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Signs of choking include:
• coughing, either forcefully or weakly
• clutching the throat with one or both hands
• inability to cough, speak, cry or breathe
• making high-pitched noises while inhaling or noisy breathing
• panic
• bluish skin color
• losing consciousness if blockage is not removed
If the Airway is not completly blocked (indicated by inability of the patient to talk, breath or cough), the provider should not do anything and because the body's natural protective mechanisms are more effective in removing the partially blocked airways.
It is important not to confuse this emergency with fainting, heart attack, seizure, an anaphylactic allergic reaction or other conditions that may cause sudden respiratory distress, cyanosis or loss of consciousness. Foreign bodies may cause either mild or severe airway obstruction. It is important to ask the conscious victim “Are you choking?”
If the victim shows signs of complete airway obstruction and is conscious (in adults and children > 1 year old):
Apply up to five back blows as follows:
1. Stand to the side and slightly behind the victim.
2. Support the chest with one hand and lean the victim well forward so that when the obstructing object is dislodged, it comes out of the mouth rather than further down the airway.
3. Give up to five sharp blows between the shoulder blades with the heel of your other hand.
4. Check to see if each back blow has relieved the airway obstruction. The aim is to relieve the obstruction with a blow/slap, not to necessarily give all five.
If five back blows fail to relieve the airway obstruction, give up to five abdominal thrusts as follows:
1. Stand behind the victim and put both arms around the upper part of the abdomen.
2. Lean the victim forward.
3. Clench your fist and place it between the umbilicus and xiphisternum.
4. Grasp this hand with your other hand and pull sharply inwards and upwards.
5. Repeat up to five times.
6. If the obstruction is still not relieved, continue alternating five back blows with five abdominal thrusts.
If the victim becomes unconscious:
1. Support the victim, while carefully lowering him or her to the ground.
2. Immediately call for EMS.
3. Begin cardiopulmonary resuscitation (CPR) at the compression part of the sequence.
The finger sweep: Avoid use of a blind finger sweep. Manually remove solid material in the airway
only if it can be seen.
If the victim shows signs of complete airway obstruction and is conscious and is < 1 years age:
Apply up to five back blows as follows:
1. Lay the infant face down along your arm with the head lower than the body. Support the infant in a head downward, prone position, to enable gravity to assist removal of the foreign body.
2. A seated or kneeling rescuer should be able to support the infant safely across his or her lap.
3. Support the infant’s head by placing the thumb of one hand at the angle of the lower jaw, and one or two fingers from the same hand at the same point on the other side of the jaw. Do not compress the soft tissues under the chin.
4. Give up to five sharp blows between the shoulder blades with the heel of your other hand.
5. Check to see if each back blow has relieved the airway obstruction. The aim is to relieve the obstruction with a blow/slap, not to necessarily give all five.
If five back blows fail to relieve the airway obstruction, give up to five chest thrusts as follows:
1. Turn the infant into a head downward, supine position. This is achieved safely by placing the free arm along the infant’s back and encircling the back part of the head with the hand. Support the infant along your arm, which is placed down (or across) your thigh.
2. Find your landmarks, two fingers below the nipple line.
3. Give chest thrusts (compress approximately 1/3 of the depth of the chest). These are similar to chest compressions but sharper and delivered at a slower rate.
4. Repeat up to five times.
5. If the obstruction is still not relieved, continue alternating five back blows with five chest thrusts.
If the victim becomes unconscious or is found unconcious:
1. Support the victim, while carefully lowering him or her to a firm surface.
2. If EMS has not arrived or been called, immediately call for EMS.
3. Open the airway.
4. Give 2 to 5 rescue breaths. During the first attempts at rescue breaths, if a breath does not make the chest rise, reposition the head before making the next attempt.
5. Begin cardiopulmonary resuscitation (CPR) at the compression part of the sequence.