Chest thrusts are a modified first-aid technique used to clear a severe airway obstruction when a person is choking. This method is an alternative to standard abdominal thrusts, which are the primary treatment for most conscious adults and children over one year old. The goal is to generate a rapid increase in pressure within the chest cavity and lungs, forcing air out of the windpipe to dislodge the foreign object. This maneuver is reserved for situations where applying pressure to the abdomen would be ineffective, unsafe, or is the standard protocol for a specific age group.
When Standard Abdominal Thrusts Are Not Possible
Chest thrusts are the recommended technique for conscious adults when a physical condition prevents the safe or effective application of abdominal thrusts. Patients in the late stages of pregnancy require chest thrusts, as forceful pressure to the abdomen poses a serious risk of injury to the fetus and the uterus. The rescuer positions their hands on the center of the breastbone, just above the joining of the lowest ribs, instead of placing the fist above the navel. The thrusts are delivered inward, compressing the chest to create the necessary force to expel the object.
Individuals with severe obesity also require chest thrusts, as the rescuer may not be able to effectively wrap their arms around the victim’s abdomen to perform the standard maneuver. The large girth makes it difficult to reach the correct anatomical landmark for abdominal compression. The chest thrust technique involves placing the hands on the sternum, bypassing the abdominal area entirely to achieve the objective.
This method is also indicated for patients with specific lower chest or abdominal injuries, or those with medical devices such as a stoma or colostomy bag that would be damaged by direct pressure. The chest thrust is a modified chest compression, delivered forcefully and rapidly to create a powerful artificial cough. Focusing the force on the sternum maximizes pressure on the lungs while avoiding injury to sensitive or compromised areas of the torso.
Airway Clearance for Infants Under One Year Old
Infants under one year old are a patient population for whom abdominal thrusts are never used due to the risk of damaging their smaller, fragile internal organs. For a conscious, choking infant, the standard procedure is a combination of back blows and chest thrusts. This two-part approach is designed for their unique anatomy.
The first step involves delivering up to five back blows with the heel of the hand. The infant is held face-down along the rescuer’s forearm, ensuring the head is lower than the chest. If the obstruction is not cleared, the infant is turned face-up, still supported with the head lower than the trunk. Chest thrusts are then delivered using two fingers in the center of the chest, just below the nipple line.
Up to five chest thrusts are given, each pushing sharply downward about 1.5 inches deep, with the goal of generating an expulsive force from the lungs. The cycle of five back blows followed by five chest thrusts is repeated until the foreign object is dislodged or the infant becomes unresponsive.
Managing Unconscious Choking Victims
The protocol shifts immediately to chest compressions when a conscious choking victim becomes unresponsive and collapses. Once the patient is lowered to a firm, flat surface, the rescuer must activate emergency medical services and begin modified cardiopulmonary resuscitation (CPR). The chest compressions delivered during CPR act as chest thrusts, forcing air out of the lungs to dislodge the obstruction.
The rescuer performs a cycle of 30 chest compressions, delivered at a rate of 100 to 120 per minute, before opening the victim’s mouth to check for the object. The compression depth for an adult is two to 2.4 inches. If the object is seen and can be easily swept out, it is removed; however, a blind finger sweep is discouraged as it may push the object deeper into the airway.
If the object is not visible or cannot be removed, the rescuer attempts two rescue breaths. If the chest does not rise with the first attempt, the head is repositioned for a second breath. If the second breath fails, the rescuer immediately returns to the cycle of 30 chest compressions. In this unconscious scenario, the chest compression element of CPR serves the dual purpose of circulating blood and creating the pressure needed to clear the airway obstruction.