Key Takeaways
- A partial airway obstruction allows some air exchange and may present with stridor, wheezing, or a weak cough.
- A complete airway obstruction allows no air exchange — the patient cannot speak, cough, or breathe.
- For a conscious choking adult or child, alternate 5 back blows with 5 abdominal thrusts (2025 AHA update) until the object is expelled or the patient becomes unconscious.
- For an unconscious choking patient, begin CPR and perform a visual check of the airway before each ventilation attempt.
- For choking infants under 1 year, alternate 5 back blows with 5 chest thrusts.
- Pregnant and obese patients who are choking should receive chest thrusts instead of abdominal thrusts.
- Never perform blind finger sweeps; only remove visible objects from the airway.
- The universal sign of choking is both hands clutching the throat.
Airway Obstruction Management
Foreign body airway obstruction (FBAO) is a life-threatening emergency that EMTs must manage quickly and effectively. Recognizing the type and severity of obstruction determines the correct intervention.
Types of Airway Obstruction
Partial Obstruction
The patient can still move some air past the obstruction:
- Good air exchange: Forceful cough, able to speak, may have wheezing between coughs.
- Poor air exchange: Weak, ineffective cough, high-pitched noise on inhalation (stridor), difficulty breathing, possible cyanosis.
EMT Action for Partial Obstruction with Good Air Exchange: Encourage the patient to cough. Do NOT intervene with thrusts — let the patient attempt to clear the obstruction naturally. Monitor closely.
EMT Action for Partial Obstruction with Poor Air Exchange: Treat as a complete obstruction.
Complete Obstruction
No air can pass the obstruction:
- Cannot speak, cough, or breathe
- May display the universal sign of choking (both hands clutching the throat)
- Will quickly become cyanotic and lose consciousness if not cleared
FBAO Management by Patient Type
Conscious Adult or Child (Over 1 Year) — Back Blows & Abdominal Thrusts (2025 AHA Update)
Per the 2025 AHA Guidelines Update, the recommended sequence for conscious choking in adults and children now includes back blows as a first-line intervention:
- Stand behind or to the side of the patient.
- Deliver 5 back blows between the shoulder blades using the heel of your hand.
- If the obstruction is not cleared, perform 5 abdominal thrusts (Heimlich maneuver):
- Wrap your arms around the patient's waist.
- Make a fist with one hand and place the thumb side against the abdomen, above the navel and below the xiphoid process.
- Grasp your fist with the other hand.
- Deliver quick, inward and upward thrusts.
- Alternate between 5 back blows and 5 abdominal thrusts until the object is expelled or the patient becomes unconscious.
For children, use the same technique but kneel behind the child and use less force.
Important: The 2025 AHA update added back blows for adults and children, aligning the protocol with existing infant FBAO management and international guidelines. Previously, back blows were only recommended for infants in AHA guidelines.
Unconscious Adult or Child — CPR Approach
If a choking patient becomes unconscious:
- Lower the patient to the ground.
- Call for additional help / activate EMS if not already done.
- Begin CPR (starting with chest compressions).
- Before each ventilation attempt, open the airway and perform a visual check — if you see an object, remove it.
- Do NOT perform blind finger sweeps.
- Continue CPR until the obstruction is cleared or advanced help arrives.
Choking Infant (Under 1 Year)
Do NOT use abdominal thrusts on infants — risk of organ damage.
For a conscious choking infant:
- Support the infant face-down on your forearm, with the head lower than the body.
- Deliver 5 back blows between the shoulder blades using the heel of your hand.
- Turn the infant face-up, supporting the head.
- Deliver 5 chest thrusts using two fingers on the center of the chest, just below the nipple line.
- Alternate between 5 back blows and 5 chest thrusts until the object is expelled or the infant becomes unconscious.
For an unconscious choking infant:
- Begin infant CPR (30 compressions to 2 ventilations).
- Perform a visual airway check before each ventilation attempt.
Special Populations
| Patient Type | Modification |
|---|---|
| Pregnant patients | Use chest thrusts instead of abdominal thrusts (hand placement on the center of the sternum) |
| Obese patients | Use chest thrusts if you cannot reach around the abdomen |
| Wheelchair-bound | Perform abdominal thrusts from behind, patient may remain seated |
Key Rules for FBAO Management
- Never perform blind finger sweeps in any patient (adult, child, or infant).
- Only remove an object you can see in the airway.
- Always reassess the airway after clearing an obstruction.
- Transport all patients who had an airway obstruction, even if it was cleared — delayed complications (swelling, aspiration) can occur.
A conscious adult patient is clutching their throat and cannot speak or cough. Per the 2025 AHA guidelines, the EMT should immediately:
When managing a choking infant, the EMT should deliver:
A choking patient who is 8 months pregnant should receive:
A conscious choking adult suddenly becomes unconscious. The EMT should:
A patient with a partial airway obstruction is coughing forcefully and able to speak between coughs. The EMT should:
Arrange the following steps in the correct order for managing an unconscious choking adult:
Arrange the items in the correct order