Your family members and friends are over for a cookout. The weather is gorgeous, the kids are playing, and there is a huge array of food for everyone to enjoy. It is a perfect day, at least until there is some type of commotion over by the platter piled with grilled steaks. Someone yells, “Help!,” and you rush over to see what is the matter. One of your neighbors is clutching his throat with both hands. His face is red, and he suddenly passes out and collapses to the ground. Everyone is in a panic. He’s choking. What do you do?

Clear the Way

A restricted airway can cause a person to pass out from a lack of oxygen. The universal sign that someone is choking is a person clutching his or her throat with both hands and the absence of breathing. The key is to keep the patient calm (which means you need to remain calm) and then conduct one of the maneuvers explained here.

The most well-known emergency procedure is the Heimlich maneuver. If someone is choking and he or she requires assistance, stand behind the individual and place one of your legs between his or her legs. This stabilizes the person in case he or she passes out. If this occurs, you can safely slide the choking victim down using your leg and lay him or her on the ground.

The universal sign that someone is choking is a person clutching his or her throat with both hands and the absence of breathing.

Make a fist with one hand, hold it against the choking victim (with your thumb toward his or her stomach), and grasp your fist with your other hand. Then continue to thrust inward and upward until the food is dislodged or the person passes out. If the choking victim is obese and you cannot get your arms around him or her, find a sturdy chair, lean the individual over the chair’s back, and place firm thrusts on his or her lower back to put pressure on the abdomen until the food is dislodged or the person passes out.

Passing Out from Choking

If the individual passes out, you will need to conduct chest thrusts and rescue breaths. Chest thrusts should be used for an obese individual if you are unable to encircle the person’s abdomen. If the choking victim is in the late stages of pregnancy, you should use chest thrusts instead of abdominal thrusts. Chest thrusts are less likely to cause regurgitation, so if you need to conduct them, place your hand in the same position as you would during CPR. And don’t forget to call or have someone call 911. It is important to get professional medical help on the way.

Abdominal thrusts are typically done to someone who is choking and conscious, but they can be done on an unconscious person too. Abdominal thrusts are not recommended for infants or children less than 1 year old. To perform abdominal thrusts on a conscious person, follow the steps in the Heimlich maneuver above. If the choking victim is unconscious, do the following:

  • Lay the individual flat on his or her back.
  • Straddle the person’s legs, facing his or her head.
  • Overlay your hands together, with your palms facing away from you.
  • Place your hands roughly above the individual’s belly button.
  • Thrust your arms and hands inward and upward. Repeat this five times.
  • Turn the choking victim on his or her side and conduct a mouth sweep with your finger. (Be careful not to lodge the obstruction deeper into his or her throat.)
  • Continue this until the obstruction is dislodged or help arrives.

Airway Management

Knowing how to manage someone’s airway is an important skill in more than just a choking emergency.

The Head-Tilt/Chin-Lift maneuver is the most common technique and is taught in all CPR courses. Simply place your hand closest to the patient’s head on his or her forehead and use your other hand to gently lift the chin. This will open the individual’s airway to initiate rescue breathing if needed.

The second technique is the Jaw-Thrust maneuver, which requires you to stand at the head of the victim, facing toward his or her feet. Place both of your hands behind the individual’s jaw and lift forward to open the airway. This method is preferred with an individual who has suffered a traumatic spinal injury, as you want to minimize moving the patient’s cervical spine as much as possible.

If the patient has serious facial injuries and neither of the above techniques can be used, use the nasopharyngeal airway, also known as an “NPA” or “nose hose.” This medical-grade soft tubing can be inserted into the nasal cavity to establish an open airway. The video above includes a short video presentation on how to use one, but there are a few things to keep in mind:

  • Make sure to have the appropriate tube length. To select the correct size, you want to measure the tip of the patient’s earlobe to the tip of his or her nose.
  • When it comes to tube diameter, you want the largest size that will fit into the nasal cavity. You can use the patient’s pinkie as a point of reference.
  • Use a water-based lubricant to prime the tubing. It will make inserting an NPA much easier for you and less traumatic for your patient.

Choking First Aid: It Doesn’t End Here

Reading this is not a replacement for the real-world medical training available at your local American Heart Association, fire department or community college. Seek further training whenever possible. You just never know when you might need to help a family member, a friend, a stranger or even yourself. Invest in your skills. Not only can you use them to save lives, but they’ll travel with you everywhere you go.

Mrs. Doubtfire to the Rescue

Few who have watched the 1993 film Mrs. Doubtfire can forget the scene in which Mrs. Doubtfire (Robin Williams) performs the Heimlich maneuver to save the life of his ex-wife’s boyfriend Stu (Pierce Brosnan) who is choking on a shrimp. Not long after the film was released, reports surfaced of children claiming this scene was how they knew how to help loved ones who were choking. In 1993, when 5-year-old Kristen Joosten, of Bellmore, New York, noticed her 2-year-old brother Craig choking on a piece of candy, she sprang into action, wrapping her arms around his stomach and forcing it out. The following year, 9-year-old Chris Brooks, of Rockford, Illinois, dislodged a fragment of Cheeto stuck in his 2-year-old brother Nate’s throat. More recently, in 2013, 7-year-old Amira Thornton, of Gresham, Oregon, saved her mother Jennifer’s life using the Heimlich maneuver to dislodge a piece of sausage in her throat.

— Frank Jastrzembski, Associate Editor