First Aid for Choking

(RxWiki News) Most choking deaths could be prevented with the proper first aid, such as abdominal thrusts.

Thousands of people die each year from choking. Most of these deaths are the result of food going down “the wrong way.” That means it doesn’t go down the esophagus as it’s supposed to, but ends up in the trachea (windpipe), thus blocking breathing.

Most of these deaths could be prevented with proper first aid, including the abdominal thrusts. This life-saving technique is popularly known as the Heimlich maneuver, named after the doctor who first described it 40 years ago.

The best way to learn how to deal with choking or other life-threatening emergencies is to take a course in basic life support, first aid, or CPR (cardio-pulmonary resuscitation).

Here are some answers to some general questions you may have.

Should you do the abdominal thrusts right away if you see someone choking?

  • First, you should make sure the person can’t speak, cough, or breathe.
  • Ask “are you choking?” and then “can you speak?”
  • If they can, you should not do the maneuver or anything else that could interfere with his ability to clear his airway by coughing forcefully.
  • If they can’t breathe, speak, or cough, make sure someone calls 911 immediately.

There’s some disagreement about what you should do next.

  • The American Heart Association and American College of Emergency Physicians still advise abdominal thrusts.
  • But since 2006 the American Red Cross has advised starting with back slaps instead.
    • That is, you should lean the person forward, supporting his torso with your arm, and give his upper back (between the shoulder blades) five blows with the heel of your hand to dislodge whatever is blocking their airway.
    • Only if that doesn’t work should you begin the abdominal thrusts, according to the Red Cross.


We think it’s okay to start with either the back slaps or abdominal thrusts.

How do you do the abdominal thrusts?

  • Stand behind the person and wrap your arms around their waist.
  • Make a fist and place the thumb side just above the navel and below the rib cage.
  • Grasp your fist with your other hand and make a quick 45­-degree upward thrusting movement.
  • The force should be confined to your hands as much as possible—do not squeeze the ribcage. Repeat five times.

According to the Red Cross guidelines, if neither the back blows nor the abdominal thrusts work, you should repeat the blows and then the thrusts until the object is forced out and the person can cough and breathe.

Many online videos show how to do the thrusts and back slaps. Here is an example. There are also smartphone apps showing first aid for choking as well as CPR. If the choking person is pregnant or obese, position your hands higher up, at the base of the breast bone.

What should you do if you’re choking and you are alone?

Try self-administered abdominal thrusts.

  • Make a fist and place the thumb side against your abdomen, slightly above the navel.
  • Grasp your fist with the other hand and press it inward and upward with quick, sharp thrusts.
  • It may help to do this while pushing your abdomen forcefully into something about waist high—the top of a chair back, edge of a table, or a railing—so that it pushes your fist in and up.
  • Repeat until air is forced out and the food is expelled.

Can abdominal thrusts be dangerous?

Yes, but rarely. There have been case reports and papers describing adverse events, usually (but not always) when the maneuver was done incorrectly and sometimes unnecessarily.

Types of potential injuries include:

  • Rib fractures
  • Perforation of the esophagus
  • Ruptures of the stomach, diaphragm, spleen, or a heart valve

Frail older people who have fragile bones or vascular disease are at increased risk for injury from the abdominal thrusts. Keep in mind that choking is a life and death situation, and the greatest danger is inaction on the part of bystanders.

Who is most likely to choke and why?

Children under five and the very old are most vulnerable.

  • While children typically choke on small pieces of solid foods, older people often choke on semi­solid food, such as ground meat, mashed fruits, and bread.
  • Older people may have trouble chewing because of dentures or dental problems. They have difficulty swallowing because of medications, like sedatives, and disorders that affect motor coordination such as stroke, Parkinson’s, and Alzheimer’s.
  • Older people may also lose some of the muscle tone needed to produce the normal gag reflex that can eject something that has gone down the wrong way.

Words to the wise

Everyone should know how to provide basic life support and first aid. You can find classes by clicking here and contacting either the American Red Cross or American Heart Association.