BLS Certification Manual: Choking Procedures for Adults & Children

CONSENT

Prior to performing any choking procedure, the rescuer should obtain the victim’s consent by asking, “Are you choking?” If there is no response or an affirmative nod, then the rescuer should proceed. If a victim is choking but still able to breathe, the appropriate first action is to instruct the victim to forcibly cough. If the victim cannot cough effectively, the rescuer should perform back blows before proceeding to the Heimlich maneuver. If the victim cannot breathe, start the Heimlich maneuver.

Common Symptoms:   Gasping for air, Inability to speak, Face and neck turning blue, Wheezing, Panic, Fainting

BACK BLOWS

Back blows are a technique used to help a choking victim when a foreign object is blocking the airway. To perform back blows, the rescuer should stand slightly to the side and behind the victim to provide support. The rescuer places one arm across the victim’s chest and leans the victim forward so the upper body is angled toward the ground. This position helps gravity assist in removing the obstruction. Using the heel of the free hand, the rescuer delivers firm blows between the victim’s shoulder blades. Each blow should be delivered with enough force to attempt to dislodge the object from the airway. Back blows should be repeated until the obstruction is removed or the victim becomes unresponsive. Signs that the choking hazard has been relieved include the victim beginning to breathe normally, visible chest rise with breathing, coughing, or the foreign object being expelled. If the victim becomes unresponsive, the rescuer should carefully lower the victim to the ground and begin CPR.

HEIMLICH MANEUVER (ABDOMINAL THRUSTS)

The most common maneuver used for an adult choking victim is the Heimlich maneuver. To perform the Heimlich maneuver, the rescuer stands behind the victim with their arms wrapped around the victim’s abdomen. The rescuer takes one hand and makes a fist placing the fist (thumb-side) into the abdomen just above the navel. The other hand will be placed on top of the fist and a thrusting motion should be performed until the object is dislodged or the victim becomes unresponsive. To perform abdominal thrusts, the rescuer should reach around the person's waist, position a clenched fist above the navel and below the rib cage, and pull the fist sharply and directly backward and upward under the rib cage. Several signs that the choking hazard is over are if the rescuer can feel breathing, see chest rise with breathing or see the removed foreign object. If the victim becomes unresponsive, the rescuer should move the victim to the ground and begin CPR.

SPECIAL CONSIDERATIONS FOR PREGNANT OR OBESE VICTIMS