Choking occurs when a foreign object, typically food, lodges in the throat or windpipe, blocking the flow of air. This obstruction is a life-threatening emergency because oxygen deprivation can cause brain damage in as little as four to six minutes. Effective intervention requires understanding the distinction between a partial and a complete blockage to clear the airway.
Recognizing the Signs of Airway Obstruction
The initial response to a choking incident depends entirely on whether the person has a mild or a severe airway obstruction. A mild blockage means the person can still move some air past the object, which is often indicated by forceful coughing, speaking, or crying. In this situation, intervention should be limited to encouraging the person to continue coughing, as their own efforts may be sufficient to expel the item.
A severe obstruction demands immediate action because no air is moving through the windpipe. Signs of a complete blockage include the inability to cough, speak, or make any sound, often accompanied by panic or the universal distress signal of clutching the throat. The person’s skin, lips, and nails may turn pale or bluish as oxygen levels drop, indicating that immediate maneuvers are required.
Emergency Steps for Helping Adults and Children
If a conscious adult or child over one year old shows signs of a severe obstruction, the rescuer must act quickly by calling emergency services. The standard procedure involves a sequence of five back blows and five abdominal thrusts, also known as the Heimlich maneuver. To administer back blows, stand to the side and slightly behind the victim, support their chest with one arm, and lean them forward so the object can exit the mouth. Using the heel of the hand, the rescuer should deliver five firm blows between the shoulder blades.
If the obstruction is not cleared, the rescuer should transition immediately to five abdominal thrusts. To perform these, stand behind the victim, wrap your arms around their waist, and place a clenched fist just above the navel and below the rib cage. Grasp the fist with the other hand and deliver five quick, inward and upward thrusts to compress the lungs and create an artificial cough to force the object out. This cycle of five back blows and five abdominal thrusts should be repeated until the object is dislodged or the victim loses consciousness.
Immediate Action When Choking Alone
Choking when alone requires performing the abdominal thrust maneuver on oneself. The first step is to call emergency services immediately, even if you can only leave the phone off the hook so help is dispatched. To begin the self-Heimlich, make a fist with one hand and place the thumb-side of the fist above the navel and below the rib cage.
The other hand should grasp the fist, and the individual should then press the fist forcibly into the upper abdomen with a quick, upward motion. If generating enough force with the hands alone proves difficult, a sturdy, fixed object can be used to increase pressure. Leaning over the back of a chair, a railing, or a countertop and thrusting the upper abdomen against the edge can provide the necessary force to dislodge the obstruction.
Adapting Techniques for Specific Groups
Special populations require modifications to the standard choking procedure. For an infant under one year old, abdominal thrusts are not used. Instead, the infant is positioned face-down along the rescuer’s forearm, with the head lower than the chest, and given up to five back blows between the shoulder blades. If the object is not cleared, the infant is turned face-up, and up to five chest thrusts are delivered using two fingers placed on the breastbone just below the nipple line, repeating the cycle until the airway is clear.
For pregnant individuals or those with significant obesity, abdominal thrusts are replaced with chest thrusts to avoid pressure on the abdomen. The rescuer should stand behind the person, wrap their arms under the armpits and around the chest, placing the thumb-side of the fist on the center of the breastbone. Five sharp, inward thrusts are delivered, alternating with five back blows. If any choking victim becomes unconscious, they should be lowered to the ground to begin cardiopulmonary resuscitation (CPR). Before attempting rescue breaths, the rescuer should check the mouth for a visible object, but a blind finger sweep should never be performed as it may push the object further into the airway.