2.5 Choking, Foreign-Body Airway Obstruction, and Opioids
Key Takeaways
- Adult foreign-body airway obstruction is a current AHA BLS algorithm topic, not a minor first-aid add-on.
- A choking patient who can cough forcefully should usually be encouraged to cough while being monitored.
- If severe obstruction develops, intervene promptly and activate emergency response as needed.
- Naloxone is incorporated into adult BLS algorithms for suspected opioid-associated respiratory or cardiac arrest.
2.5 Choking, Foreign-Body Airway Obstruction, and Opioids
BLS providers must recognize the difference between mild and severe choking and must know how opioid-associated emergencies fit into respiratory arrest and cardiac arrest response.
Current official baseline
The adult BLS guidance covers recognition of cardiac arrest, emergency response activation, high-quality CPR, AED use, adult foreign-body airway obstruction, and opioid antagonist integration. Use the official AHA 2025 Adult Basic Life Support Guidelines page when your course materials or training-center instructions differ from third-party summaries: AHA 2025 Adult Basic Life Support Guidelines.
What you need to know
| Decision point | What to do |
|---|---|
| Mild obstruction | If the patient can cough, speak, or breathe, encourage coughing and monitor closely. Do not interfere unnecessarily. |
| Severe obstruction | If the patient cannot breathe, speak, or cough effectively, act. Follow the current adult FBAO algorithm taught in your AHA course. |
| Unresponsive patient | If the patient becomes unresponsive, lower them safely, activate help, begin CPR, and look for the object when opening the airway. |
| Opioid emergency | For suspected opioid-associated respiratory arrest, provide ventilatory support and use naloxone according to local protocol while continuing standard BLS priorities. |
How this shows up on BLS/ACLS questions
BLS and ACLS items usually test priority. Read the patient state first: age, pulse status, breathing status, rhythm, stability, and number of rescuers. Then choose the action that protects perfusion, oxygenation, defibrillation timing, or the correct algorithm branch. If an answer sounds advanced but delays CPR, shock delivery, ventilation, or an urgent stability intervention, it is usually a distractor.
Scenario anchor
A patient with pinpoint pupils is not breathing normally but has a pulse. The priority is ventilation and activation of help; naloxone can be given, but it should not replace airway and breathing support.
Common traps
- Performing blind finger sweeps.
- Treating all choking as the same severity.
- Letting naloxone distract from CPR when the patient is pulseless.
Study action
Write this section as a one-line rule in your own words, then test it with mixed questions from the BLS/ACLS practice bank. Do not review only the matching topic. Mix it with nearby branches so you can tell when the rule applies and when it does not. For example, compare respiratory arrest with a pulse against pulseless arrest, or compare unstable tachycardia against VF/pVT arrest. The exam rewards that discrimination more than memorizing isolated facts.
A rescuer is providing bag-mask ventilation during CPR. The chest is NOT rising with each breath. What is the MOST likely cause?
A patient is given nitroglycerin for chest pain and develops severe hypotension. The patient's BP drops to 65/40 mmHg. What is the MOST appropriate initial treatment?