Adult Choking Facts

• Occurs primarily during eating.
• Mainly occurs in the upper airway.
• Early recognition will increase chances of obstruction removal.
• Relieved primarily by alternating back blows and abdominal thrusts (Heimlich maneuver).

Foreign Body Airway Obstruction (FBAO)

FBAO is a preventable cause of death and one of the least common. When there is choking, however, the most common cause in adults is FBAO, which is caused by food becoming lodged in the upper airway, such as steak or chicken.

SIGNS OF CHOKING

A person may begin to cough at first. If they are able to cough, encourage them to continue doing so to try and clear the obstruction. Some signs of a person choking are:

• Universal sign for choking (hands around their throat).
• Silent coughing.
• Being unable to talk or breathe.
• Cyanosis or skin color turning blue.

The Heimlich Maneuver and Back Blows

Once the universal sign for choking is recognized and the patient verifies that they are choking and cannot cough effectively, alternating between abdominal thrusts (the Heimlich maneuver) and back blows is the approved method for assisting the patient, possibly with some variations depending on patient size.

Technique and Special Considerations

TECHNIQUE:

Give sets of back blows and abdominal thrusts until one of two things occurs:

1. The object is cleared from the airway AND the patient is able to breathe normally; or
2. The patient becomes unresponsive.

To give BACK BLOWS:

• Stand slightly behind and to the side of the patient, and have them lean forward so the mouth is angled toward the ground.
• Using the heel of your hand, deliver 5 firm back blows between the shoulder blades to try to dislodge the object.

To give ABDOMINAL THRUSTS (HEIMLICH MANEUVER):

• Stand behind the patient and wrap your arms around their upper abdomen.
• Make a fist with one hand and place it just above the navel, then grasp that fist with your other hand.
• Deliver 5 quick, inward and upward thrusts into the abdomen.

Continue to alternate sets of 5 back blows AND 5 abdominal thrusts until the object is expelled or the patient becomes unresponsive.

If the patient is able to clear their airway, they should then seek medical attention to be evaluated for upper airway injury or to ensure there isn't any object still remaining in the airway.

If the patient becomes unresponsive while performing back blows and abdominal thrusts, carefully lay them down on a hard, flat surface and open their mouth to see if the object is visible to take out. If not, begin chest compressions and follow the steps for CPR. However, when breaths are to be given, look first to see if the object has dislodged and become visible to where you can retrieve it.

Do not perform a blind finger sweep. That is where you stick your finger into their mouth beyond where you can visualize. This could further wedge the object into the upper airway causing more harm. It can also stimulate a vagal response which would be counterproductive.

If breaths will not go in, continue doing chest compressions per the BLS algorithm and recheck the airway prior to attempting additional ventilations.

CAVEAT Per the American Heart Association:

"Chest thrusts should be used for obese patients if the rescuer is unable to encircle the victim's abdomen. If the choking victim is in the late stages of pregnancy, the rescuer should use chest thrusts instead of abdominal thrusts."