A true choking emergency is a life-threatening event caused by a complete or severe blockage of the airway. If someone is choking, call 911 or your local emergency number immediately. Lack of oxygen can cause irreversible brain damage in as little as four to six minutes, making prompt activation of Emergency Medical Services (EMS) a priority. Professional medical help must be on the way while first aid maneuvers are underway.
Immediate Assessment and the Decision to Call
The first step is determining the severity of the airway obstruction. If the person can cough forcefully, speak, or make sounds, they have a partial obstruction. Encourage them to keep coughing to dislodge the object naturally, as physical intervention may push the object further down.
If the victim cannot speak, cough, or breathe, or if their cough is weak, this signifies a complete airway obstruction. The person may display the universal distress signal by clutching their throat, and their skin may turn blue or gray from lack of oxygen. Simultaneously initiate first aid relief and ensure 911 is called. If another person is present, one should call for help while the other begins the relief sequence.
When speaking with the 911 operator, clearly state your exact location, the nature of the emergency, and the victim’s current status. The dispatcher will provide guidance and ensure paramedics are dispatched immediately. Do not hang up until the dispatcher tells you to, as they will continue to offer instructions until help arrives.
Step-by-Step Choking Relief for Conscious Adults
The standard sequence for relieving choking in a conscious adult involves alternating between five back blows and five abdominal thrusts (the Heimlich maneuver). Position yourself slightly to the side and behind the victim, using one arm across their chest for support. Lean the person forward so that gravity assists in expelling the foreign object.
Deliver five firm back blows with the heel of your hand to the area between the person’s shoulder blades. Immediately transition to five abdominal thrusts. Stand directly behind the person and wrap your arms around their waist. Place a clenched fist just above the navel and below the breastbone, covering your fist with your other hand.
Execute five quick, inward and upward thrusts to create a surge of pressure that may force the object out. Continue alternating the sequence of five back blows and five abdominal thrusts until the obstruction is cleared, the person can breathe or cough forcefully, or the victim loses consciousness.
Specialized Protocols for Infants and Unconscious Victims
The technique for clearing an airway obstruction varies for infants under one year of age, as abdominal thrusts are not safe. For a conscious, choking infant, deliver a cycle of five back blows followed by five chest thrusts. Hold the infant face-down along your forearm, resting your arm on your thigh, with the baby’s head lower than their chest.
Deliver five gentle but firm back blows between the shoulder blades using the heel of your hand. Next, turn the infant face-up on your thigh, supporting the head and neck, ensuring the head remains lower than the chest. Administer five quick chest thrusts using two fingers placed in the center of the chest, compressing the chest about 1.5 inches deep. Repeat this cycle until the object is expelled or the infant becomes unresponsive.
If any victim becomes unconscious, immediately lower them gently to the floor and begin Cardiopulmonary Resuscitation (CPR), starting with chest compressions. Before attempting rescue breaths, open the victim’s mouth and look for the foreign object. If the object is clearly visible and easily accessible, attempt to remove it with a finger sweep. Never perform a blind finger sweep, as this risks pushing the object deeper. For pregnant individuals or those with significant abdominal obesity, use chest thrusts instead of abdominal thrusts.
The Necessity of Medical Follow-up
Even if the choking victim successfully dislodges the foreign object and appears to be breathing normally, medical follow-up is required. The intense pressure exerted during abdominal or chest thrusts can lead to internal injuries that are not immediately apparent. Potential complications include fractured ribs, contusions to internal organs (like the liver and spleen), or trauma to the larynx and airway.
A medical professional needs to assess the victim to rule out internal bleeding or damage caused by the maneuvers. If the victim temporarily lost consciousness or the object was only partially cleared, there is a risk of aspiration. Aspiration occurs when debris or fluid enters the lungs and can lead to serious respiratory complications, including pneumonia, requiring prompt medical evaluation.