Get certified in CPR + First Aid for All Ages for just $39.95.
To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video
Now we’re gonna take a look at the conscious adult choking. Before we get started though, let’s talk about a few things. First, is the scene safe? Do we have our gloves available or on? And then secondly, do we have some way to access EMS via 911 or sending somebody like, "Hey, you in the plaid shirt, go call 911 and come back. I might need your help." And bring an AED if you find one. So these are some establishing things that should always be part of our rescue. And those are all taken care of now. Secondly, when we are looking at the patient, there's a few signs and symptoms that we're looking for to establish if the patient is actually choking and needs assistance. Are they coughing? Are they talking? Are they breathing? If they're not coughing or coughing well, if they're not breathing, and if they're not able to speak, those are three major signs that they truly have an obstructed airway and may need our help. If the person is coughing forcefully, we're just simply going to encourage them to keep coughing and hope that they can clear that object themselves. In the airway obstruction, we have a sign called the universal sign for choking, which is the hands around the throat sign. In my career, not everybody does this. Many times they just look panicked. They might want to leave the room, but this is indeed the universal sign for choking. Once we see this, the patient is not coughing, not breathing, not talking, we're going to establish contact and see if we can help them. Sir, are you okay? Are you choking? He refers to himself as a choking victim and he agrees he wants my help. That gives me permission to actually help him. From this point, I'm going to then bring my hand up like a seat belt across his chest where my hand is virtually on his collar bone. I'm going to lean the patient over. Remember, we're going to establish the location between the shoulder blades with the heel of one hand for the backs, the back blows. And we're going to give five back blows. Firm enough to be able to push a little bit of trapped air up and out of the trachea and the larynx to remove the obstruction, but not so hard that we hurt them. And here we go. Five back blows. One, two, three, four, five. After I complete those five back blows, I'm going to slide that cross arm down in front. As I find his belly button, I'm actually going to make a fist and then perch the fist onto the finger. Once I found the abdomen, I'm going to grab that fist and deliver five inward and upward abdominal thrusts. After I give one, two, three, four, five abdominal thrusts, I'm going to return to the arm across the chest, lean the victim over, palm between the shoulder blades, and repeat the process. Five more back blows, followed by five more abdominal thrusts. We're gonna continue this process until either the patient becomes unconscious, unresponsive, of which then we're going to help assist them to the floor and begin unconscious choking technique, or EMS arrives and takes over. I wanted to mention a very important special consideration as it relates to a pregnant woman who may be choking and conscious. It's important for us to understand that when a pregnant woman is in distress, there are two patients involved, the mother and the child. And it's important for us to save the mother's life so as to save the child's life. Now that also includes not doing any further harm whenever possible. So like in a conscious choking victim where we normally do abdominal thrusts obviously if the baby is in womb and developed to a point where it's higher in the uterus any type of abdominal thrust could cause potential risk to mother and baby by rupturing the placenta hurting the baby internally. It's important for us to modify then, our means of actually removing the obstructed airway without causing further damage which we're going to demonstrate now. So in the pregnant female, we're still going to perform the crossbody support leaning the patient over and followed by the five back blows like in the non-pregant choking adult. But the difference here is that when we find ourselves behind the choking victim, we need to make sure that we're not pressing on the baby or the placenta, we want to go above that by going under the breast with the the fist on the center of the sternum. The other hand is going to cup the actual fist that we're making and we're going to do inward thrusts on the sternum. So those are then chest thrusts from standing from behind five times pushing air up the airway out of the trachea in hopes to remove the obstructed airway. If that doesn't work, we're going to go back to the back blows. Five back blows with the support across the chest followed again by the five chest thrusts with the fist on the center of the chest on the sternum. We're going to continue this five back blows, five chest thrusts on the pregnant female until they either go unresponsive, unconscious, or help arrives via EMS.
This conscious adult choking lesson is for situations where you can see that an adult is choking and he or she is conscious. The choking victim will usually be exhibiting some unmistakable signs, including:
Another sign to look for is the universal sign for choking – when the victim places both of their hands around their throat.
The good news is that, even when dealing with a full obstruction, in most situations the obstruction will come out if you perform the back blows and abdominal thrusts correctly.
Pro Tip #1: Only worry about calling 911 and activating EMS if doing so is quick and easy, or there is another person nearby that can call. Otherwise, don't waste time calling 911 and go right into assessing and rescuing the victim.
The first thing you want to do is face the person and look them in the eyes. You want confirmation that the victim is choking, and you want to receive permission to help the person.
"Are you choking?"
The person will probably nod yes.
"May I help you?"
You'll likely get another nod. If the victim is conscious, it's always a good idea to get permission and it only takes a second.
Pro Tip #2: Make sure you stay below the bottom tip of the rib cage (xyphoid process) and above the belly button (navel). This is the diaphragmatic region where you'll be performing the abdominal thrusts.
Pro Tip #3: It's important to turn your hands upward as you perform each thrust, as this will bring the diaphragm up and in and compress the lower lobes of the lungs, forcing air to shoot up the trachea and pop the obstruction out. This works in the majority of choking situations.
If you called 911, let them come anyway, so the person can be examined. EMS responders can check the choking victim's airway and listen to their lungs to make certain that there are no partial obstructions remaining. Advanced medical evaluation is still usually encouraged to ensure there is no interal injuries.
If you did not call 911, it's always a good idea to encourage the choking victim to see his or her own doctor to make sure everything is OK.
If you weren't able to remove the obstruction using the abdominal thrust technique, the victim will go unconscious pretty quickly. Help lower them to the ground, so they don't fall and injure themselves. Call 911 immediately and activate EMS or call in a code if in a healthcare setting. Then begin performing the unconscious adult choking procedure.
It's important to remember that when treating a pregnant woman, regardless of the situation, you're actually treating two patients. Saving mom is always the priority, as saving mom will also save the baby. So, be just as aggressive in your treatment.
However, you don't want to injure the baby while performing the abdominal thrusts. Which is why you'll be using a different area for the thrusts – directly under the breasts and on top of the sternum. Therefore, if the 5 back blows do not work perform 5 chest thrusts. Switch between back blows and chest thrusts until the object is dislodged, the victim loses consciousness or trained rescuers take over.
Pro Tip #4: Besides the point of thrusting, there is only one other difference when dealing with an adult choking victim who's pregnant. The thrusts will be inward only; not up and in.
There are two types of airway obstructions – anatomical and mechanical, also referred to as Foreign Body Airway Obstruction (FBAO).
Anatomical obstructions occur when a part of the victim's anatomy is causing the blocked airway. It could be due to the tongue, swollen mouth tissues, or a swollen throat.
The tongue is the most common type of anatomical obstruction, as it relaxes in unconscious victims when their bodies are deprived of oxygen. Because the tongue tends to relax on the back of the throat in these situations, it can block airflow to the lungs.
Mechanical or FBAO obstructions include food, toys, and liquids. Poorly chewed food is the biggest culprit – eating too fast and/or laughing, talking, or running while eating can contribute to choking. And with small children, it's no surprise that toys are also a common choking obstruction.