Choking is a life-threatening emergency that occurs when a foreign object becomes lodged in the throat, partially or completely blocking the flow of air to the lungs. This obstruction can quickly lead to unconsciousness and death if not cleared rapidly. Recognizing the difference between a partial obstruction (where the person can still cough forcefully) and a complete obstruction (where the victim is silent and cannot breathe) is the first step in a rapid response. Immediate action is required in cases of complete obstruction to clear the airway and restore breathing.
Initial Response and Standard Abdominal Thrusts
The first aid sequence for a responsive adult who is choking involves back blows and abdominal thrusts. First, ask the victim if they are choking. If they cannot speak or cough, immediately call for emergency medical services or instruct someone nearby to do so. The standard procedure begins with five firm back blows delivered between the victim’s shoulder blades using the heel of the hand while supporting the chest and leaning them forward.
If back blows fail, the rescuer transitions to five abdominal thrusts (the Heimlich maneuver). The rescuer stands behind the victim, wrapping their arms around the waist. A fist is made with one hand, thumb side placed against the abdomen just above the navel and below the rib cage. The other hand grasps the fist, and five quick, forceful thrusts are delivered inward and upward to create an artificial cough.
Abdominal thrusts work by rapidly compressing the lungs, increasing airway pressure high enough to expel the trapped object. The rescuer alternates between five back blows and five abdominal thrusts until the object is expelled, the victim can breathe or speak, or the victim becomes unresponsive. This alternating “five-and-five” approach is the recommended protocol for a conscious adult or child over one year of age.
Situations Requiring Alternative Relief Methods
The standard abdominal thrust technique may not be feasible or safe in every choking scenario, necessitating alternative procedures. The challenge arises when the rescuer cannot effectively wrap their arms around the victim’s abdomen to apply the required inward and upward force. This is most common when assisting a victim who is overweight or obese, where body mass prevents proper hand placement and compression.
Standard abdominal thrusts must also be avoided when the victim is in the late stages of pregnancy. Applying forceful pressure to the abdomen poses a danger to the fetus. Therefore, a modified technique is required to safely generate the air pressure needed to dislodge the foreign object.
Size disparity between the rescuer and the victim can also make the standard maneuver impossible. If the rescuer is unable to reach around the victim’s waist to form the proper fist-and-hand grip, they must immediately use the alternative method. These scenarios require shifting the point of pressure from the abdomen to the chest, which is the basis for the chest thrust technique.
Technique for Performing Chest Thrusts
Chest thrusts are the recommended alternative when abdominal thrusts cannot be performed safely or effectively, especially for victims who are too large or pregnant. The mechanism relies on compression to create a forced cough that clears the airway, but the target area is shifted higher on the body. The rescuer stands behind the victim, ensuring they are stable and ready to support the victim.
To execute a chest thrust, the rescuer wraps their arms around the victim’s chest, positioning hands under the armpits. One hand is made into a fist, with the thumb side placed directly on the center of the breastbone (sternum). This placement must be above the lower tip of the sternum but lower than the neck, generally just above the imaginary line connecting the nipples.
The other hand is then placed over the fist to reinforce the grip and deliver the force. Unlike the upward-angled force of the abdominal thrust, the pressure for the chest thrust is directed straight inward, creating a forceful, rapid compression of the lungs. The rescuer delivers up to five quick, distinct chest thrusts, alternating this with five back blows until the obstruction is cleared.
This technique is used for pregnant women to bypass the risk of injury to the uterus and fetus. For a person whose size prevents the rescuer from reaching around the waist, the chest area provides a stable and accessible point for compression. The inward thrust generates the pressure needed to expel the foreign object.
When the Choking Victim Becomes Unresponsive
If a conscious adult who is choking suddenly loses consciousness, the procedure for airway clearance must be escalated. The rescuer must gently lower the victim to the ground, position them on their back, and immediately call emergency services if this has not already been done. The focus shifts from conscious choking relief techniques to modified cardiopulmonary resuscitation (CPR).
The rescuer begins with chest compressions, following the standard CPR rhythm of 30 compressions at a rate of 100 to 120 per minute. After 30 compressions, the rescuer opens the victim’s mouth and looks for the foreign object. If the object is visible and can be easily grasped, it should be removed. A blind finger sweep is never performed, as it risks pushing the object deeper into the airway.
If no object is seen or removed, the rescuer attempts two rescue breaths. If the chest does not rise, the rescuer repositions the head and attempts the breaths again. If the breaths are unsuccessful, the rescuer immediately returns to 30 chest compressions. This cycle of compressions, checking the mouth, and attempting rescue breaths continues until help arrives or the victim recovers.