TL;DR
Choking can become a life-threatening emergency in minutes. Knowing how to recognize the signs, perform the Heimlich maneuver on adults and children, give back blows and chest thrusts to infants, and start CPR if the person becomes unresponsive can save a life.
Overview of Choking
A choking emergency can happen when you least expect it. Whether it’s someone choking on food, an infant choking on something they put in their mouth, or a foreign object blocking someone’s airway, choking can be a life-threatening emergency.
Statistics on choking are largely unreliable. Most choking incidents are resolved without medical intervention and go unreported. We do know that, on average, 5000 – 6000 people die from choking in the United States each year.
The good news is that almost anyone can help prevent a choking emergency from becoming a fatality. However, it is essential to know what to do and act quickly.
What Happens During Choking?
Choking occurs when food or a foreign object blocks the airway, therefore preventing normal breathing.
The blockage may be caused by:
- Food
- Coins
- Small toys
- Batteries
- Dentures
- Other foreign objects
Without oxygen, permanent brain damage can begin within minutes.
Partial vs. Complete Airway Obstruction
Not every choking episode is immediately life-threatening.
Partial Airway Obstruction
The airway is only partially blocked. A partial airway obstruction can be broken down into two subcategories.
- Partial obstruction with good exchange
- Partial obstruction with poor exchange
Good Exchange
Signs of a partial airway obstruction with good exchange:
- The victim can cough forcefully
- The victim is able to speak
- They can breathe effectively, air moves in and out
What should you do?
Encourage them to keep coughing.
A strong cough is often the most effective way to clear the obstruction.
Do not hit them on the back if they are coughing effectively, as this could worsen the obstruction.
Continue monitoring them closely.
Poor Exchange
Signs of a partial airway obstruction with poor air exchange:
- Can barely speak
- Coughing is silent and ineffective
- Cannot breathe effectively
A partial airway obstruction with poor airflow is a life-threatening medical emergency
Complete Airway Obstruction
The airway is fully blocked.
Signs of a complete airway obstruction:
- The victim is unable to speak
- The victim can not cough
- They make little or no sound
- The victim turns blue around the lips or face
- They lose consciousness
A complete airway obstruction is a life-threatening medical emergency.
What To Do If Someone Is Choking
The first step is to determine the severity of the choking.
If someone has a complete obstruction or a partial obstruction with poor airflow, it is essential to act immediately.
How to Help a Conscious Choking Adult or Child One Year or Older
Step 1: Confirm they are choking
Ask: “Are you choking?” and “Can you speak?”
If they say yes: Stand by and be ready to assist if it gets worse.
If they can not speak: Continue to step 2
Step 2: Get permission to assist
Tell them “I’ve been traind, I’m going to help you”. If they push you away or indicate they don’t want your help, you must back off until they lose consciousness. If they allow you to help, go to step 3.
Step 3: Perform the Heimlich Maneuver
Stand behind the person.
- Position yourself behind the victim, placing one leg between their legs for balance. Take a wide stance
- Wrap your arms around their waist.
- Make a fist with your knuckles pointing up.
- Place the thumb side just above the belly button.
- Grab your fist with your other hand.
- Deliver quick inward and upward thrusts.
Thrusts should be delivered with enough force to knock the wind out of someone.
Continue until:
- The object comes out
- The person begins breathing
- The person becomes unconscious
What If the Person Is Pregnant or Obese?
Perform chest thrusts instead of abdominal thrusts by placing your hands on the center of the chest and pushing straight backward.
Helping a Conscious Infant (Under One Year Old)
Infants can not tell us that they are choking. When an infant is choking, they will kick, thrash, and attempt to scream but will not make any sound. Infants will quickly start turning blue (cyanotic).
Provide Back Blows and Chest Thrusts
Give 5 Back Blows
- Pick up the infant and hold them with their head lower than their body.
- Support the infant face-down along your forearm.
- Support the head and neck.
- Deliver five firm back blows between the shoulder blades.
Give 5 Chest Thrusts
- Turn the infant face-up.
- Using two fingers, give five quick chest thrusts in the center of the chest just below the nipple line. Similar to CPR compressions
Alternate back blows and chest thrusts:
- 5 back blows
- 5 chest thrusts
- Repeat the cycle
Continue back blows and chest thrusts until any of the following:
- The object comes out
- The infant becomes unresponsive
- EMS takes over
How to Help an Unconscious Choking Victim
If the choking victim loses consciousness:
- Carefully lower them to the floor (or table for an infant).
- Have someone call 911 if it hasn’t already been done.
- Begin CPR immediately.
During CPR, look in the victim’s mouth to see if the obstruction is visible. If you can see it, try to remove it. If not:
- For an adult: Perform a blind finger sweep.
- For a child or infant: Do NOT perform a blind finger sweep.
Continue CPR until:
- The object is removed
- The person begins breathing
- EMS takes over
What If the Person Is Pregnant or Obese?
Use chest thrusts in place of abdominal thrusts. If you cannot wrap your arms around a person’s chest, it may be easier if they were lying down or standing with their back against a wall.
What Should I Do if I Begin to Choke?
- Place your hands around your neck to give the universal sign for choking.
- Do not walk away from people and try to relieve the obstruction
What if I Choke While Alone?
If you are alone and cannot cough or breathe:
- Call 911 if possible. Enhanced 911 can guide EMS to your location. Bang the phone or make noise to let the dispatcher know it’s an emergency.
- Perform self-abdominal thrusts by pushing your upper abdomen forcefully against the back of a sturdy chair, countertop, or railing. Plan ahead and find a usable object before you choke. Performing the Heimlich Maneuver on yourself is nearly impossible.
- If you can not relieve the obstruction, run outside. EMS will find you more quickly. A bystander may be able to assist.
Preventing Choking Emergencies
Many choking incidents are preventable.
- Cut food into smaller, bite-sized pieces.
- Encourage slow eating.
- Avoid laughing or talking with food in your mouth.
- Learn CPR, the Heimlich Maneuver, and First Aid for Choking.
For small children:
- Cut grapes in quarters.
- Slice hot dogs lengthwise before cutting into small pieces.
- Avoid giving whole nuts or popcorn to young children.
- Keep small objects away from infants and toddlers.
- Check toys for age-appropriate safety warnings.
When Should You See a Doctor After Choking?
Even if the object is removed successfully, medical evaluation may be necessary if the victim has:
- Throat pain
- Persistent coughing
- Trouble swallowing
- Chest pain
- Wheezing
- Shortness of breath
- Fever (possible aspiration pneumonia)
Food or liquid may have entered the lungs, leading to complications that require treatment.
Why First Aid & CPR Training Matters
Anyone can help save a life. Taking a First Aid & CPR training course can help develop the confidence to act quickly in an emergency.
A CPR and First Aid course teaches you how to:
- Recognize choking emergencies quickly
- Perform the Heimlich Maneuver correctly
- Help an infant who is choking
- Perform CPR if the victim becomes unresponsive
- Use an AED if cardiac arrest occurs
In an emergency, seconds count. These skills can make the difference between life and death while waiting for emergency responders.
Final Thoughts
Choking emergencies happen each and every day. They often happen at home and without warning. Knowing how to recognize when choking becomes a medical emergency, when to call 911 promptly, and how to provide the appropriate first aid can help save a life.
Learning CPR and how to help someone who is choking is one of the most valuable investments you can make. When every second counts, being prepared can turn a frightening emergency into a life-saving success.