Basic First Aid: Severe Choking


In our previous article, we dealt with mild choking in adults and children over one year of age. In today’s article, we’ll be seeing how to manage people with severe choking.

In severe choking, the person usually cannot speak or breathe as the airway is fully blocked and coughing is ineffective. Severe choking can also develop from mild choking if the victim deteriorates, so one has to keep monitoring someone with mild choking as this can develop into a severe form.

With a blocked airway the lungs cannot effectively oxygenate the blood. When the brain does not receive oxygenated blood permanent brain damage can occur in as little as 4 minutes, so it is important to act quickly.

The first thing to do to when someone is severely choking is to bend the person forward, supporting their chest with your hand. This will help the object come out of their mouth rather than moving further down.

First, give 5 sharp blows between the shoulder blades, aiming to dislodge the object out of the airway. This manoeuvre is called a back blow. Check after every back blow to see if the object has been coughed up.

If 5 back blows do not dislodge the object, move on to what is known as the Heimlich manoeuvre (shown in the second and third figures). First, make a fist with one hand and place it just above the belly button, thumb facing inwards, and wrap your other hand over the fist, effectively wrapping both arms around the person’s abdomen. Then, make quick thrusting movements up into the person’s abdomen, moving upwards and inwards as you do so. Keep in mind that the aim is to help the patient cough up the obstructing object.

Alternate between 5 back blows and 5 abdominal thrusts until the object becomes dislodged, or the patient loses consciousness. If the patient loses consciousness, phone the ambulance and start performing CPR if you are trained to do so (see future articles). If the obstructing object is visible, you can try to remove it by grasping it with your fingers, without putting the choking victim in further danger.

If 3 cycles of back blows and abdominal thrusts do not help, phone an ambulance and get help.

Do not use the Heimlich manoeuvre if the patient is obese or in pregnant women. In these situations, modify the manoeuvre slightly so that the hands are placed on the middle of the breastbone between the nipples, and the chest is being thrusted backwards.

For further information, I encourage all readers to enrol in a first aid training course. It doesn’t take much to become a certified first aider and perhaps your efforts will help save someone’s life.