Choking – Obstructed Airway

Choking occurs when a foreign object becomes lodged in the throat or windpipe, blocking the flow of air. In adults, a piece of food often is the culprit. Young children often swallow small objects. Because choking cuts off oxygen to the brain, administer first aid as quickly as possible.

The universal sign for choking is hands clutched to the throat. If the person doesn’t give the signal, look for these indications:

  • Inability to talk
  • Difficulty breathing or noisy breathing
  • Inability to cough forcefully
  • Skin, lips and nails turning blue or dusky
  • Loss of consciousness

If choking is occurring, the Red Cross recommends a “five-and-five” approach to delivering first aid:

  • First, deliver five back blows between the person’s shoulder blades with the heel of your hand
  • Next, perform five abdominal thrusts (also known as the Heimlich maneuver).
  • Alternate between five back blows and five abdominal thrusts until the blockage is dislodged.

The Heimlich Maneuver (also called the abdominal thrust) is the most effective first-aid measure for choking. If the airway is blocked, the victim, unless relieved of the obstruction, may die in less than 5 minutes.

Make sure the person is choking and not having a heart attack. If a person who is eating suddenly looks startled, puts a hand to the throat, cannot speak or breathe or begins to turn blue, quickly ask them if they are choking. If they are unable to speak and nod their head “Yes”, apply the Heimlich maneuver.

To Apply the Heimlich Maneuver if the person is standing or sitting:

  • Stand behind the person. Wrap your arms around the waist. Tip the person forward slightly.
  • Make a fist with one hand. Position the thumb-side against the victim’s abdomen, slightly above the navel and below the rib cage.
  • Grasp the fist with the other hand. Press forcefully into the abdomen with a quick, upward thrust – as if trying to lift the person up.
  • Perform a total of five abdominal thrusts, if needed, until the stuck object is ejected. If the blockage still isn’t dislodged, repeat the five-and-five cycle.

Caution: Don’t squeeze the person with your arms; this could damage the ribs. To avoid squeezing, keep your arms bent at the elbows.

If you’re the only rescuer, perform back blows and abdominal thrusts before calling 911 or your local emergency number for help. If another person is available, have that person call for help while you perform first aid.

If the choking victim is lying down, position them face up on their back and kneel astride their hips.

With one of your hands on top of the other, place the heel of your bottom hand on the abdomen between the navel and the rib cage. Press with a quick upward thrust.

If you are alone and choking, you’ll be unable to effectively deliver back blows to yourself. However, you can still perform abdominal thrusts to dislodge the item.

Place the thumb-side of the fist of one hand against the abdomen, slightly above the navel and below the rib cage, grasping the fist with the other hand. Or try anything that will apply upward force just below the diaphragm. Lean forward and press into the edge of a table, countertop, the kitchen sink, or the back of a chair.

Shove your fist inward and upward – repeating, if needed, until the stuck object is ejected.

If an Infant is Choking

  • Assume a seated position and hold the infant face down (with the infant’s head lower than the rest of the body) over your forearm, which is resting on your thigh.
  • Thump the infant gently but firmly five times on the middle of the back between the shoulder blades using the heel of your hand. The combination of gravity and the back blows should release the blocking object.
  • Hold the infant face up on your forearm with the head lower than the torso, if the the back blows fail to eject the object from the windpipe and the infant is younger than age 1. Using two fingers placed at the center of the infant’s breastbone just below the level of the nipples, compress the chest five times in rapid succession.
  • Repeat the back blows and chest thrusts if breathing doesn’t resume. Call for emergency medical help.
  • Begin infant CPR if one of these techniques opens the airway but the infant doesn’t resume breathing.

If the child is older than age 1, give abdominal thrusts only.

Caution: Don’t apply any measures if the child can breathe, speak or make sounds, and is coughing. These signs mean they are getting air in the windpipe that can expel the object partially blocking the airway. And maneuvers by you interfere with this natural process and may convert the partial blockage to a total obstruction.

If the Procedure Is Not Successful, Do As Follows:

Open the airway by grasping the tongue and lower jaw between the thumb and finger, and lifting (this draws the tongue away from the back of the throat and may help relieve the obstruction). Look for a foreign body in the victim’s throat. Attempt to remove a foreign object only if it is plainly visible. If no spontaneous breathing occurs, deliver two breaths through the mouth or mouth-nose (as in artificial respiration). If the chest fails to rise, repeat the sequence of back blows and chest thrusts while having someone call for help and emergency transport to a medical facility. or for a rescue unit to come. CPR may be necessary.