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Choking
First aid basics can save a life

Choking occurs when a blockage somewhere between the nose and mouth and the lungs (the airway) prevents air from getting into a person's lungs. The obstruction means trouble breathing or no breathing at all. The person will die if first aid is not given right away.

What happens when a person chokes

Choking is a life-threatening emergency. When the air supply to the lungs is cut off, the face immediately becomes red. Shortly after, as the oxygen in the body is used up, the face becomes grey while lips and ear lobes become bluish. This change in color is called cyanosis. Soon the person becomes unconscious and the heart will stop.

Signs of choking

Those who are choking show different symptoms depending upon how completely the airway is blocked.
The most obvious and universal sign of choking is when the person grabs the throat. Other signs are given in the illustration to the left. Notice how signs differ depending whether there is good breathing or little to no breathing.

First aid for choking

The type of first aid you give depends on:

• the cause of choking
• how well the person is breathing
• the age, size and condition of the person.

In many cases, an airway blocked by food or a foreign object can be cleared by abdominal thrusts (also known as the Heimlich Manoeuvre). If choking is caused by swelling of the airway from an infection, injury or allergic reaction, abdominal thrusts will not work. Get medical help quickly. Call 911 or the emergency number in your area.

If the choking person is conscious

If the person can cough forcefully, speak or breathe, encourage coughing. This may dislodge the object. If choking lasts for more than a few minutes, call 911 and get medical help. Do not slap the person on the back. This could drive the object down the airway.

If the choking person cannot cough forcefully, speak or breathe, use abdominal thrusts to try to remove the blockage.

How abdominal thrusts work

When you choke on something, your body tries to clear your airway by coughing. Abdominal thrusts try to do the same thing with an artificial cough. The illustration on the right shows how an abdominal thrust creates a cough.
An abdominal thrust pushes the diaphragm up towards the lungs very quickly - this forces air from the lungs up the airway and, hopefully, blows the object out. For the best effect, your fist has to be in the right place, the forearms off the abdomen and each thrust a strong and sudden movement.

Using Abdominal Thrusts (the Heimlich manoeuvre)

One
Stand behind, ready to support the person. Try to get a sitting person to stand up. If this is not possible, try reaching around from the back of the chair to give abdominal thrusts. If the choking person is a child, you may have to kneel so you are at the right height to perform abdominal thrusts.

Two
Find the correct hand position and give abdominal thrusts to try to remove the airway blockage.

Three
Keep performing abdominal thrusts until either the object is removed or the person becomes unconscious.

If the choking person becomes unconscious

One
If the casualty is or becomes unconscious, don't panic. Lower the collapsing person to the ground, remembering to protect the head and neck. Send someone to call 911 for medical help.

Two
Open the mouth and look for any foreign matter. If you see something, use a hooked finger to remove it. Open the airway and check breathing for no more than 10 seconds.

Hold the mouth open to see if you can spot a foreign object. Hook any foreign matter with your finger and pull it up against the near cheek - be careful, it may be sharp or slippery.Open the airway by tilting the head back. Placing your ear just above the person's mouth look, listen and feel for signs of breathing.

Three
Try to breathe into the casualty's mouth.

If the chest doesn't rise, reposition the head, check the seals at the nose and mouth and try again. If the chest does rise, give another breath and continue with artificial respiration.

If there is no pulse, begin CPR. (Both artificial respiration and CPR should be learned in an approved first aid course.)

If the chest doesn't rise on your second try, conclude the airway is blocked - try to clear the airway.

Four
Begin chest compressions. Landmark and give 15 compressions.

Kneel so your hands can be placed mid-chest. Locate the bottom edge of the rib cage, placing fingers of your hand closest to the person's feet - this is the landmarking hand.

Slide fingers to the notch where the ribs meet. Place the heel of the other hand midline on the breastbone above the fingers.

Place the landmarking hand on top and raise the fingers off the chest. Give compressions.

Five
Repeat steps 2, 4 and 4 until the chest rises when you blow into the casualty's mouth or medical help takes over. If the chest rises, go to the next step.

Six
If you remove the blockage, or if the chest rises when you ventilate, give a total of two slow breaths, then check breathing and pulse. If the person is breathing effectively, give ongoing care for choking as described on the next page.

First aid for a choking obese or pregnant person

If a choking person is very obese, abdominal thrusts will not be effective. In the late stages of pregnancy, abdominal thrusts may be harmful to the baby. Appropriate first aid treatment for these situations can be learned in a first aid course.

First aid for a choking child

One
Find out how badly the child is choking. Ask, "Are you choking?" If he can speak, breathe or cough, don't touch him. Tell him to try to cough up the object. If this partial blockage lasts for more than a few minutes, get medical help. If you think there might be poor or no air exchange, check by asking, "Can you cough?" If the child cannot cough, use abdominal thrusts to try to remove the blockage.

Two
Stand or kneel behind the child, ready to support him if he becomes unconscious. Find the correct hand position.

Find the tops of the hip bones. Kneel behind the casualty so you are at the right height.

Place your fist midline, just above the other hand.

Give abdominal thrusts to try to remove the airway blockage.

Hold the fist with the other hand and press inward/upward with a sudden, forceful thrust - this is an abdominal thrust.

Give each abdominal thrust with the intention of removing the object. Use only your fist - make sure you don't press against the ribs with your forearms.

Self-Help Abdominal Thrusts

If you begin to choke on an object, what should you do?

One
Don't panic, though it won't be easy. If there are others nearby, get their attention.
Grab your throat to show them you are choking. This is the universal sign of choking. Do not leave others when you are choking (e.g. do not go to the bathroom).

If you are alone and you are choking, you must get help quickly - you will be unconscious within minutes. Do whatever you must do to get someone's attention. Call 911.

Two
If you can cough forcefully, try to cough up the object. Do not allow anyone to slap you on the back.

Three
If you can't cough forcefully, breathe or speak, and there is no one else to give you abdominal thrusts, give them to yourself as shown. Use either your hands or a piece of furniture, whichever works best.

Make a fist, thumb-side in, midline on your abdomen just above your pelvis. Hold the fist with your other hand and pull inward/upward forcefully. Give yourself abdominal thrusts until you can cough forcefully, breathe or speak.

A second method is to use a solid object like the back of a chair, a table or the edge of a counter. Position yourself so the object is just above your pelvis. Press forcefully to produce an abdominal thrust - keep giving yourself thrusts until you can cough forcefully, breathe or speak.

Ongoing care for choking

Your job is not over when the airway blockage is removed and the airway has been cleared. The person may be conscious, semi-conscious or unconscious. Continue giving first aid as shown here.

The advice given in this article cannot, nor is it intended to, replace first aid skills that can only be learned in an approved first aid course. Sign up for a first aid course from your local St. John Ambulance Branch or other recognized organization.

ADAPTED FROM First on the Scene, a First Aid and CPR Training Manual published by St. John Ambulance, 2004 by J. E. Hutson, MB, ChB, former Provincial Medical Advisor, Alberta Council, St. John Ambulance in Edmonton, Alberta.