Choking

Clearing airway obstructions in adults, children, and infants.

A choking adult has roughly four minutes before brain damage starts. The good news: the technique is simple, the failure mode is not acting fast enough, and the technique on infants is different in ways that matter.

Recognizing Choking

Universal Choking Sign

Hands clutching throat.

Other Signs

Mild obstruction (partial):

• Can cough forcefully
• Can speak
• May wheeze
• Getting air

Severe obstruction (complete):

• Cannot speak or cough
• Silent or high-pitched sounds
• Cannot breathe
• Turning blue (lips, face)
• Loss of consciousness (if not cleared)

Adult/Child Choking (Conscious)

First: Ask

"Are you choking? Can you speak?"

If Mild Obstruction

• Encourage coughing
• Do NOT interfere
• Stay with them
• Monitor closely
• If worsens, intervene

If Severe Obstruction

Alternate between back blows and abdominal thrusts:

Back Blows (5)

1. Stand to side and slightly behind
2. Support chest with one hand
3. Bend them forward
4. Give 5 sharp blows between shoulder blades with heel of hand

Abdominal Thrusts - Heimlich Maneuver (5)

1. Stand behind victim
2. Wrap arms around waist
3. Make fist with one hand
4. Place thumb side against abdomen, above navel, below ribcage
5. Grasp fist with other hand
6. Give quick upward thrusts (inward and upward)
7. Each thrust should be separate and distinct

Continue alternating 5 back blows and 5 abdominal thrusts until:

• Object is expelled
• Victim can cough/breathe
• Victim becomes unconscious

Adult/Child Choking (Unconscious)

If victim becomes unconscious:

1. Lower to ground carefully

   • Support head and neck
   • Position on back

2. Call 911 (if not already done)

3. Begin CPR

   • Start with chest compressions
   • Compressions may dislodge object

4. Before giving breaths, check mouth

   • Look for visible object
   • If seen, sweep out with finger
   • Do NOT blind finger sweep

5. Attempt breaths

   • If chest doesn't rise, retilt head and try again
   • If still doesn't rise, continue compressions

6. Continue CPR cycle

   • 30 compressions
   • Check mouth
   • Attempt 2 breaths
   • Repeat

Infant Choking (Under 1 Year)

Conscious Infant - Severe Obstruction

Position:

1. Place infant face-down on your forearm
2. Support head and jaw with your hand
3. Keep head lower than chest
4. Rest forearm on your thigh

Back Blows (5):

1. Give 5 firm back blows between shoulder blades
2. Use heel of hand

Turn infant over:

1. Support head
2. Sandwich between arms/hands
3. Turn face-up on other forearm

Chest Thrusts (5):

1. Place 2 fingers on breastbone, just below nipple line
2. Give 5 quick downward thrusts
3. About 1.5 inches deep

Continue until:

• Object expelled
• Infant becomes unconscious

Unconscious Infant

1. Place on firm surface
2. Call 911 (if not done)
3. Begin CPR
   • 30 compressions (2 fingers, 1.5 inches)
4. Check mouth before breaths
   • Look for visible object
   • Remove only if clearly visible
5. Attempt 2 breaths
   • Cover mouth and nose
   • Small puffs
6. If chest doesn't rise
   • Retilt head
   • Try again
7. Continue CPR cycle

Special Situations

Pregnant Woman (Conscious)

Use chest thrusts instead of abdominal thrusts:

1. Stand behind
2. Wrap arms around chest (under armpits)
3. Place fist on center of breastbone
4. Give backward thrusts
5. Continue until object expelled or unconscious

Obese Person

Same as pregnant woman: chest thrusts if you can't wrap arms around abdomen.

Choking Alone (Self)

Abdominal thrusts on yourself:

1. Make fist, place above navel
2. Grasp with other hand
3. Thrust inward and upward

Using chair or counter:

1. Position hard edge against upper abdomen
2. Press forcefully into edge
3. Repeat as needed

Choking on Food vs. Object

Food: Usually softens, may break apart with thrusts

Hard object: May require more forceful intervention

Both: Same technique applies

After Choking

If Object Expelled Successfully

• Encourage slow, deep breaths
• Watch for breathing difficulties
• If abdominal thrusts given, recommend medical evaluation (internal injury possible)

Seek Medical Care If

• Multiple thrusts needed
• Persistent cough
• Difficulty swallowing
• Sensation of object still present
• Abdominal pain after thrusts
• Blood in saliva

Prevention

High-Risk Foods

• Hot dogs (cut lengthwise)
• Grapes (cut in quarters for children)
• Popcorn
• Nuts
• Hard candy
• Raw carrots
• Chunks of meat or cheese
• Peanut butter (thin layer only for children)

Prevention Tips

For children:

• Cut food into small pieces
• Supervise meals
• Don't allow eating while playing/running
• Avoid high-risk foods for young children
• Teach to chew thoroughly

For adults:

• Eat slowly
• Chew thoroughly
• Don't talk with mouth full
• Limit alcohol (impairs swallowing)
• Be careful with dentures

For everyone:

• Keep small objects away from children
• Check toys for small parts
• Keep floor clear of small items

Quick Reference

Adult/Child Choking

Conscious:
1. "Are you choking?"
2. 5 back blows
3. 5 abdominal thrusts
4. Repeat until cleared or unconscious

Unconscious:
1. Lower to ground
2. Call 911
3. CPR (check mouth before breaths)

Infant Choking

Conscious:
1. 5 back blows (face down)
2. 5 chest thrusts (face up)
3. Repeat until cleared or unconscious

Unconscious:
1. Place on firm surface
2. Call 911
3. CPR (check mouth before breaths)

Key Points

1. Encourage coughing if airway is partially blocked
2. Alternate back blows and thrusts for severe obstruction
3. Start CPR if victim becomes unconscious
4. Check mouth before giving rescue breaths
5. Never blind finger sweep - may push object deeper
6. Different technique for infants - back blows + chest thrusts
7. Seek medical care after choking incident

Next Steps

Continue to 05-shock.md to recognize and treat shock, the silent killer that follows trauma.