Choking
Tell a mild blockage from a severe one, and clear a severe one in an adult with back blows and abdominal thrusts.
Mild or severe?
Mild blockage
They can cough forcefully, speak and breathe. Air is still getting past the object, and a strong cough is the best tool there is for pushing it out.
Severe blockage
They can't speak, the cough is weak or silent, they can't breathe or breathe with a high-pitched noise, may clutch their throat, and may turn pale or blue. Ask "Are you choking?" A nod with no voice means act now.
Check yourself
Mild or severe blockage?
- Coughing loudly and saying "it went down the wrong way"
- Nods when asked if they're choking, but makes no sound
- Red in the face, coughing hard, breathing between coughs
- Clutching the throat, lips turning blue
- A weak, silent cough and no breath coming in
- Can answer "yes, I'm okay" between coughs
Show the answer
Mild: encourage coughing: Coughing loudly and saying "it went down the wrong way", Red in the face, coughing hard, breathing between coughs, Can answer "yes, I'm okay" between coughs
Severe: act now: Nods when asked if they're choking, but makes no sound, Clutching the throat, lips turning blue, A weak, silent cough and no breath coming in
MILD BLOCKAGE
Let the cough do the work
If they can cough forcefully, encourage them to keep coughing. Don't slap their back, don't give them water or bread to push it down, and don't put your fingers in their mouth: any of these can turn a partial blockage into a complete one. Stay with them and watch. If the cough gets weak or they can't breathe or speak, it has become severe, and you act.
"Keep coughing, you're doing well, I'm right here." Calm words help: panic makes breathing harder.
Check yourself
At a family lunch, Parisa is coughing hard after a bite of kebab. Between coughs she says, "I'm okay, it went down the wrong way." What should you do?
- Give her five firm back blows straight away
- Hand her a glass of water to wash it down
- Encourage her to keep coughing and stay with her
- Start abdominal thrusts
Show the answer
Encourage her to keep coughing and stay with her
Right. She can speak and cough forcefully, so it's a mild blockage and her cough is the best tool. Stay with her and watch: act only if the cough gets weak or she can't breathe.
Severe choking in an adult or a child over 1
- Get help coming
Have someone call the emergency number, or call on speaker yourself, but don't let it delay the next steps.
- Up to 5 back blows
Stand to the side and slightly behind them. Support their chest with one hand and lean them well forward, so the object comes out of the mouth rather than going further down. Give up to 5 firm blows between the shoulder blades with the heel of your other hand. Check after each one: stop as soon as it clears.
- Up to 5 abdominal thrusts
If it's still stuck, stand behind them and put your arms around the upper abdomen. Make a fist and place it just above the navel, well below the breastbone. Grab it with your other hand and pull sharply inwards and upwards, up to 5 times, checking after each one.
- Alternate
Still blocked? Keep alternating 5 back blows and 5 abdominal thrusts until it clears, help arrives, or they become unresponsive.
Check yourself
Reza is choking on a piece of apple and can't make a sound. You've given 5 back blows and it's still stuck. What next?
- Give him a glass of water
- Up to 5 abdominal thrusts, then keep alternating with back blows
- Sweep your fingers deep in his mouth to find it
- Keep giving back blows only, as many as it takes
Show the answer
Up to 5 abdominal thrusts, then keep alternating with back blows
Yes. Back blows first, then up to 5 abdominal thrusts, then alternate 5 and 5 until it clears, help arrives or he becomes unresponsive.
IF THEY COLLAPSE
From choking to CPR
If they become unresponsive, lower them carefully to the floor, make sure the emergency number has been called, and start CPR (lesson 04). Chest compressions can also help push the object out. If you see an object in the mouth that you can clearly get hold of, remove it, but never do blind finger sweeps: poking around where you can't see can push it deeper.
Kian's grandfather goes limp while choking. Kian eases him down to the floor, shouts to his sister to call 115, and starts pushing on the chest.
Check yourself
Daniyal choked on a piece of meat. After two abdominal thrusts it came out, and now he's laughing and wants to finish dinner. What should happen?
- Nothing: the object is out, so he's fine
- He should drink some water and rest for ten minutes
- He should be checked by a doctor, even though he feels fine
- He should only see a doctor if he starts coughing again
Show the answer
He should be checked by a doctor, even though he feels fine
Right. Abdominal thrusts can cause internal injuries that don't show straight away, so a medical check is part of the treatment, not an optional extra.
BABIES UNDER 1
Never abdominal thrusts on a baby
For an infant under one year with a severe blockage, never use abdominal thrusts. Instead: lay the baby face down along your forearm, head lower than the body, supporting the jaw with your hand, and give up to 5 back blows between the shoulder blades. If that fails, turn the baby face up along your other forearm, head low, and give up to 5 chest thrusts with two fingers on the centre of the chest. Keep alternating and get help coming.
This is one to practise on an infant manikin in a course: the grip and the force are hard to picture from words alone.
Check yourself
Abdominal thrusts are safe to use on a baby under one year old.
Show the answer
False
False. Babies under one get back blows (face down along your forearm) and chest thrusts with two fingers (face up), never abdominal thrusts.
Lesson recap
- Mild: they can cough, speak and breathe. Encourage coughing, stay with them, no slaps, water or fingers.
- Severe: can't speak, weak or silent cough, can't breathe. Ask "Are you choking?" and get help coming.
- Adults and children over 1: up to 5 back blows, leaning them forward, then up to 5 abdominal thrusts, fist just above the navel, in and up. Alternate.
- If they become unresponsive: to the floor, call, start CPR. No blind finger sweeps. Anyone given abdominal thrusts sees a doctor.
- Babies under 1: back blows and two-finger chest thrusts, never abdominal thrusts.