7.2 Conscious Adult & Child Choking Relief

7.2 Conscious Adult & Child Choking Relief

The 2025 AHA adult FBAO update uses a combined sequence for a responsive adult or child with severe obstruction: 5 back blows followed by 5 abdominal thrusts. Continue alternating those groups until the object comes out or the person becomes unresponsive.

Confirm severe obstruction

Ask a responsive adult or child, “Are you choking?” Severe obstruction is indicated by inability to speak, an ineffective or silent cough, little or no airflow, cyanosis, or declining responsiveness. If the person can cough forcefully or speak, encourage coughing and monitor rather than beginning thrusts.

Activate emergency response early when severe obstruction is present, especially if another person can call while care begins.

Five back blows

1. Stand to the side and slightly behind the person.
2. Support the chest with one hand and lean the person forward when feasible so a dislodged object can exit the mouth.
3. With the heel of the other hand, give 5 firm, separate blows between the shoulder blades.
4. Observe after each blow for expulsion or return of effective airflow.

Back blows are distinct actions, not rapid slaps without reassessment. If the obstruction remains severe after 5, move to abdominal thrusts.

Five abdominal thrusts

1. Stand or kneel behind the person as size requires.
2. Wrap your arms around the waist.
3. Make a fist and place the thumb side against the abdomen above the navel and below the lower end of the sternum.
4. Grasp the fist with the other hand.
5. Deliver 5 quick inward-and-upward thrusts, keeping pressure away from the ribs and xiphoid process.

Reassess after each thrust. Then return to 5 back blows if severe obstruction continues.

Chest-thrust alternative

Use 5 back blows followed by 5 chest thrusts when the rescuer cannot encircle the abdomen or when the person is in late pregnancy.

For chest thrusts, place the arms under the armpits and around the chest. Put the thumb side of a fist on the lower half of the sternum, grasp it with the other hand, and pull straight inward. Do not place the fist on the ribs or the lower tip of the sternum.

Late pregnancy changes the thrust site, not the need to act. Continue alternating 5 back blows and 5 chest thrusts until relief or unresponsiveness.

If the object is expelled

Stop the thrust sequence when the person can breathe, speak, or cough effectively. Encourage controlled coughing and monitor for recurrence. Persistent pain, difficulty swallowing, wheezing, coughing, or a sensation of retained material should be evaluated. Forceful thrusts can also cause injury, so a person who required severe-obstruction maneuvers may need medical assessment according to local practice.

Do not sweep the mouth unless an object is clearly visible and easily removable.

If the person becomes unresponsive

Support and lower the person to a firm surface. Activate emergency response and obtain an AED if that has not occurred. Begin CPR with chest compressions. Each time the airway is opened to give breaths, look in the mouth and remove a visible object. Do not perform a blind finger sweep.

Continue CPR and use the AED as soon as available. Do not keep performing standing back blows or thrusts after the person is unresponsive.

Child technique

Use the same 5-and-5 back-blow and abdominal-thrust sequence for a responsive child with severe FBAO. Kneel if needed to achieve correct hand placement and controlled force. Adjust force to the child's size while still making each action effective. For an infant younger than about 1 year, use the separate infant sequence of back blows and heel-of-one-hand chest thrusts; never use abdominal thrusts.

Common errors

• Using abdominal thrusts alone without the 2025 back-blow sequence.
• Placing the fist on the lower sternum or ribs during abdominal thrusts.
• Using abdominal rather than chest thrusts in late pregnancy.
• Continuing maneuvers after effective breathing returns.
• Attempting a blind finger sweep.
• Keeping an unresponsive person upright.

The exam memory line is: adult or child severe FBAO—5 back blows, 5 abdominal thrusts; late pregnancy or cannot encircle—5 back blows, 5 chest thrusts.

Technique rehearsal

Use a choking manikin to practice five distinct back blows, repositioning, and five abdominal thrusts without losing control of the patient. Then rehearse the chest-thrust alternative and name the two indications: late pregnancy or inability to encircle the abdomen. Finally, practice lowering an unresponsive person safely and starting compressions. Linking the three transitions—mild, severe, and unresponsive—helps prevent continued standing thrusts after the situation has changed.