An unresponsive choking incident is a medical emergency where a blocked airway prevents oxygen from reaching the lungs. This scenario demands an immediate, coordinated response that integrates cardiopulmonary resuscitation (CPR) with a specific procedural adjustment to address the foreign body obstruction. The goal is to clear the airway blockage and ensure the delivery of oxygen through effective rescue breaths. This combined approach offers the best chance of survival until professional medical help arrives.
Recognizing the Need for CPR in a Choking Victim
A choking victim who was conscious and receiving abdominal thrusts or back blows may suddenly lose consciousness, signaling a significant shift in the rescue protocol. The moment the person collapses or is unresponsive, standard choking first aid must transition immediately to modified CPR. The victim should be lowered gently to a firm, flat surface, and emergency medical services must be called without delay.
The priority action is to begin chest compressions. These forceful movements generate enough pressure in the chest cavity to potentially dislodge the foreign object. Compressions are performed at a rate of 100 to 120 per minute, pressing down about two inches into the center of the chest. This action attempts to clear the obstruction and maintains blood circulation to the brain and vital organs. Compressions should be initiated without pausing to attempt rescue breaths first.
The Critical Modification: Checking the Airway
The most significant procedural change when performing CPR on an unresponsive choking victim occurs before attempting rescue breaths. After completing 30 chest compressions, the rescuer must perform an airway check by opening the victim’s mouth and looking inside for the obstructing object. This visual inspection is performed quickly by using the head-tilt/chin-lift maneuver to provide a clear view of the throat.
Removing the Obstruction
The rescuer must only attempt to remove the foreign object if it is clearly visible and within easy reach. If a solid object is seen, a finger can be used in a sweeping motion to carefully scoop it out of the mouth. It is crucial to avoid a blind finger sweep, which involves inserting a finger into the mouth without being able to see the object. Blindly probing the throat risks pushing the obstruction further down the airway, which can worsen the blockage. If no object is seen, or if the visible object cannot be easily reached, no attempt at removal should be made at this stage.
Continuing the Modified Resuscitation Sequence
After the visual check of the mouth, the rescuer attempts to deliver two rescue breaths, using the standard head-tilt/chin-lift technique to open the airway. If the first breath does not cause the chest to visibly rise, the rescuer must immediately reposition the head and attempt the second breath. Failure of the chest to rise after the second attempt confirms that the airway remains blocked.
The continuous cycle then reverts to 30 compressions, followed by the modified sequence of checking the airway and giving two breaths. This 30:2 ratio is maintained, with the critical step of visually checking the mouth for the object inserted between the compressions and the breaths every time. High-quality compressions must continue with minimal interruption to maintain blood flow, even if the rescue breaths remain ineffective.
The entire sequence is repeated until the foreign object is successfully expelled, the victim begins to breathe or move, or trained medical personnel arrive to take over. The mechanical force of the compressions is intended to increase pressure in the chest, acting as an artificial cough to relieve the obstruction. The periodic visual check ensures that an object dislodged by the compressions is not pushed back down by a subsequent rescue breath.