Adult Choking Relief Techniques for Emergency Response
Author:
CPR Select
Last updated:
10/31/2025
Choking is a potentially life-threatening situation that occurs when an object becomes lodged in the throat, blocking the airway and making it difficult for the person to breathe. Swift and effective action is crucial to preventing severe injury or death. This comprehensive guide outlines the steps to take when responding to choking incidents involving adults.
Choking is the fourth leading cause of unintentional injury death overall, with the risk rising sharply in adults over the age of 70. Choking in adults occurs when a foreign object obstructs the airway, preventing airflow into the lungs. This can happen while eating, drinking, or inhaling small objects or substances. Knowing how to respond to a choking adult can mean the difference between life and death.
What to do if someone is choking?
The 2025 American Heart Association (AHA) Guidelines now recommend a unified approach for managing choking (foreign-body airway obstruction) in conscious adults and children. The focus is on alternating back blows and abdominal thrusts until the object is expelled or the victim becomes unresponsive.
Assess the Situation: Determine if the person can breathe, speak, or cough. If they can cough forcefully, encourage them to continue.
If Partial Obstruction: Do not intervene; encourage continued coughing and monitor closely.
If Complete Obstruction: The person cannot breathe, cough, or speak, and may appear cyanotic or clutch their throat.
Call for Help: Have someone call emergency services (e.g., 911) immediately.
Alternate 5 Back Blows and 5 Abdominal Thrusts: Deliver 5 firm back blows between the shoulder blades using the heel of your hand, then perform 5 quick upward abdominal thrusts just above the navel. Continue alternating until the object is expelled or the person becomes unresponsive.
If the Person Becomes Unresponsive: Gently lower them to the ground, call for help if not already done, and begin CPR starting with chest compressions. Before rescue breaths, open the airway and remove any visible obstruction. Do not perform blind finger sweeps.
Why the Guideline Changed:
The 2025 AHA update reflects evidence showing that alternating 5 back blows and 5 abdominal thrusts is more effective than abdominal thrusts alone in relieving airway obstruction. This combined approach increases the chance of dislodging the object while minimizing injury risk. The update also reinforces the importance of recognizing early signs of choking, calling for help immediately, and initiating CPR if the person becomes unresponsive.
1. Assess the Situation
First, quickly determine if the person can speak, cough, or breathe. If they can cough forcefully or make any sound, the airway is only partially blocked. Encourage them to keep coughing to expel the object on their own. Avoid interfering or performing any thrusts at this stage, as unnecessary actions may worsen the obstruction.
According to ILCOR and ERC guidelines, early recognition of obstruction severity is critical to prevent hypoxia and potential death. If in doubt, treat as severe to prevent delays.
2. Identify if the Obstruction Is Complete
If the person cannot breathe, speak, or make any noise, and you see them clutching their throat or turning blue, this indicates a complete airway obstruction. Immediate action is required to prevent respiratory arrest. Stay calm but act quickly.
3. Call for help
If another person is nearby, ask them to call emergency services (911 or your local emergency number) and get ready to assist. If you’re alone with an adult victim, call for help first before providing care. For children or infants, provide about two minutes of care before leaving to call for help.
4. Perform 5 Back Blows
Stand slightly behind and to the side of the choking victim.
Support their chest with one hand while leaning them forward at the waist so that gravity helps clear the airway.
Using the heel of your free hand, deliver five firm back blows between the shoulder blades.
After each blow, check whether the obstruction has been cleared.
5. Perform 5 Abdominal Thrusts
If back blows do not clear the obstruction, stand behind the person and wrap your arms around their waist.
Make a fist with one hand and place it just above the navel, keeping away from the lower tip of the breastbone.
Grasp your fist with your other hand and deliver quick, inward and upward thrusts toward the diaphragm.
Perform five abdominal thrusts
Alternate between five back blows and five abdominal thrusts until the object is expelled or the person becomes unresponsive.
6. If the Person Becomes Unresponsive
If the choking person becomes unconscious, carefully lower them to the ground and start CPR immediately. Begin with 30 chest compressions, followed by 2 rescue breaths. Before giving breaths, quickly look inside the mouth and remove any visible obstruction. But never perform a blind finger sweep. Continue CPR until the person starts breathing, an AED becomes available, or emergency medical responders arrive.
Whether the obstruction is successfully relieved or professional help arrives, remain with the choking adult. Continue providing support and reassurance until the situation is fully resolved. Your presence and care can make a significant difference in their well-being during this critical time.
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How Does CPR Differ in an Unresponsive Adult Choking Victim?
When performing CPR on an unresponsive adult choking victim, some adjustments are necessary due to the potential airway obstruction.
Airway Check: Quickly check for any visible obstruction in the throat. Only attempt to remove an object with a finger sweep if it is clearly visible and easily reachable. Never perform a blind finger sweep.
Chest Compressions: Perform 30 chest compressions followed by 2 rescue breaths, checking the airway for a visible object each cycle.
Monitoring Airway: While performing compressions, periodically reassess the airway. Remove visible objects if safely possible, but prioritize chest compressions over rescue breaths if the object cannot be easily removed.
Professional Help: Continue CPR and airway checks until emergency responders arrive. Advanced medical personnel may use specialized tools or intubation to clear the airway if standard measures fail.
The primary goal of CPR in a choking victim is to maintain blood circulation and oxygenation to vital organs. Rescue breaths are important for trained rescuers, but chest compressions take precedence when the airway is obstructed. Effective early interventions, like abdominal and back thrusts, remain crucial for the best outcome.
What are the Risks of Choking?
Choking incidents in adults can occur due to various factors, often resulting from a momentary lapse in chewing or swallowing properly. Some common causes and situations that lead to choking include:
Eating Too Quickly or Not Chewing Thoroughly: Adults who eat too quickly or fail to chew their food adequately increase the risk of larger food particles becoming lodged in their throats.
Consuming Tough or Dry Foods: Foods that are tough, dry, or sticky, such as meat, bread, or peanut butter, can pose a choking hazard, especially if not chewed thoroughly.
Eating While Distracted: Engaging in conversation, laughing, watching TV, or using electronic devices while eating can lead to distracted swallowing and increase the risk of choking.
Alcohol and Drug Use: Intoxication or drug use can impair coordination and increase the likelihood of choking while eating or consuming substances.
Elderly Population: Older adults often face increased risks due to weakened muscles, dental issues, and medical conditions that affect swallowing.
Medical Conditions: Certain conditions, such as dysphagia (difficulty swallowing), neurological disorders, and GERD (gastroesophageal reflux disease), can contribute to choking incidents.
What are the signs that someone is choking?
Identifying the physical signs and behaviors that indicate a person is choking is crucial for ensuring prompt intervention and potentially saving a life. Some common signs that suggest a person is choking include:
Inability to speak
Clutching the throat
Fear or panic in their facial expressions
Ineffective coughing accompanied by a wheezing or high-pitched noise while inhaling.
Cyanosis
Inability to breathe
Agitation or aggressive gestures
What Does CPR Select Suggest to Prevent Choking in Adults?
Choking incidents can often be prevented through awareness, proper food preparation, mindful eating habits, and safe behaviors. Here are some practical tips and precautions to reduce the risk of choking:
Cut food into small, bite-sized pieces, especially for foods like meat, fruits, and vegetables.
Be cautious with foods that are round and have the potential to block the airway, such as whole grapes, cherries, and nuts.
Ensure that foods are properly cooked, avoiding overly tough or undercooked items.
Take your time while eating. Chew your food thoroughly before swallowing.
Focus on chewing and swallowing before engaging in conversation or laughter.
Take small bites and avoid stuffing your mouth with too much food at once.
Maintain an upright posture while eating to aid in proper swallowing.
Avoid eating while walking or in a moving vehicle: These situations can increase the risk of choking due to jostling or lack of focus.
Be cautious with dental devices. Dentures or dental appliances can affect chewing and swallowing. Ensure they fit properly.
By following these practical tips and precautions, you can significantly reduce the risk of choking incidents and create a safer eating environment for yourself and those around you.
What is LifeVac?
LifeVac is a device designed to assist in removing airway obstructions when traditional methods, like back blows and abdominal thrusts, are ineffective. It creates suction to dislodge objects from the airway. Evidence for routine use is limited, and it should only be used after standard first-aid techniques and according to organizational or local policy. It is not a replacement for proper first-aid training.
Are there any risks associated with performing abdominal thrusts on a choking adult?
Yes. While abdominal thrusts are effective, they can cause injury, especially in elderly adults or those with medical conditions. Risks include rib fractures, internal injury, or soft tissue damage. Use controlled, firm pressure, and follow proper technique.
Can I perform abdominal thrusts on myself if I am choking and alone?
Yes. Self-administered abdominal thrusts can help if alone:
Place a fist just above your navel, grasp it with the other hand, and push inward and upward.
Alternatively, lean over a sturdy object (back of a chair or countertop) and press your upper abdomen firmly.
Are there differences in performing choking first aid on an adult vs. an infant?
Yes. Infants receive back blows and chest thrusts instead of abdominal thrusts. Familiarize yourself with both adult and infant techniques to be prepared for all scenarios.
How do I assist a choking pregnant or obese person?
For pregnant or obese adults, chest thrusts are preferred over abdominal thrusts. Stand behind the person, place your hands on the center of the chest (just above the sternum), and push inward and upward repeatedly until the obstruction is cleared or the person can breathe.
When should I call emergency services for a choking victim?
Call immediately if the person cannot clear the obstruction, cannot breathe, or loses consciousness. If trained, start CPR for unresponsive victims while waiting for help. Timely action is critical to prevent severe complications.
Are there legal protections for helping a choking person?
Many regions have Good Samaritan laws, protecting bystanders who provide reasonable emergency assistance in good faith, as long as aid is within their knowledge or training.
Is it necessary to take a BLS training course to be prepared for choking emergencies?
While it's not mandatory, taking a BLS training course can greatly enhance your ability to respond effectively in choking emergencies and other life-threatening situations. BLS courses provide hands-on training, simulations, and certification that can give you the confidence and skills needed to save lives.
