When a foreign body airway obstruction (FBAO) progresses from conscious distress to unconsciousness, the situation becomes an immediate, life-threatening emergency. This lack of oxygen leads to collapse and will quickly result in cardiac arrest if the airway is not cleared. Intervention must shift from conscious choking maneuvers to a modified form of cardiopulmonary resuscitation (CPR). This sequence of actions is necessary to dislodge the obstruction and restore breathing.
Recognizing Unresponsiveness and Calling for Help
When a choking victim collapses, the initial focus is on safe positioning and activating the emergency response system. Carefully lower the person flat onto their back on a firm surface. This stable position is necessary for effective chest compressions.
Quickly assess consciousness by shouting their name and gently tapping or shaking their shoulder. If there is no response, immediately escalate the situation to emergency medical services (EMS). Instruct a bystander to call 911 and return, or if alone, place the call on speakerphone before beginning intervention. Activating EMS ensures professional help is en route while you focus on the life-saving procedure.
Starting Modified CPR
The primary intervention for an unresponsive choking victim is to initiate chest compressions. The goal of these compressions is not to circulate blood but to create a forceful, artificial cough. Compressing the chest cavity rapidly increases pressure within the lungs, which may be sufficient to push the foreign object out of the trachea.
Kneel beside the victim and place the heel of one hand on the center of the chest, specifically the lower half of the breastbone. Place your other hand on top, interlocking your fingers. Keep your elbows straight and shoulders directly over your hands. This alignment allows you to use your upper body weight to deliver the necessary force.
Deliver 30 compressions at a rate between 100 and 120 per minute. The depth of compressions for an adult should be at least two inches, but no more than 2.4 inches. Allow the chest to fully recoil between each compression. This consistent technique is the most effective means of generating the necessary pressure to expel the obstruction.
Checking the Airway and Attempting Rescue Breaths
After completing 30 chest compressions, transition to managing the airway and attempting rescue breaths. Open the victim’s mouth using the head-tilt, chin-lift maneuver to align the airway and allow for a visual inspection. Look inside the mouth for the foreign body.
If you clearly see the object and can easily grasp it, carefully remove it using your finger. This is the only time a finger sweep is permitted. Attempting a blind finger sweep risks pushing the obstruction further down the airway. If no object is visible, or if you cannot safely retrieve the one you see, do not attempt a sweep.
Pinch the victim’s nose shut and create a complete seal over their mouth before attempting two rescue breaths, each lasting about one second. Observe the victim’s chest during the breath to see if it rises, indicating air is successfully entering the lungs. If the chest rises, continue the 30 compressions to two breaths cycle.
If the chest does not rise after the first breath, reposition the head and attempt the second breath. If both breaths fail to enter the lungs, immediately return to chest compressions. The continuous cycle of modified CPR is 30 compressions followed by a visual check and two attempted breaths.
Management Continuation and Post-Event Care
The sequence of 30 compressions, visual check, and two attempted breaths must continue without interruption until one of three conditions occurs. Continue the procedure until the object is expelled, the victim begins to breathe or move on their own, or trained EMS personnel arrive and take over care. If possible, rescuers should switch roles every two minutes to prevent fatigue and maintain compression quality.
Once the foreign body is expelled and the victim is breathing, they still require immediate medical evaluation. The force necessary for effective chest compressions can cause injuries such as fractured ribs or sternum damage, which must be assessed by a physician. Furthermore, the event itself, involving a period of oxygen deprivation, necessitates a comprehensive medical check to rule out any lasting complications from the obstruction or potential aspiration of foreign material.