Person, Currently Choking
Foreign body airway obstruction, back blow mechanics, and abdominal thrusts
// IMMEDIATE ACTIONS
Execute these steps in order:
- 01 ASSESS SEVERITY AND ENCOURAGE COUGHING
Determine if the airway obstruction is mild or severe:
Mild Obstruction (Can speak/cough) Encourage continuous coughing; do NOT perform back blows or thrusts.Severe Obstruction (Cannot speak/cough) Proceed immediately to back blows and abdominal thrusts. - 02 DELIVER 5 SHARP BACK BLOWS
Deliver sharp blows between the shoulder blades:
- ├─ Stand slightly behind and to the side of the person.
- ├─ Support their chest with one hand and lean them well forward.
- └─ Deliver up to 5 sharp blows between the shoulder blades with the heel of your other hand.
- 03 DELIVER 5 ABDOMINAL THRUSTS (HEIMLICH)
If back blows fail, perform abdominal thrusts:
- ├─ Stand behind the person and wrap both arms around their upper abdomen.
- ├─ Clench a fist and place thumb side against their abdomen, between navel and ribcage.
- └─ Grasp fist with your other hand and pull sharply inward and upward up to 5 times.
- 04 REPEAT 5+5 CYCLE OR BEGIN CPR
Alternate 5 back blows and 5 abdominal thrusts until object is expelled or help arrives:
If Person Becomes Unresponsive Lower carefully to the floor, call 911/112, and start CPR immediately.
// CRITICAL MISTAKES (DO NOT)
- ✕ Do not slap someone on the back while they are standing completely uprightWHY: this allows gravity to pull the dislodged foreign object deeper into the trachea
- ✕ Do not perform blind finger sweeps in the mouthWHY: you risk pushing lodged food or objects deeper past the vocal cords
- ✕ Do not perform abdominal thrusts on infants under 1 yearWHY: use alternating back slaps and gentle two-finger chest thrusts
- ✕ Do not skip medical evaluation after successful abdominal thrustsWHY: inward thrusts can cause internal bruising or lacerations to the spleen, liver, or stomach
“If they can cough, encourage coughing; if they cannot breathe or speak, alternate 5 back blows and 5 abdominal thrusts.”
The human pharynx serves as a shared structural intersection for both the digestive and respiratory systems. During normal deglutition (swallowing), the epiglottis folds downward over the laryngeal inlet like a trapdoor, directing solids and liquids safely into the esophagus.
Foreign body airway obstruction occurs when food or foreign items slip past the epiglottis into the trachea before the vocal cords can spasm shut.
The Dynamics of 5 Back Blows and 5 Abdominal Thrusts
- Forward Lean and Back Blows: Leaning the person forward uses gravity to prevent dislodged objects from dropping deeper into the mainstem bronchi. Delivering a firm blow with the heel of the hand over the thoracic spine creates a sudden shockwave and instantaneous pressure spike in the respiratory tract.
- Abdominal Thrusts (The Heimlich Maneuver): Pulling inward and upward just above the umbilicus forcibly elevates the diaphragm. This suddenly compresses the residual volume of air trapped in the lower lobes of the lungs, generating an artificial explosive expiration that ejects the foreign object out through the glottis.
When to Restrain from Physical Intervention
If the victim is making noisy breathing sounds, coughing vigorously, or able to speak in complete sentences, the obstruction is partial. A spontaneous, voluntary human cough generates a subglottic pressure wave exceeding 100 mmHg and velocity reaching hundreds of kilometers per hour. Delivering premature back blows while someone is actively coughing can dislodge a partial obstruction into a catastrophic total blockage.
112 reaches fire and emergency medical dispatch directly. 110 is police.
Additional safety instructions and adjacent hazard knowledge.