeters) deep, using two fingers or the encircling thumbs technique.
Deliver compressions at a rate of 100 to 120 compressions per minute, ensuring full chest recoil between each compression. After 30 compressions, open the airway again using the head-tilt, chin-lift maneuver. Look inside the mouth for the object; if it is now visible and can be easily swept out, remove it carefully. If no object is seen, or if it cannot be easily removed, attempt two rescue breaths.
To deliver rescue breaths, pinch the person’s nose closed and create a seal over their mouth with yours. Deliver a breath lasting about one second, observing for chest rise. If the chest does not rise, reposition the head and attempt a second breath. If both breaths are unsuccessful in causing the chest to rise, this suggests the airway remains obstructed. Do not spend excessive time attempting breaths if they are ineffective; instead, return to chest compressions.
Continue cycles of 30 chest compressions followed by an airway check and two rescue breaths. Each time the airway is opened, quickly look for the obstructing object. If the object becomes visible and can be safely removed, do so before attempting breaths. The goal is to dislodge the foreign body and restore effective breathing.
Ongoing Management and When to Conclude
Continue performing CPR cycles without interruption until the person shows signs of responsiveness, such as coughing, breathing, or moving. If the object becomes dislodged and the person begins breathing effectively on their own, place them in a recovery position. This involves turning the person onto their side, which helps keep the airway open and prevents aspiration if they vomit. Even if the person appears to recover fully, medical evaluation is important to assess for any potential complications from the choking episode or CPR.
CPR should also continue until trained medical professionals, such as paramedics, arrive and take over care. Once these professionals are on scene, clearly communicate the situation and the actions already taken. In rare circumstances, if the rescuer becomes physically exhausted and can no longer continue effective chest compressions, or if the scene becomes unsafe, ceasing CPR may be necessary. However, the primary focus remains on sustaining life support until professional help assumes responsibility or the obstruction is cleared and spontaneous breathing resumes.