The immediate first aid for choking involves a sequence of actions designed to dislodge the obstruction from the person's airway. Rapid assessment and intervention are crucial to prevent the situation from becoming life-threatening.
Recognizing Choking
It's vital to quickly identify whether someone is truly choking and if it's a mild or severe obstruction.
Signs of Choking:
- Mild Choking:
- Able to cough forcefully.
- Can speak, cry, or make sounds.
- May be able to breathe.
- Severe Choking (Complete Airway Obstruction):
- Unable to cough, speak, or breathe.
- May clutch their throat (universal choking sign).
- Skin may turn blue (cyanosis) due to lack of oxygen.
- May become unconscious.
First Aid Steps for a Conscious Adult or Child with Severe Choking
If a person is conscious but experiencing severe choking (cannot cough, speak, or breathe), follow these steps immediately:
1. Encourage Coughing
If the person is still able to cough, even weakly, encourage them to keep coughing forcefully. A natural cough is often the most effective way to clear a partial obstruction.
2. Administer Back Blows
If coughing doesn't work or the person is unable to cough, proceed with back blows:
- Positioning: Stand slightly to the side and behind the person. For an adult, support their chest with one hand and lean them forward. This helps gravity assist in dislodging the object and prevents it from going further down the airway.
- Execution: With the heel of your other hand, deliver up to five sharp blows between their shoulder blades.
- Check After Each Blow: After each blow, check if the obstruction has cleared. The goal is to clear the airway with as few interventions as possible.
3. Perform Abdominal Thrusts (Heimlich Manoeuvre)
If five back blows do not dislodge the blockage, immediately move on to abdominal thrusts:
- Positioning: Stand behind the person and wrap your arms around their tummy.
- Hand Placement: Make a fist with one hand and place it just above the person's navel, below their breastbone. Grasp your fist with your other hand.
- Execution: Pull your hands sharply inwards and upwards, as if trying to lift the person. This creates a forceful expulsion of air from the lungs, which can dislodge the obstruction.
- Repetition: Repeat this action up to five times.
4. Alternate Back Blows and Abdominal Thrusts
If the obstruction remains after five back blows and five abdominal thrusts, continue to alternate between these two techniques until the blockage is cleared or emergency medical help arrives. The sequence is: 5 back blows, then 5 abdominal thrusts, then 5 back blows, and so on.
What to Do If the Person Becomes Unconscious
If the person becomes unconscious at any point while you are performing first aid:
- Lower to Ground: Carefully lower them to the floor.
- Call Emergency Services: Immediately call for emergency medical help (e.g., 999 in the UK, 911 in the US).
- Start CPR: Begin Cardiopulmonary Resuscitation (CPR) if you are trained, starting with chest compressions. Check the mouth for the object before each rescue breath.
Important Considerations
- Call for Help: If you are alone, perform the initial first aid sequence (back blows and abdominal thrusts) for about one minute before calling emergency services yourself. If someone else is present, have them call immediately.
- Pregnant Individuals/Very Large People: For pregnant individuals or very large people where abdominal thrusts are difficult, perform chest thrusts instead. Place your hands on the breastbone, similar to CPR compressions, and deliver sharp inward thrusts.
- Infants (Under 1 Year): The technique for infants is different, involving back blows and chest thrusts while supporting their head and neck. Do not perform abdominal thrusts on infants.
- Medical Follow-up: Even if the obstruction is successfully removed and the person appears fine, they should still be medically assessed to ensure there is no damage to the airway or other internal injuries, especially after abdominal thrusts.
By following these steps, you can effectively provide immediate life-saving assistance to someone who is choking.
