Choking occurs when a foreign object, most commonly food, becomes lodged in the throat or windpipe, blocking the passage of air. This blockage prevents oxygen from reaching the lungs, which can quickly lead to unconsciousness and brain injury if not addressed immediately. Recognizing the signs is crucial because the person cannot communicate verbally. Identifying the primary physical indicator of a blocked airway allows for a swift, accurate response to dislodge the obstruction and restore breathing.
The Universal Sign and Its Significance
The universal sign of choking is the instinctive gesture of an individual clutching their own throat with one or both hands. This non-verbal signal is recognized globally and serves as the primary means of communication when speech is impossible due to a blocked airway. The gesture is often accompanied by a look of panic or a distressed facial expression. Seeing this sign is an immediate prompt for a bystander to intervene, as it strongly suggests the airway is severely obstructed.
Differentiating Partial Versus Complete Obstruction
The severity of the obstruction dictates the appropriate response. A partial airway obstruction still allows some air to pass, evidenced by the person’s ability to cough forcefully, speak, or make high-pitched, wheezing noises. The person should be encouraged to continue coughing, as their own bodily force is often the most effective way to clear the blockage. Physical intervention should be avoided while the person maintains a strong, effective cough.
A complete obstruction is indicated by the inability to cough, speak, or make any sound at all. The person may also exhibit bluish discoloration around the lips and nail beds, known as cyanosis, signaling a lack of oxygen. The universal sign usually points to this complete blockage, which requires immediate and forceful intervention to expel the object. Without rapid assistance, the person will lose consciousness.
Immediate First Aid Response
For a conscious adult or child over one year old with a complete obstruction, first aid involves a combination of back blows and abdominal thrusts. To administer back blows, stand to the side and slightly behind the person, supporting their chest with one arm while leaning them forward. Deliver five sharp blows with the heel of your hand between the person’s shoulder blades.
If back blows fail, immediately transition to performing abdominal thrusts, also known as the Heimlich maneuver. Stand behind the person and wrap your arms around their waist, placing one foot between their feet for balance. Make a fist with one hand and place the thumb side just above the navel and below the breastbone. Grasp the fist with your other hand and deliver five quick, inward and upward thrusts. This sequence of five back blows followed by five abdominal thrusts should be repeated until the object is expelled, breathing resumes, or the person becomes unresponsive. If the person loses consciousness, they should be lowered to the ground to begin cardiopulmonary resuscitation (CPR).
Addressing Choking in Infants and Small Children
Infants under one year of age require different recognition cues and physical techniques, as they cannot perform the universal sign. Signs of choking include a weak cry or cough, difficulty breathing, or a blue tint to the skin. Abdominal thrusts are never performed on infants due to the risk of internal injury.
The recommended intervention involves a cycle of five back blows and five chest thrusts. For back blows, lay the infant face-down along your forearm, ensuring the head is lower than the chest, and support the head. Deliver five firm blows between the shoulder blades with the heel of your free hand. If the object remains, turn the infant face-up, supporting the head, and use two fingers to give five quick chest thrusts on the breastbone, just below the nipple line. This cycle is repeated until the airway is clear.