Choking (airway obstruction)

Signs: the person puts their hands to their throat, cannot speak, cough forcefully, or breathe; they may turn blue. If they are coughing forcefully, encourage them to keep coughing and do not intervene.

1. Ask "Are you choking?" If they nod and cannot speak, tell them you are going to help and ask someone to call 911.
2. 5 back blows: stand to one side and slightly behind, lean them forward supporting their chest with one arm, and deliver 5 firm blows between the shoulder blades with the heel of your hand.
3. 5 abdominal thrusts: stand behind, wrap your arms around their waist, place your fist (thumb side in) just above the navel, grasp it with your other hand, and pull inward and upward forcefully, 5 times.
4. Alternate 5 and 5 until the object comes out, the person can breathe or cough forcefully, or they lose consciousness.
5. If they lose consciousness: lower them carefully to the floor, call 911 if no one has, and start CPR. Before each breath attempt, look in the mouth and remove the object only if you see it.

• Advanced pregnancy or a very large person (you cannot reach around the waist): give chest thrusts, with your fist on the center of the breastbone, instead of abdominal thrusts.
• If you are alone and choking: call 911 (even if you cannot speak, leave the line open) and give yourself abdominal thrusts with your own fist, or press your abdomen hard against the back of a sturdy chair or the edge of a table.
• Anyone who received abdominal thrusts should be checked by a doctor afterward.