How To Do Abdominal Thrusts and Back Blows in the Conscious Adult or Child Who Is Choking

• Choking due to severe upper airway obstruction due to a foreign object.

The patient will be unable to speak cough, or breathe adequately. The patient may signal by grasping or clutching their throat with both hands.

Abdominal thrusts and other maneuvers should be used only when the airway obstruction is severe and life is endangered. If the choking person can speak, cough forcefully, or breathe adequately, no intervention is required.

Absolute contraindications:

• Age < 1 year is a contraindication to the abdominal thrust maneuver (see How to Treat the Choking Conscious Infant).

• For an unconscious patient with a suspected upper airway obstruction, chest compressions (eg, cardiopulmonary resuscitation [CPR] should be initiated instead of abdominal thrusts (1).

Relative contraindications:

• Children < 20 kg (45 lb; typically < 5 years) should receive only moderate pressure abdominal thrusts and back blows.

• Patients who are obese and women in late pregnancy should receive chest thrusts instead of abdominal thrusts.

• Rib injury or fracture

• Internal organ injury

• These rapid first aid procedures are done immediately wherever the person is choking.

• Use of significant, abrupt force is appropriate for these maneuvers. However, clinical judgment is needed to avoid excessive forces that can cause injury.

• The epiglottis usually protects the airway from aspiration of foreign objects (eg, food).

• Aspirated objects may be lodged or impacted above or below the vocal cords.

• In general, the rescuer stands behind the choking person or kneels behind a child.

Determine if there is severe airway obstruction:

• Look for signs such as inability to speak, cough, or breathe adequately.

• Look for hands clutching the throat, which is the universal distress signal of severe airway obstruction.

• Ask: “Are you choking?”

• If the person can speak and breathe, encourage them to cough but do not initiate airway clearance maneuvers; instead, activate the emergency response system (eg, call 911 or other local public safety answering point).

• If the choking person nods yes or cannot speak, cough, or breathe adequately, that suggests severe airway obstruction and the need for airway clearance maneuvers.

Treat the choking conscious adult or child:

• Stand directly behind the choking adult or kneel behind a child.

• Begin with abdominal thrusts for people who are not pregnant or obese; do chest thrusts for patients who are obese and women in late pregnancy.

• Alternate between sets of 5 abdominal thrusts, (5 chest thrusts for patients who are obese or in late pregnancy), and 5 back blows.

• Continue alternating between sets of abdominal/chest thrusts and back blows until obstruction is removed or advanced airway management is available.

  If the person loses consciousness, start cardiopulmonary resuscitation (CPR). After each set of chest compressions, look inside the patient's mouth before giving rescue breaths and remove any visible obstruction that can be reached. Do not do blind finger sweeps.

Abdominal thrusts:

• Encircle the patient’s abdomen with your arms.

• Clench one fist and place it midway between the umbilicus and xiphoid.

• Grab the fist with the other hand (see figure Abdominal thrusts with victim standing or sitting).

• Deliver a firm inward and upward thrust by pulling with both arms sharply backward and upward.

• Rapidly repeat the thrust 5 times as needed.

Abdominal Thrusts With Victim Standing or Sitting (Conscious)

Chest thrusts (to be performed instead of abdominal thrusts for patients who are obese and women in late pregnancy):

• Encircle the patient’s chest with your arms.

• Clench one fist and place it on the lower half of the sternum.

• Grab the fist with the other hand.

• Deliver a firm inward thrust by pulling both arms sharply backward.

• Rapidly repeat the thrust 5 times.

Back blows:

• Wrap one arm around the waist to support the patient's upper body; small children can be laid across your legs.

• Lean the person forward at the waist, about 90 degrees if possible.

• Using the heel of your other hand, rapidly deliver 5 firm blows between the person's shoulder blades.

Continue alternating between sets of abdominal/chest thrusts and back blows until obstruction is removed.

Successful performance of any these maneuvers should result in the person being able speak and breathe normally. The person may also cough out the foreign body.

How To Do Abdominal Thrusts in...

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• Patients with any symptoms such as difficulty breathing, difficult swallowing, throat pain, abdominal pain, or chest pain remaining after foreign body removal should have a medical evaluation. It is best to have all patients even without symptoms evaluated by a medical provider to ensure the obstruction was completely removed and no damage was done from the object or from the maneuvers attempted to dislodge it.

• These maneuvers should not be done if the choking person can speak, cough forcefully, or breathe adequately.

• In patients who are obese and women in late pregnancy, chest thrusts are used instead of abdominal thrusts.

• The maneuver may induce vomiting. Although vomiting may assist in dislodging a tracheal foreign body, it does not necessarily mean that the airway has been cleared.

1. 1. Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020;142(16_suppl_2):S366-S468. doi:10.1161/CIR.0000000000000916