When a person loses consciousness, the muscles controlling the airway relax, which can allow the tongue to fall back and block the passage of air. If this unresponsive person vomits, an immediate danger arises because protective reflexes, like coughing and swallowing, are compromised. The primary risk is aspiration, which occurs when vomit is drawn into the lungs. This can lead to choking, chemical burns from stomach acid, and potentially fatal lung infections like aspiration pneumonia. Prompt intervention is required to clear the airway and prevent this material from entering the respiratory system.
The Critical First Step: Positioning the Person
The most immediate action is to move the person onto their side, utilizing gravity to help drain the vomit away from the airway. This technique, known as the recovery position, should be initiated instantly upon recognizing that the person is unresponsive and has vomited. To begin, kneel beside the person and ensure their legs are straight.
Position their limbs to facilitate the roll. Take the arm nearest to you and place it at a right angle to their body, with the elbow bent and the palm facing upward. Then, bring the arm farthest from you across their chest and hold the back of that hand against the cheek closest to you, which supports the head during the turn.
Bend the person’s far leg at the knee, lifting the foot slightly off the ground. While keeping the hand pressed against the cheek, gently pull on the bent knee to roll the person toward you onto their side. The bent knee acts as a prop to maintain stability, preventing them from rolling back.
Once the person is on their side, adjust the upper leg so the hip and knee are bent at right angles. The head must be tilted slightly back and the face angled downward to keep the airway open and allow fluids to drain freely from the mouth. Even if a spinal injury is suspected, maintaining an open airway takes precedence.
Techniques for Clearing the Airway
After the person is safely positioned on their side, quickly check the mouth and throat to ensure the airway is clear of any solid or thick material. The recovery position addresses fluid drainage, but larger pieces of vomitus may still obstruct the back of the throat. If you observe any visible solid material within the mouth, you may attempt a finger sweep to remove it.
To perform this action, wrap a clean piece of cloth or gauze around your index and middle fingers to create a barrier. Use the two-fingered sweep method to carefully enter the mouth and clear the material, using a hooking motion toward the cheek. You must only perform a finger sweep if the material is clearly visible and within reach.
Never blindly insert your fingers deep into the throat, as this risks pushing the obstruction further down into the airway, worsening the blockage. If the material is not visible, the positioning on the side, combined with the head tilt, will often be sufficient to allow gravity to move the obstruction.
The moment you have cleared the mouth and confirmed the person is on their side, immediately check for normal breathing. Listen closely for breath sounds, look for the rise and fall of the chest, and feel for air movement on your cheek. If the person is breathing, maintain the recovery position and prepare for the next steps of emergency response.
Post-Incident Monitoring and Emergency Response
The first step after clearing the airway and positioning the person is to immediately call emergency medical services by dialing 911 or your local equivalent. When relaying information to the dispatcher, you must clearly state that the person is unresponsive and has vomited, providing a precise location and a description of their current breathing status. This information is vital for the emergency team to prepare for the specific complications associated with aspiration.
After making the call, do not leave the person alone and continue to monitor their condition closely until professional help arrives. Maintain the recovery position, as this remains the safest orientation for an unconscious person to prevent further aspiration. You should regularly check for changes in their breathing rate, looking for signs of distress such as shallow or labored breathing.
Keep a watchful eye on the person’s skin color, particularly around the lips and nail beds. A bluish or grayish tint, known as cyanosis, indicates poor oxygenation and is a serious sign of respiratory compromise. Aspiration can cause immediate symptoms like coughing, wheezing, or difficulty breathing, or it may lead to complications hours or days later.
Aspiration pneumonia is a lung infection that can develop from the acidic content and bacteria in the vomit entering the lungs. Even if the person wakes up and seems fine, the risk of aspiration pneumonia remains a serious concern due to the inhalation of gastric contents.
Signs of this complication can include fever, persistent coughing, chest pain, and shortness of breath, which may not appear for up to 72 hours after the initial event. Because of this delayed risk, a thorough evaluation at a hospital is mandatory, even if the person appears fully recovered, to assess for lung injury and preemptively manage potential infection.