CPR + First Aid Certification Manual: Choking Procedures for Adults & Children

First Aid: Adult Choking Procedures

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


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.


Abdominal thrusts are not recommended for pregnant women. The Heimlich maneuver can be modified upward so that the victim receives chest thrusts instead. Chest thrusts should be delivered over the sternum, avoiding the xiphoid process (a small extension on the lower part of the sternum). Also, in the case of obese individuals, chest thrusts are preferred if the rescuer cannot fully reach around the abdomen.

1. Ensure scene safety
2. Ask the victim, "Are you choking?"
3. If there is no answer or an affirmative nod, instruct the victim to forcibly cough
4. If the victim cannot breath or need further assistance, perform with the Heimlich maneuver (or, chest thrusts for pregnant or obese victims)
5. If the victim becomes unresponsive, lower him/her to the ground and check his/her airway and remove the foreign body if easily viewable and removable (never perform a blind finger sweep)
7. Dial 911 and Perform CPR if necessary