The scenario of a person who was choking suddenly becoming unresponsive represents an immediate, life-threatening emergency. At this point, the victim is no longer able to cough, speak, or breathe, and standard conscious choking interventions like abdominal thrusts are no longer applicable. The collapse signals a transition from a conscious foreign body airway obstruction to a situation requiring full cardiopulmonary resuscitation (CPR) with a specific modification. This emergency requires a seamless shift in rescue technique to incorporate an airway clearing maneuver into the standard CPR sequence, aiming to dislodge the obstruction. The primary goal becomes simultaneously circulating oxygenated blood and attempting to remove the blockage.
Review of Standard Cardiopulmonary Resuscitation
Standard CPR is the foundational procedure that must be initiated without delay once the victim is lowered safely to the ground. The process begins with chest compressions, which are prioritized over rescue breaths in the initial sequence for the adult victim. High-quality compressions are delivered in a cycle of thirty, forming the mechanical force that helps circulate blood and may also generate enough pressure to move the lodged foreign body.
These compressions should be performed rapidly, at a rate of 100 to 120 compressions every minute, and forcefully. The compression depth for an adult must be at least two inches, but should not exceed 2.4 inches (six centimeters). Allowing the chest to fully recoil between each compression is equally important, as this permits the heart to adequately refill with blood. Minimizing interruptions to chest compressions is also a significant factor in maximizing effectiveness.
Following the thirty compressions, the rescuer must attempt to open the victim’s airway using the head-tilt, chin-lift maneuver. This step precedes the delivery of two rescue breaths, completing the standard 30:2 compression-to-ventilation ratio. For the victim with a suspected foreign body airway obstruction, this point is where the necessary modification takes place. The mechanical action of the chest compressions is thought to increase pressure in the chest cavity, potentially moving the obstruction up into a position where it can be seen and removed.
Integrating the Foreign Body Check into CPR
The modification integrated into the CPR sequence for a choking victim occurs during the attempted rescue breathing phase, specifically after the thirty chest compressions are completed. Before attempting to deliver the two rescue breaths, the rescuer must first perform a quick, deliberate check of the victim’s mouth and throat. This check is performed by opening the airway with the head-tilt, chin-lift technique and actively looking inside the oral cavity for the foreign object.
If a solid object is clearly visible and can be easily reached, the rescuer should attempt to remove it using a finger sweep. This action must be precise and only performed on an object that is undeniably within sight and grasp. This procedure is modified from standard CPR because the primary problem is a mechanical blockage preventing air from entering the lungs.
The rescuer must never perform a blind finger sweep. Sweeping blindly risks pushing the foreign body further down the throat, potentially wedging it more securely into the larynx or trachea. If no object is seen, or if the visible object cannot be easily retrieved, the rescuer must proceed immediately to the attempt at rescue breaths. This modified check is repeated every time the airway is opened for ventilation throughout the rescue effort.
Resumption and Completion of the Rescue Sequence
After the foreign body check is performed, and any visible object is removed, the rescuer attempts to deliver two rescue breaths while observing for visible chest rise. If the chest rises with the first breath, the rescuer delivers the second breath and then immediately returns to the cycle of thirty chest compressions. If the chest does not rise, the rescuer should reposition the victim’s head and attempt the breath a second time, as an improperly opened airway is a common reason for unsuccessful ventilation.
If both attempted rescue breaths do not result in a visible chest rise, the rescuer must assume the obstruction remains in place and immediately return to the chest compressions. The compressions are the most effective maneuver at this stage for generating pressure to dislodge the object. The rescuer must continue the cyclical pattern of thirty compressions, followed by the foreign body check, and then the two attempted rescue breaths.
This entire sequence must be continued without interruption until one of three outcomes occurs: the foreign object is successfully cleared and the victim begins to breathe effectively, the victim shows signs of revival and responsiveness, or trained emergency medical services personnel arrive to take over the resuscitation effort. If the victim becomes responsive and is breathing normally, they should be placed into a recovery position while awaiting medical assessment. The continuous repetition of the modified CPR cycle provides the best chance of survival.