choking (adult basic life support)

Last reviewed 01/2018

Choking (adults)

Choking (airway obstruction by a foreign body) is an emergency situation which should not be confused with fainting, heart attack, seizure, or other conditions that may cause sudden respiratory distress, cyanosis, or loss of consciousness (1).

• general signs of choking (1)
• attack occurs while eating
• victim may clutch his neck

Airway obstruction caused by a foreign body may be mild or severe (1).

• signs of severe airway obstruction (1)
• in response to the Question ‘ Are you choking’
• victim unable to speak
• victim may respond by nodding
• other signs
• victim unable to breathe
• breathing sounds wheezy
• attempts at coughing are silent
• victim may be unconscious

• signs of mild airway obstruction (1)
• in response to the Question ‘ Are you choking’
• victim speaks and answers yes
• other signs
• victim able to breathe, cough and speak

Sequence for the treatment of adult choking is as follows (This sequence is also suitable for use in children over the age of 1 year) (1)

• if the victim shows signs of mild airway obstruction:
• encourage him to continue coughing, but do nothing else.
• if the victim shows signs of severe airway obstruction and is conscious:
• give up to five back blows.
• stand to the side and slightly behind the victim.
• support the chest with one hand and lean the victim well forwards so that when the obstructing object is dislodged it comes out of the mouth rather than goes further down the airway.
• give up to five sharp blows between the shoulder blades with the heel of your other hand
• check to see if each back blow has relieved the airway obstruction. The aim is to relieve the obstruction with each blow rather than necessarily to give all five.
• if five back blows fail to relieve the airway obstruction give up to five abdominal thrusts.
• stand behind the victim and put both arms round the upper part of his abdomen.
• lean the victim forwards.
• clench your fist and place it between the umbilicus (navel) and the bottom end of the sternum (breastbone).
• grasp this hand with your other hand and pull sharply inwards and upwards.
• repeat up to five times.
• if the obstruction is still not relieved, continue alternating five back blows with five abdominal thrusts
• if the victim becomes unconscious:
• support the victim carefully to the ground.
• call an ambulance immediately.
• begin CPR (from 5B of the adult BLS sequence). Healthcare providers, trained and experienced in feeling for a carotid pulse, should initiate chest compressions even if a pulse is present in the unconscious choking victim.

The foreign object may remain in the airway even after successful treatment for choking and may lead to complications later. Therefore patients with persistent cough, difficulty swallowing, or with the sensation of an object being still stuck in the throat should be referred for an immediate medical opinion.

Reference:

• (1) Resuscitation Council (UK). Resuscitation Guidelines 2010.