Choking occurs when a foreign object obstructs the airway, preventing breathing. It is a life-threatening emergency requiring immediate action. The ability to recognize choking and perform abdominal thrusts (Heimlich maneuver) can save a life.
Recognizing Choking
The universal choking sign — clutching the throat with one or both hands — signals that a person is choking. Other signs: inability to speak or cry out, difficulty breathing (or no breathing), high-pitched sounds or no sounds during breathing attempts, cyanosis (bluish skin, especially around the lips and nail beds), and collapse.
Mild airway obstruction. The person can cough forcefully, breathe, and speak. Encourage continued coughing — do not interfere. Stay with the person and monitor.
Severe airway obstruction. The person cannot cough effectively, cannot speak or breathe, or becomes unresponsive. Immediate intervention is required.
Abdominal Thrusts — Adults and Children Over 1 Year
Stand behind the person and wrap your arms around their waist. Make a fist with one hand and place the thumb side against the person’s abdomen, just above the navel and well below the ribcage. Grasp your fist with the other hand and perform quick, upward thrusts. Repeat until the object is expelled or the person becomes unresponsive. Each thrust should be forceful enough to create artificial cough pressure.
Self-Heimlich. If alone, perform abdominal thrusts on yourself using your fist, or lean forward and thrust your upper abdomen against a firm object (countertop, chair back, railing).
Back Blows and Chest Thrusts — Infants Under 1 Year
Hold the infant face-down along your forearm, supporting the head and jaw with your hand. Keep the head lower than the trunk. Give 5 back blows between the shoulder blades using the heel of your hand. Turn the infant face-up on your other forearm (supporting the head). Give 5 chest thrusts using two fingers on the lower half of the sternum (same position as infant CPR compressions). Alternate 5 back blows and 5 chest thrusts. Do not perform abdominal thrusts on infants — internal organs are vulnerable to damage.
Unresponsive Choking Victim
If the choking person becomes unresponsive: lower them to the ground, call 911 (or have someone call), and begin CPR starting with chest compressions. Before giving rescue breaths, look inside the mouth for the foreign object. If visible, remove it with a finger sweep. Do not perform blind finger sweeps — you may push the object deeper. Continue CPR until EMS arrives.
Special Considerations
Pregnancy or obesity. For a choking pregnant woman or person with obesity, perform chest thrusts instead of abdominal thrusts. Place the fist in the center of the chest (on the lower sternum) and perform backward thrusts.
Wheelchair users. Position yourself behind the wheelchair, lock the wheels, and perform abdominal thrusts. If you cannot get behind, perform chest thrusts from the front.
Summary
Recognize severe choking by inability to speak, ineffective cough, or cyanosis. Perform abdominal thrusts (Heimlich maneuver) for adults and children over 1 year. Use back blows and chest thrusts for infants under 1 year. For unresponsive choking victims, start CPR and check for a visible object before rescue breaths. Chest thrusts are used in pregnancy and obesity. Prevention through proper food preparation and supervision is essential.