When a person actively choking on a foreign object becomes unresponsive, it signals a medical emergency. Loss of consciousness means the body’s natural defenses have failed to clear the airway obstruction, critically blocking oxygen flow. Because the underlying cause is a mechanical blockage, the standard Cardiopulmonary Resuscitation (CPR) sequence must be modified. This modified protocol addresses the obstruction while maintaining circulation, using chest compressions as a tool for both blood flow and potential foreign body expulsion. Immediate action is necessary to prevent cardiac arrest, as lack of oxygen can cause irreversible damage quickly.
Transition to Emergency CPR Protocol
When a conscious choking victim collapses, the focus shifts immediately from abdominal thrusts to chest compressions. The rescuer must gently lower the person to a firm, flat surface and activate the emergency medical system. The priority then shifts to initiating CPR, starting with chest compressions rather than attempting initial rescue breaths.
Standard CPR aims to circulate oxygenated blood, but here, compressions also generate a pressure change within the chest cavity. This increase in intrathoracic pressure can act as an artificial cough, potentially dislodging the foreign body. The rescuer performs 30 compressions at the center of the chest, pushing hard and fast at a rate between 100 and 120 per minute. This initial focus on compressions, before any attempt to breathe, is the first distinction from the usual protocol.
Compressions are performed at a depth of about two inches for an adult, creating the necessary force to maintain blood flow and potentially move the obstruction. The initial ventilation attempt is skipped because the airway is known to be blocked, making rescue breaths ineffective until the object is moved. This immediate mechanical action maximizes the chances of clearing the airway while circulating limited oxygen remaining in the bloodstream.
The Critical Airway Check Modification
The primary modification for an unresponsive choking victim occurs during the ventilation phase of the cycle. After completing the initial 30 chest compressions, the rescuer must perform a visual check of the mouth and throat before attempting rescue breaths. This step deliberately interrupts the standard sequence, replacing the routine immediate delivery of two breaths.
To perform the check, the rescuer opens the victim’s mouth to look for a visible foreign object. If the object is clearly seen and easily reachable, the rescuer may attempt removal with a finger sweep. The rescuer must only perform a finger sweep if the object is visible, avoiding a “blind finger sweep.” A blind sweep risks pushing the obstruction further down the airway, cementing the blockage.
If no object is seen or easily grasped, the rescuer should proceed directly to attempting rescue breaths. This visual inspection after every set of compressions is the specific modification distinguishing this emergency from non-choking CPR. The rescue breath is attempted using the head-tilt, chin-lift maneuver. If the chest does not rise, the rescuer knows the blockage remains, prompting an immediate return to compressions.
Continuous Cycle Management and Post-Obstruction Care
The emergency procedure continues in a constant, modified cycle of 30 compressions, a visual airway check, and two attempted rescue breaths. If the first rescue breath fails, the rescuer must quickly reposition the head and attempt the second breath. If the second breath also fails, the rescuer immediately returns to chest compressions. The priority remains circulating blood and generating force to dislodge the object.
The cycle continues until the foreign body is cleared, emergency medical services arrive, or the victim shows definitive signs of life. If the obstruction is successfully removed, indicated by the chest rising with rescue breaths, the rescuer must not stop care if the victim remains unresponsive. The protocol then shifts to standard CPR, maintaining the 30:2 ratio until professional help takes over.
Even if the foreign body is cleared and the victim regains consciousness, immediate professional medical evaluation is necessary. The force of chest compressions can cause injury to the ribs or internal organs. Furthermore, the choking incident may have caused complications like aspiration pneumonia. A medical professional needs to assess the victim for internal trauma and ensure no fragments of the foreign object remain in the lungs or airway.