A complete obstruction of the airway, known as choking, is a life-threatening emergency that demands immediate action to restore breathing. While the standard response involves abdominal thrusts, this technique becomes impractical or unsafe when the victim has a body type that prevents the rescuer from reaching around their abdomen effectively. Understanding how to adapt the rescue technique for a larger individual is a preparedness measure that can save a life when the standard procedure fails.
Recognizing a True Choking Emergency
A person experiencing a partial airway obstruction can usually produce a strong cough or speak, indicating that air is still passing the blockage. In this situation, encourage the victim to continue coughing forcefully, as their own efforts may dislodge the object. A complete obstruction is signaled by the universal sign of distress, where the person instinctively clutches their throat with one or both hands. The inability to speak, breathe, or make any sound confirms the need for immediate physical intervention. Skin color may begin to turn blue or gray due to the lack of oxygen, which is a late-stage indicator of a severe problem.
The Limitations of Abdominal Thrusts
The standard intervention for a conscious choking adult is the abdominal thrust. This technique generates a sudden, forceful expulsion of air from the lungs, which is intended to push the foreign object out of the trachea. The force is applied by wrapping the arms around the victim’s waist, placing a fist just above the navel, and administering rapid inward and upward thrusts. This maneuver is highly effective in many situations, but its practicality is compromised by certain physical characteristics.
The technique cannot be performed effectively on a person who is significantly larger than the rescuer because the rescuer may be unable to wrap their arms around the torso to achieve proper hand placement and leverage. Furthermore, the standard abdominal thrust is specifically contraindicated for women in the late stages of pregnancy. Applying forceful pressure to the abdomen in these cases could cause serious injury to the fetus. These limitations necessitate the use of an alternative technique that targets a different part of the body.
Executing Chest Thrusts on a Large Victim
When abdominal thrusts are impossible due to the victim’s large size or a late-stage pregnancy, the procedure must be modified to use chest thrusts. This technique leverages the same principle of suddenly increasing air pressure within the chest cavity to dislodge the obstruction, but it redirects the force away from the abdomen. To begin, position yourself behind the victim, just as you would for abdominal thrusts. Wrap your arms around the person’s chest, positioning them directly over the breastbone, or sternum.
Proper hand placement involves making a fist with one hand and grasping it with the other, then placing the thumb side of the fist onto the middle of the sternum. This location is centered between the nipples, slightly below the collarbones. The thrusts must be sharp, quick compressions directed straight back, rather than the upward scoop used in the abdominal maneuver. Repeat these thrusts rapidly and continuously until the object is expelled and the victim can breathe, cough, or speak.
Protocol if the Victim Becomes Unresponsive
If the chest thrusts do not succeed in clearing the airway and the victim loses consciousness, a distinct emergency protocol must be initiated immediately. Support the victim and gently lower them to the floor, ensuring they are lying flat on their back on a firm surface. Immediately, direct someone to call emergency medical services (EMS), or call yourself if alone, putting the phone on speaker. The next step is to begin cardiopulmonary resuscitation (CPR), starting with chest compressions.
Administer thirty compressions, pushing hard and fast in the center of the chest at a rate of 100 to 120 per minute. After the compressions, open the victim’s mouth and look for the object that caused the choking. Only attempt a finger sweep to remove the obstruction if you can clearly see the object; a blind finger sweep risks pushing the object further down the airway. Following the check, attempt two rescue breaths, and if the chest does not rise, continue the cycle of thirty compressions, checking the mouth, and two attempted breaths. Continue this sequence until the obstruction is cleared, EMS arrives, or the victim begins to breathe normally.