Relief of Choking
A foreign-body airway obstruction can kill within minutes, but the response depends on whether the obstruction is mild or severe and whether the victim is responsive. The BLS exam expects you to distinguish these situations and act correctly for adults, children, and infants.
Mild versus severe obstruction
With a mild (partial) obstruction, the victim can still cough forcefully, speak, or breathe — stand by, encourage continued coughing, and do not interfere, because a strong cough is more effective than any maneuver. A severe obstruction is signaled by a silent cough, inability to speak or breathe, high-pitched or no sound, cyanosis, and often the universal choking sign (hands clutching the throat). Severe obstruction demands immediate action.
Maneuvers by age and responsiveness
For a responsive adult or child with severe obstruction, give cycles of 5 back blows followed by 5 abdominal thrusts until the object is expelled or the person becomes unresponsive; for a pregnant or very large person, use chest thrusts instead of abdominal thrusts. For a responsive infant, give cycles of 5 back blows followed by 5 chest thrusts with the heel of the hand — never abdominal thrusts, which can injure abdominal organs. If a choking victim becomes unresponsive, activate emergency response and begin CPR starting with compressions; in infants and children, do not stop for a pulse check. Before giving breaths, look in the mouth and remove an object only if you can see it — never perform a blind finger sweep.
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