The sudden loss of consciousness in an adult who was actively choking represents a severe medical emergency requiring immediate and decisive action. A foreign body airway obstruction (FBAO) prevents oxygen from reaching the brain and vital organs when the person is unable to cough, speak, or breathe. This lack of oxygen rapidly leads to unresponsiveness and, without intervention, cardiac arrest. The immediate goal of rescue is to dislodge the obstruction, restore the flow of air, and maintain circulation until professional medical help arrives. The protocol transitions from conscious choking maneuvers to a modified version of cardiopulmonary resuscitation (CPR). This sequence uses the force of chest compressions to create an artificial cough, which may expel the lodged object.
Activating Emergency Services and Initial Assessment
The response begins by confirming unresponsiveness. Gently tap the person’s shoulder and shout, “Are you okay?” If the victim does not respond, ensure that emergency medical services (EMS) are immediately activated. If you are alone, call 911 or your local emergency number before starting any physical intervention.
If a bystander is present, direct them to make the call and simultaneously ask them to locate and retrieve an Automated External Defibrillator (AED) if one is nearby. Before approaching, quickly scan the immediate environment for any obvious safety hazards. Once the scene is safe, lay the person flat on their back on a firm, level surface. This initial assessment and activation phase must be completed before the physical resuscitation sequence begins.
The Primary Sequence: Modified Cardiopulmonary Resuscitation
Once the person is lying flat and EMS has been activated, the intervention shifts to the modified CPR sequence, which starts with chest compressions rather than breaths. The goal of the compressions is to increase the pressure within the chest cavity, effectively pushing the lodged object out of the airway. Position yourself directly over the victim’s chest, placing the heel of one hand on the center of the chest, specifically on the lower half of the breastbone, and placing the other hand on top.
You must deliver 30 high-quality chest compressions at a rate of 100 to 120 compressions per minute. Push down approximately two inches deep into the adult’s chest. This force creates the necessary surge of air pressure to potentially move the foreign body. After completing the 30 compressions, the focus shifts to the airway and breathing components of the sequence.
The next step is to attempt to clear the airway and provide rescue breaths. Open the person’s mouth using the head-tilt/chin-lift maneuver. This involves tilting the head back slightly and lifting the chin to move the tongue away from the back of the throat. This action is performed to maximize the visibility of the throat.
Once the airway is open, look inside the person’s mouth to see if the object is now visible. If you can clearly see the foreign object, attempt to remove it using a finger sweep. It is important not to attempt a blind finger sweep, as this can inadvertently push the object further down the airway, worsening the obstruction.
If no object is seen or removed, attempt to give one rescue breath while maintaining the head-tilt/chin-lift. Pinch the person’s nose closed and create a tight seal over their mouth with your own. Deliver a breath that should make the chest rise over one second. If the chest does not rise, reposition the head and attempt a second rescue breath.
If both attempts at rescue breaths fail, immediately return to the chest compressions. The sequence then becomes a continuous cycle of 30 compressions followed by checking the mouth for a visible object and attempting up to two rescue breaths. This cycle is performed continuously without interruption until the object is successfully removed, the person begins to breathe or cough forcefully, or professional help arrives to take over. Every time you complete the 30 compressions, look for the expelled object before attempting the breaths. Discontinue the cycle only when the obstruction is cleared or when a professional rescuer takes charge.
Post-Intervention Care and Recovery Position
After the foreign body has been dislodged and the person is breathing adequately, or if the individual remains unconscious but is breathing normally, move them into the recovery position. This specific lateral, or side-lying, posture that helps maintain an open airway without requiring the rescuer to hold the head. Placing the person on their side prevents the tongue from falling back and blocking the airway.
The recovery position also allows any fluids, such as vomit or blood, to drain out of the mouth, reducing the risk of aspiration into the lungs. While supporting the head and neck, gently roll the person onto their side. Ensure the mouth is angled downward and the head is slightly tilted back to keep the airway open. The person’s limbs are positioned to provide stability.
Continuous monitoring of breathing and responsiveness is necessary until the EMS team arrives. If the person’s breathing stops or becomes irregular, immediately roll them back onto their back and restart the modified CPR sequence. Upon the arrival of professional responders, relay clear and concise information, including what the person was choking on and the exact steps taken during the modified CPR.