A choking emergency becomes a severe crisis when the victim, who may have been receiving back blows or abdominal thrusts, suddenly loses consciousness. This signifies a complete foreign body airway obstruction (FBAO) that the body can no longer fight using protective reflexes like coughing. Intervention must change from conscious choking maneuvers to a modified form of Cardiopulmonary Resuscitation (CPR) designed to address the blockage and prevent cardiac arrest. The goal changes from encouraging a cough to actively providing assisted ventilation and circulation.
Recognizing the Critical Transition and Activating Emergency Services
The immediate sign of this critical transition is the victim slumping, becoming floppy, and no longer responding to verbal or physical stimuli. They will not be breathing or will only exhibit gasping or ineffective breaths, indicating a loss of consciousness. This moment requires a swift and prioritized sequence of actions to maximize survival.
First, shout for help from anyone nearby to assist with the rescue effort. Simultaneously, the rescuer must call or immediately delegate someone else to call emergency services (EMS). While waiting for EMS to arrive, the victim must be carefully lowered flat onto their back on a firm, level surface for effective chest compressions.
Core Procedure: Chest Compressions and Visual Airway Check
When the victim is positioned, the rescuer must begin cycles of modified CPR, starting with chest compressions. Compressions are the primary focus because they increase pressure within the chest cavity, acting as an artificial cough to potentially dislodge the object. The standard rate is 100 to 120 compressions per minute, pushing hard and fast approximately two inches deep for an adult.
The cycle begins with 30 compressions, followed by an airway check and attempted rescue breaths. After compressions, the rescuer should open the airway using the head-tilt/chin-lift technique. It is necessary to visually check the mouth and throat for the foreign object at this point.
If the object is clearly visible and can be easily grasped and removed, the rescuer should take it out. This follows the “look before you sweep” rule, which prohibits a blind finger sweep that could push the obstruction deeper. If no object is seen, the rescuer attempts to give two rescue breaths.
If the chest does not rise with the first breath, the airway should be repositioned with another head-tilt/chin-lift, and a second breath should be attempted. A lack of chest rise confirms the airway remains blocked. The rescuer should immediately return to 30 chest compressions without attempting further breaths. This cycle of 30 compressions, visual check, and two attempted breaths is repeated continuously until the object is dislodged or professional help takes over.
Adapting the Procedure for Infants
The approach changes significantly when the unresponsive victim is an infant (under one year of age). If the rescuer is alone, the protocol prioritizes providing immediate care, meaning two minutes of modified CPR should be completed before activating EMS. If another person is present, one person should call for help immediately while the other begins resuscitation.
Infant compressions are performed using two fingers placed on the breastbone just below the nipple line. The compression depth is shallower, approximately one-third the depth of the chest, typically about 1.5 inches. The rate remains the same as for adults, between 100 and 120 compressions per minute.
After 30 compressions, the rescuer must open the infant’s airway with a neutral or slightly past-neutral head position, as over-tilting can close the delicate airway. The rescue breath is administered by covering both the infant’s mouth and nose with the rescuer’s mouth, giving small, gentle puffs of air. If an obstruction is visible, it should be removed gently, possibly with a pinky finger, but a blind sweep must be avoided.
After the Obstruction is Cleared
Once the foreign object is expelled and the victim begins to breathe or respond, the active resuscitation phase concludes. The victim should be carefully placed into the recovery position, typically lying on their side with the top knee bent to stabilize the body. This position helps keep the airway open and allows any fluids to drain safely from the mouth.
Monitor the victim’s breathing and level of consciousness until medical professionals arrive. Even if the victim appears recovered and breathing normally, they must be transported to a hospital for medical evaluation. The forceful nature of compressions can cause internal injuries, such as broken ribs or lung bruising, and a physician must rule out any remaining fragments of the foreign body.