Choking Response

Mild Obstruction

• Can speak, cry, or cough forcefully
• May be wheezing
• Able to breathe (though difficult)
• Clutching throat but still making noise

Action: Encourage coughing. Stay with them. Monitor for worsening. Do NOT intervene yet.

Severe Obstruction

• Cannot speak, cry, or make sounds
• Cannot breathe or only minimal breathing
• Weak or silent cough
• Clutching throat (universal sign)
• Blue/gray lips or nail beds (cyanosis)
• Panic, wide eyes, desperate expression
• Loss of consciousness

Action: Immediate Heimlich maneuver (abdominal thrusts).

Conscious Patient

1. Position: Stand behind person, wrap arms around their waist
2. Make fist: Place thumb side of fist against abdomen, midline, ABOVE navel but BELOW ribs
3. Grasp fist: Place other hand over fist
4. Thrust: Quick, forceful, INWARD and UPWARD motion
5. Repeat: Continue until object expelled or person becomes unconscious

Each thrust should be distinct and deliberate, not continuous. Pull IN and UP to force air from lungs to dislodge object.

If Person Becomes Unconscious

1. Lower carefully to ground, on back
2. Call 911 or direct someone to call
3. Begin CPR: Start with chest compressions
4. Check mouth: Before each breath, look in mouth. If you SEE object, remove it with finger sweep.
5. Never blind sweep: Only remove if visible - blind sweeps can push object deeper
6. Continue CPR until help arrives or person recovers

Chest compressions can generate enough force to dislodge airway obstruction. The object may come out during compressions.

Back Blows and Chest Thrusts

1. Position: Hold infant face-down on your forearm, head lower than body
2. Support: Support head with your hand, jaw forward, keep head angled down
3. Rest your forearm on your thigh for stability
4. 5 back blows: Firm blows between shoulder blades with heel of your hand
5. Turn over: Carefully flip infant to face-up, still head-down, on your other forearm
6. 5 chest thrusts: Use 2 fingers in center of chest (same location as CPR), compress about 1.5 inches
7. Repeat: Alternate 5 back blows, 5 chest thrusts until object expelled or infant unconscious

Do NOT use abdominal thrusts on infants - organs are not protected by ribcage yet.

If Infant Becomes Unconscious

1. Begin infant CPR
2. Before each breath, check mouth for visible object
3. Remove only if visible
4. Continue CPR

Heimlich on Yourself

1. Make fist, place above navel below ribs
2. Grasp with other hand
3. Thrust inward and upward forcefully

Using Furniture

1. Find chair back, countertop edge, railing, or similar
2. Position edge against upper abdomen, below ribs
3. Lean forward and thrust your body weight against edge
4. Repeat forcefully until object dislodged

Source: Any firm edge at waist height works. Chair backs, tables, countertops, fences.

Call for Help

If possible, call 911 even while choking. Put on speaker. Pound on wall/floor to attract attention. Open front door so responders can enter.

Pregnant or Obese Person

Abdominal thrusts may not be effective or safe. Use CHEST THRUSTS instead:

1. Stand behind, wrap arms under armpits around chest
2. Place fist on center of chest, between breasts (same location as CPR)
3. Grasp fist with other hand
4. Thrust straight backward (not upward)

Wheelchair User

If possible, have person lean forward. Perform Heimlich from behind or to the side. If chair has removable armrests, remove for better access. For chest thrusts if needed.

Tracheostomy

Person with trach (breathing hole in neck) may need suctioning or tube change, not Heimlich. If they have spare tube, assist with change. If tube blocked and removable, remove it. If new tube not available, may need to breathe through stoma (hole). CPR breaths would go through neck hole, not mouth.