The sudden loss of consciousness in a person who was actively choking represents an immediate medical emergency. This event signifies that the obstruction has caused a severe lack of oxygen, leading to unresponsiveness. The rescue protocol must immediately shift from conscious choking efforts, such as abdominal thrusts, to a modified form of cardiopulmonary resuscitation (CPR). Swift action is paramount, as brain cells begin to die from oxygen deprivation within minutes. The goal is to dislodge the foreign object while providing oxygenation and circulation until professional help arrives.
Activating Emergency Services and Safe Positioning
The very first action upon realizing a choking person has become unconscious is to activate the emergency medical services (EMS). If you are alone, immediately call 911 or your local emergency number before beginning any physical intervention. If a bystander is present, direct them precisely to call for help and, if possible, to locate an automated external defibrillator (AED) while you prepare to start care.
The next immediate step is to safely lower the person to a hard, flat surface like the floor, taking care to support their head and neck to prevent additional injury. Confirming unresponsiveness is then necessary; gently tap the person and shout to see if they respond. Once positioned on their back, the hard surface is required to allow for effective chest compressions, which will become the primary tool for rescue.
This change in consciousness marks the point where standard choking maneuvers cease and the life support sequence begins. Safe positioning provides a stable base for the rescuer’s efforts and ensures the person’s airway is ready for assessment. This preparation must be completed quickly to minimize any delay before starting active rescue steps.
Airway Checks and Rescue Breathing
After positioning the unconscious person, the rescue sequence begins with an attempt to open the airway and provide rescue breaths. Use the head-tilt/chin-lift maneuver by placing one hand on the forehead and gently tilting the head back while lifting the chin with the fingers of the other hand. This action moves the tongue away from the back of the throat, which is a common cause of airway blockage in an unconscious person.
Before attempting to deliver a breath, quickly look inside the mouth to check for the foreign object. If the object is clearly visible and easily accessible, you may attempt to remove it with a finger sweep. Never perform a blind finger sweep, as this risks pushing the obstruction deeper into the airway.
After the check, deliver one rescue breath, which should last about one second and cause the chest to visibly rise. If the chest does not rise, the obstruction is still present; immediately reposition the head and try a second rescue breath. If the second breath is also unsuccessful, do not attempt further breaths and immediately proceed to chest compressions.
Chest Compressions and Foreign Body Removal
When rescue breaths fail to enter the lungs, the focus shifts to chest compressions. These compressions are modified from standard CPR to serve as a method for dislodging the foreign object. The mechanical force increases pressure within the chest cavity, acting as a forceful, artificial cough to expel the item. High-quality compressions are delivered by placing the heel of one hand in the center of the chest, on the lower half of the breastbone, with the other hand placed on top.
The compressions must be delivered at a rate between 100 and 120 times per minute, reaching a depth of 2 to 2.4 inches (5 to 6 centimeters) for an adult. It is important to allow the chest to fully recoil after each compression. This recoil ensures the maximum change in chest pressure is achieved, creating the necessary force to move the object.
The cycle of modified CPR for an unconscious choking victim follows a 30:2 ratio: 30 chest compressions followed by two rescue breath attempts. Before each set of rescue breaths, quickly open the mouth and look for the object again. If the foreign object is seen, remove it immediately with your fingers.
If the object is not seen, continue with the two rescue breath attempts, repositioning the head if the first attempt fails. The 30 compressions and two breaths cycle must be continuous until the foreign object is cleared and the chest rises, the person begins breathing normally, or EMS personnel arrive. Compressions are the most effective means of generating the force required to relieve the obstruction.
Post-Rescue Care and Handover
Once the foreign object is successfully dislodged and you are able to deliver rescue breaths that make the chest rise, or if the person begins to breathe normally, the immediate life-threatening crisis is over. If the person remains unconscious but is breathing effectively, they should be placed into the recovery position. This involves carefully rolling the person onto their side, which helps keep the airway open and allows any fluids to drain from the mouth.
Continuous monitoring of the person’s breathing and responsiveness is required until emergency medical services arrive. Even if the person regains full consciousness, they must seek medical attention. Forceful maneuvers used to clear the airway can cause secondary complications, such as soft tissue injury to the throat, bruising, or broken ribs.
When EMS personnel arrive, provide a concise account of the events. Include what the person was doing before choking, the nature of the object if known, the duration of unresponsiveness, and the exact steps taken during the rescue. This handover is important for the medical team to continue appropriate care. Do not stop continuous CPR until a medical professional takes over responsibility.