Help a Choking Victim

Would you know what to do if someone started choking? What about if it's a baby, or yourself? Choking is caused by a foreign object that gets stuck in the throat and restricts airflow. Most often, choking is the result of someone getting food stuck in the windpipe, or commonly in children, it occurs when toys, coins, or other small objects become stuck in the throat or windpipe. Choking can also occur as a result of injury trauma, drinking alcohol, disease, or from swelling after a severe allergic reaction.

Choking means that a person is unable to breathe or speak because the throat or windpipe is completely obstructed. Without first aid, the lack of airflow can cause serious brain damage or even death by asphyxiation. If you think someone is choking, here's what to do.

Note: This article covers adults and children over 1 year of age. For children under one year, see How to Administer First Aid to a Choking Child.

Steps

 * 1) Make sure the person is choking. It is important to be able to distinguish between partial and total airway obstruction. If a person is not truly choking, and has partial airway obstruction, you are better off letting him cough to remove the obstruction himself. Someone who is truly choking (total airway obstruction) will display one or more of the following signs:
 * 2) *The "choking sign" -- both hands clutched to the throat
 * 3) *Being unable to talk
 * 4) *The person cannot breathe effectively without difficulty, there will be no air movement
 * 5) *Cannot cough effectively
 * 6) *Noisy breathing
 * 7) *Changes in skin color: blue lips and fingernails
 * 8) *Eventual unconsciousness.
 * 9) *Signs that the obstruction is partial rather than total include:
 * 10) **Able to speak, cry, respond to you
 * 11) **Breathing is noisy, labored, or gasping, some air will come from the mouth
 * 12) **Coughing, or making "crowing" noises
 * 13) **Very agitated or anxious
 * 14) **Skin goes paler, blue color.
 * 15) Ask the person, "Are you choking?". If the person can respond to you verbally, wait. Someone who is truly choking will not be able to speak. If they can speak, cough, breathe, or cry, the obstruction is partial. It is important that you do not use back blows on a person who has partial airway obstruction because there is a risk of lodging the previously semi-loose object even more deeply, potentially causing a total obstruction. If the person responds:
 * 16) *Reassure the person.
 * 17) *Encourage the person to cough. Do not use back blows.
 * 18) *Keep monitoring the situation.
 * 19) *Call an ambulance if the obstruction is not relieved, or you can hear wheezing or noisy breathing.
 * 20) If the person cannot respond, shout for help. If there is someone nearby, tell him to call for emergency services.
 * 21) If the person is conscious, communicate your intent to perform first aid. It's best to make sure that someone who is conscious know what you plan to do; this will also give him an opportunity let you know if your assistance is welcomed.
 * 22) Administer first aid as described in the following steps immediately. Do not waste time calling emergency services if you are the only person who can help the choking victim. Note that the following instructions apply to a person sitting or standing.
 * 23) Administer up to 5 back blows using the heel of your hand.
 * 24) *Take the bottom part (heel) of your hand and deliver 5 separate forceful strikes between the person's shoulder blades.
 * 25) *Keep the back blows separate. Try to dislodge the object with each one.
 * 26) *Look for improvement after each one.
 * 27) If the back blows fail, perform 5 abdominal thrusts (aka, the Heimlich maneuver).
 * 28) *Get behind the victim.
 * 29) *Wrap your arms around his waist.
 * 30) *Take the underside of one fist and place it near the middle of the person's abdomen, with the thumb-side against the abdomen, just above the navel and below the breastbone.
 * 31) *Grasp that fist in your other hand.
 * 32) *Give up to 5 separate, inward and upward thrusts. Continue until the obstruction is dislodged - check after each thrust. Stop if the victim becomes unconscious.
 * 33) If the obstruction has not been relieved, alternate between 5 back blows and 5 abdominal thrusts until the object becomes unstuck.
 * 34) Make sure the object is completely gone.
 * 35) *If the person is able, look for him to spit it out and breathe without difficulty.
 * 36) *Perform a finger sweep on an unconscious or incapacitated person to remove the object from his mouth. Grasp the person's tongue and and lower jaw and lift to open his mouth. Sweep the object out.
 * 37) Check to see if normal breathing has returned. Once the object is gone, most people will return to breathing normally. If normal breathing has not returned or if the person is unconscious, check the mouth and remove any visible solid obstruction and begin cardiopulmonary resuscitation (CPR). There may be some resistance to inflations until the object is dislodged. Alternate between abdominal thrusts, checking the airway, and performing rescue breathing until help arrives.

Self-administration
If you are choking, you can perform the Heimlich maneuver on yourself. You may not be able to do this as forcefully as someone else, however.
 * 1) Make a fist. Place it on your abdomen just above your navel.
 * 2) Hold that fist with your other hand.
 * 3) Bend over a chair, table, counter or other solid object.
 * 4) Drive your fist in and up as described above.
 * 5) Repeat until the object is removed.

Tips

 * If treating a pregnant woman or an obese person, you should modify your Heimlich maneuver technique as follows:
 * Place your hands higher than described above. The correct position is with the hands on the breast bone just above where the lowest ribs join.
 * Press hard into the chest with quick thrusts as described above. However, you will not be able to make the same upward thrusts.
 * Choking will likely occur quickly if it is as the result of a swallowed object or item of food; choking caused by internal swelling is usually more gradual.

Related Tips and Steps

 * How to Administer Adult CPR (Cardiopulmonary Resuscitation)
 * How to Do CPR on a Baby
 * How to Treat Sudden Cardiac Arrest
 * How to Perform the Heimlich Maneuver
 * How to Perform the Heimlich Maneuver on Yourself
 * How to Administer First Aid to a Choking Child