The moment a person actively choking becomes unresponsive represents a rapid and dangerous progression from a partial or complete airway obstruction to a life-threatening lack of oxygen. This transition signifies that the body’s compensatory mechanisms have failed, and the victim has entered a state of respiratory or cardiac arrest due to asphyxia. Time is measured in mere minutes before irreversible brain damage begins, making the immediate sequence of emergency actions absolutely paramount. While consciousness allows for targeted abdominal thrusts, unresponsiveness shifts the rescue focus entirely to a modified form of Cardiopulmonary Resuscitation (CPR) aimed at both clearing the obstruction and maintaining blood flow.
Immediate Actions Upon Collapse
When the choking victim loses consciousness and begins to collapse, the first action must be to safely guide their body to the floor. The rescuer should attempt to gently lower the person onto their back on a firm, flat surface, minimizing the risk of secondary injuries like a concussion or fractures from an uncontrolled fall. This positioning is necessary to allow for the effective delivery of chest compressions, which cannot be performed properly on an upright or soft surface.
The next action must be to activate the Emergency Medical Services (EMS) system by calling 911 or the local emergency number. If a second person is present, the rescuer should immediately and specifically delegate the task, stating clearly, “You, call 911 and come back to tell me they are on the way.” Simultaneously, the rescuer should shout for help to alert any nearby individuals who might be able to retrieve an Automated External Defibrillator (AED) or assist with the physical demands of resuscitation.
Once the victim is positioned and emergency services have been notified, the rescuer should immediately begin chest compressions. Unlike standard CPR where compressions follow an assessment of breathing and pulse, the goal here is to use the mechanical force of the compressions to create an artificial cough. This sudden increase in intrathoracic pressure may be sufficient to dislodge the foreign object blocking the upper airway. Starting with 30 compressions before attempting to look in the mouth is the standard protocol for an unresponsive choking adult.
Checking the Airway for the Obstruction
After the initial cycle of 30 chest compressions is completed, the rescuer must transition to assessing the airway for the object that has potentially been moved by the compressions. The rescuer should perform the head-tilt/chin-lift maneuver to physically open the airway. This maneuver is performed by placing one hand on the victim’s forehead and two fingers of the other hand under the bony part of the chin, gently tilting the head back and lifting the chin forward.
With the airway now open, the rescuer must visually inspect the victim’s mouth for the foreign object. This visual sweep is the only time a rescuer should attempt to remove the obstruction manually. If the object is clearly visible, within reach, and appears graspable, the rescuer may use a finger to attempt to hook or sweep it out of the mouth.
It is important to understand the restriction against a blind finger sweep, which means inserting a finger into the mouth without seeing the object. A blind sweep carries a substantial risk of pushing the foreign body further down the throat, turning a partial obstruction into a complete one or lodging the item more securely in the trachea. If the object is not seen or cannot be easily removed, the rescuer must proceed directly to attempting rescue breaths.
If the object is successfully removed and the victim begins to breathe normally but remains unconscious, they should be placed into the recovery position. This position involves gently turning the victim onto their side with the top arm supporting the head. This helps to keep the airway open and allows any fluids to drain safely from the mouth. If the object is not removed, the sequence of compressions and breaths must be continued without delay.
Initiating the CPR Cycle
If the visual check of the mouth does not reveal a visible and removable object, or if it is removed but the victim still does not breathe, the full Cardiopulmonary Resuscitation (CPR) cycle must begin. This cycle alternates between chest compressions and rescue breaths at a ratio of 30 compressions to 2 breaths, which is necessary to both circulate oxygenated blood and attempt to ventilate the lungs.
The compressions must be delivered with precision to maximize effectiveness. Place the heel of one hand on the center of the victim’s bare chest, specifically the lower half of the breastbone. The compressions should be performed at a rate of 100 to 120 times per minute, pushing straight down to a depth of at least two inches, but not exceeding 2.4 inches. The rescuer must ensure that the chest fully recoils after each compression, which allows the heart to refill with blood before the next push.
After the 30 compressions, the rescuer must deliver two rescue breaths, using the head-tilt/chin-lift maneuver again to maintain an open airway. The rescuer should pinch the victim’s nose shut, make a complete seal over their mouth, and deliver a breath over one second, watching for the chest to visibly rise. If the chest rises, the breath was successful, and the second breath should be delivered immediately following the same technique.
If the first rescue breath does not cause the chest to rise, it suggests the airway remains blocked. The rescuer should immediately reposition the head using the head-tilt/chin-lift maneuver and attempt the second breath. If the second breath is also unsuccessful, the rescuer must not attempt any further breaths and should immediately return to 30 chest compressions.
Before starting the next cycle of compressions, the rescuer should quickly re-examine the mouth for the object, as the compressions may have dislodged it further. The continuous cycling of 30 compressions, a quick mouth check, and up to two rescue breaths must be maintained until the victim shows obvious signs of life, an AED is ready for use, or qualified EMS personnel arrive and take over care.