Choking - adult or child over 1 year

Definition

Choking is when someone is having a very hard time breathing because food, a toy, or other object is blocking the throat or windpipe (airway).

A choking person's airway may be blocked so that not enough oxygen reaches the lungs. Without oxygen, brain damage can occur in as little as 4 minutes. Rapid first aid for choking can save a person's life.

Alternative Names

Abdominal thrusts - adult or child over 1 year; Heimlich maneuver - adult or child over 1 year; Choking - back blows - adult or child over 1 year

Causes

Choking can be caused by any of the following:

Symptoms

When an older child or adult is choking, they will often grab their throat with the hand. If the person does not do this, look for these danger signs:

First Aid

First ask, "Are you choking? Can you speak?" DO NOT perform first aid if the person is coughing forcefully and is able to speak. A strong cough can dislodge the object. Encourage the person to keep coughing to dislodge the object.

If the person cannot speak or is having a hard time breathing, you need to act fast to help the person. You can perform abdominal thrusts, back blows, or both.

To perform abdominal thrusts (Heimlich maneuver):

  1. Stand behind the person and wrap your arms around the person's waist. For a child, you may have to kneel.
  2. Make a fist with one hand. Place the thumb side of your fist just above the person's navel, well below the breastbone.
  3. Grasp the fist tightly with your other hand.
  4. Make a quick, upward and inward thrust with your fist.
  5. Check if the object is dislodged.
  6. Continue these thrusts until the object is dislodged or the person loses consciousness (see below).

To perform back blows:

  1. Stand behind the person. For child, you may have to kneel.
  2. Wrap one arm around to support the person's upper body. Lean the person forward until the chest is about parallel to the ground.
  3. Use the heel of your other hand to deliver a firm blow between the person's shoulder blades.
  4. Check if the object is dislodged.
  5. Continue back blows until the object is dislodged or the person loses consciousness (see below).

To perform abdominal thrusts AND back blows (5-and-5 approach):

  1. Give 5 back blows, as described above.
  2. If the object is not dislodged, give 5 abdominal thrusts.
  3. Keep performing the 5-and-5 until the object is dislodged or the person loses consciousness (see below).

IF THE PERSON FAINTS OR LOSES CONSCIOUSNESS

  1. Lower the person to the floor.
  2. Call 911 or the local emergency number or tell someone else to do so.
  3. Begin CPR. Chest compressions may help dislodge the object. Abdominal thrusts are for a conscious choking victim. Chest compressions are for an unconscious choking victim.
  4. If you see something blocking the airway and it is loose, try to remove it. If the object is lodged in the person's throat, DO NOT try to grasp it. This can push the object farther into the airway.

FOR PREGNANT OR OBESE PEOPLE

  1. Wrap your arms around the person's CHEST.
  2. Place your fist on the MIDDLE of the breastbone between the nipples.
  3.  Make firm, backward thrusts.

After removing the object that caused the choking, keep the person still and get medical help. Anyone who is choking should have a medical examination. Complications can occur not only from the choking, but also from the first aid measures that were taken.

Do Not

When to Contact a Medical Professional

Seek medical help right away if you find someone unconscious.

When the person is choking:

After the object is successfully dislodged, the person should see a health care provider because complications can arise.

In the days following a choking episode, contact the provider right away if the person develops:

The above signs may indicate:

Prevention

To prevent choking:

References

American Red Cross. First Aid/CPR/AED Participant's Manual. 2nd ed. Dallas, TX: American Red Cross; 2016. www.pdfdrive.com/american-red-cross-first-aidcpraed-d128296673.html. Accessed February 20, 2023.

Duff JP, Topjian AA, Berg MD, et al. 2019 American Heart Association focused update on pediatric basic life support: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Pediatrics. 2020;145(1):e20191358. PMID: 31727861 pubmed.ncbi.nlm.nih.gov/31727861/.

Easter JS. Pediatric resuscitation. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 158.

Goodloe JM, Soulek J. Foreign bodies. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 51.

Haas NL, Kurz MC. Adult resuscitation. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 5.

Kleinman ME, Goldberger ZD, Rea T, et al. 2017 American Heart Association focused update on adult basic life support and cardiopulmonary resuscitation quality: an update to the American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2018;137(1):e7-e13. PMID: 29114008 pubmed.ncbi.nlm.nih.gov/29114008/.



Review Date: 1/2/2023
Reviewed By: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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