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Choking is a condition where the airway gets blocked, causing breathing difficulties. In adults, choking typically happens when food becomes stuck in the windpipe. For children, choking is often caused by small objects like toys, coins, or other tiny items falling into the throat or windpipe. Choking can also result from trauma, alcohol consumption, or swelling from a severe allergic reaction. If not treated with first aid, lack of air from choking can lead to serious brain damage or even death from asphyxiation. It is crucial to know how to perform first aid if you or someone else is choking. Note: This article focuses on first aid for adults and children over one year old. For choking in infants under one year, refer to How to Perform First Aid for Choking Infants.
Steps
Helping Others
Assess the Situation. It is important to confirm that the person is indeed choking and to determine whether their airway is partially or completely blocked. If the person is only mildly choking or the airway is only partially blocked, it is often best to allow them to cough in order to expel the obstruction.
- A sign that the airway is partially blocked is if the victim is able to talk, cry, cough, or respond. They may still be able to breathe, though with some difficulty, and their face may appear slightly pale.
- In contrast, a person with a completely blocked airway will not be able to talk, cry, cough, or breathe. You may also notice the victim making the "choking sign" (grasping their throat with both hands), and their lips and nails may turn blue due to lack of oxygen.
Ask the victim, "Are you choking?" If the person can respond verbally, wait. A person who is truly choking cannot speak, but they may nod or shake their head to indicate whether they are choking. It's important not to use back blows for someone with a partial blockage, as there is a risk that the object may move further down and completely obstruct the airway. If the victim is able to respond, you should:
- Reassure the victim. Let them know you are there and ready to assist if needed.
- Encourage the victim to try coughing to dislodge the object. Do not perform back blows.
- Continue monitoring and be ready to assist if the airway becomes completely blocked or the situation worsens.
Perform First Aid. If the victim is severely choking or has a completely blocked airway but remains conscious, you must inform them of your intention to administer first aid. It is best to let the victim know what you plan to do to ensure they agree to your assistance.
- If you are the only one available to help, proceed with the first aid steps outlined below before calling emergency services. If others are present, you can ask them to call for help.
Back Blows. Note that these instructions apply to individuals who are sitting or standing.
- Stand behind the victim, slightly to one side. If you are right-handed, stand on the left, if left-handed, stand on the right.
- Place one hand on the victim's chest and tilt their body forward so the object is more likely to come out through the mouth (instead of falling deeper into the throat).
- Use the heel of your hand (between the palm and wrist) to deliver five firm back blows to the area between the shoulder blades. Pause after each blow to check if the object has been expelled. If not, proceed with five abdominal thrusts (described below).
Perform Abdominal Thrusts (Heimlich Maneuver). The Heimlich maneuver is a first aid technique used for adults and children over one year of age. It should not be used for infants under one year old.
- Stand behind the choking person.
- Wrap both arms around their abdomen and have the person lean slightly forward.
- Clench one fist and place it just above the victim's navel, below the ribcage.
- Place your other hand over the clenched fist and press both hands firmly into the victim's abdomen with an upward thrust.
- Repeat the abdominal thrusts up to five times. After each thrust, check to see if the object has been expelled. Stop if the victim becomes unconscious.
Modify Heimlich Maneuver for Pregnant Women and Obese Individuals. For these cases, you should position your hands higher during the Heimlich maneuver. Place both hands just below the breastbone, above the last rib joint. Apply strong pressure to the chest with the described motion, but do not perform the upward thrust. Repeat until the victim stops choking and the object is expelled or until the victim becomes unconscious.
Make sure the object is completely expelled. Once the airway is clear, small remnants of the object may still be present. If the victim is able, ask them to spit it out and breathe freely.
- Recheck to see if anything is obstructing the airway. If there is, you can use your finger to sweep inside the victim's mouth to remove the object. Only do this if you can see the object. If not, it could be pushed deeper into the airway.
Check if the victim is breathing normally again. After the object is expelled, most victims resume normal breathing. If they are still unable to breathe properly or are unconscious, proceed with the next step.
Provide first aid if the victim is unconscious. If the choking victim becomes unconscious, lay them flat on their back on the floor. Open the airway if possible. If the object is visible, use your finger to sweep and remove it from their throat through the mouth. Do not attempt to sweep if you can't see the object. Be cautious to avoid pushing it further into the airway.
- If the object remains lodged and the victim is unresponsive, check for breathing. Place your cheek near the victim’s mouth. Within 10 seconds: observe if their chest rises and falls, listen for breath, and feel for airflow on your cheek.
- If the victim is not breathing, begin CPR. The chest compressions during CPR may also help expel the object.
- Ask someone else to call for emergency assistance, or if you are alone, make the call yourself, then return to assist the victim. Alternate chest compressions, airway checks, and artificial respiration while awaiting help. For every 30 compressions, give two rescue breaths. Be sure to check the victim’s mouth frequently during CPR.
- The chest may not rise until the object is expelled.
Consult a doctor. If the victim continues to cough, has difficulty breathing, or feels something is still lodged in their throat after choking, they must seek immediate medical attention.
- Abdominal thrusts can sometimes cause injury and bruising. If the victim has been treated with this method or CPR, they need to be examined by a doctor.
Self-Help
Call emergency services. If you're alone and choking, dial 911 or the emergency number in your area (in the US). In Vietnam, call emergency number 115. Even if you're unable to speak, most emergency services will still dispatch someone to check all calls.
Perform the Heimlich maneuver yourself. While you may not be able to apply the maneuver as forcefully as you would on someone else, you can still attempt to push the object out.
- Clench your fist. Position it just above your navel.
- Use your other hand to grip your fist.
- Lean against a chair, table, or another sturdy object for support.
- Perform the inward and upward thrust with your fist, as described above.
- Repeat until the object is expelled or emergency help arrives.
- Ensure the object is completely removed. Try to expel any small fragments if possible.
Consult a doctor. If you experience persistent coughing, difficulty breathing, or a sensation of something stuck in your throat, seek medical attention immediately.
- Abdominal thrusts can potentially cause serious injury. If you've performed the maneuver on yourself, you should visit a doctor for an evaluation afterward.
