3.1 Protocol 11: Choking (Foreign Body Airway Obstruction)
Key Takeaways
Severe choking may cause a weak or absent cough, inability to speak or cry, and inadequate breathing; obtain emergency help promptly and follow the current agency protocol.
With an effective cough and mild obstruction, encourage coughing and monitor for deterioration; do not interrupt an effective cough with thrusts or blind finger sweeps.
AHA 2025 recommends repeated cycles of 5 back blows and 5 abdominal thrusts for responsive adults and children with severe choking; use chest thrusts instead of abdominal thrusts in late pregnancy or when the abdomen cannot be encircled.
For a responsive infant under 1 year with severe choking, alternate 5 back blows and 5 chest thrusts using the heel of one hand; do not use abdominal thrusts.
If a choking patient becomes unresponsive, begin CPR with chest compressions. Remove a foreign body only if visible when opening the airway for breaths; never perform a blind finger sweep.
Choking: Recognition and Response
Version and scope: The clinical overview below follows the 2025 AHA guidelines. It is not a reproduction of an MPDS card, an exact dispatch script, or a determinant-code reference. During an actual call, the EMD uses the agency's current licensed protocol and medical direction; clinical guideline updates must be implemented through that authorized process.
Recognize severity and obtain help
A patient who can cough effectively may still move enough air to clear an obstruction. Encourage coughing and observe closely. A weakening or silent cough, inability to speak or cry, worsening breathing, or loss of responsiveness requires urgent reassessment. Do not wait for blue skin before recognizing severe choking. Activate emergency response promptly for severe obstruction.
Responsive severe choking: AHA 2025
| Patient | Repeated sequence while responsive |
|---|---|
| Adult or child | 5 back blows followed by 5 abdominal thrusts |
| Late pregnancy or abdomen cannot be encircled | 5 back blows followed by 5 chest thrusts |
| Infant under 1 year | 5 back blows followed by 5 chest thrusts; use the heel of one hand for the chest thrusts |
Continue the appropriate cycle until the object is expelled or the patient becomes unresponsive. Support an infant's head and neck and keep the head lower than the chest during the maneuvers. Do not perform abdominal thrusts on an infant. The 2025 infant chest-thrust technique replaces the earlier two-finger technique.
If responsiveness is lost
Lower the patient to a firm, flat surface and start CPR, beginning with compressions. When opening the airway to provide breaths, look for and remove a visible object. Do not probe blindly for an unseen obstruction. CPR after collapse is different from the five chest thrusts used in a responsive infant.
Sources: AHA 2025 adult BLS, AHA/AAP 2025 pediatric BLS, foreign-body airway obstruction.
Apply the distinction without inventing a dispatch script
Fictional learning example: A diner initially coughs forcefully after swallowing food. Bystanders encourage coughing and monitor the diner. If the cough becomes ineffective and the diner can no longer speak, the situation has changed to severe obstruction. The AHA 2025 adult sequence includes back blows before abdominal thrusts. If the diner becomes unresponsive, the response changes again to CPR beginning with compressions.
This example teaches recognition of a changing condition. It does not supply the exact words, dispatch code, or response assignment for a live call. Those come from the current licensed protocol and agency configuration.
Avoid common errors
- Back blows are not reserved for infants: AHA 2025 includes them in responsive adults and children with severe choking.
- Do not confuse mild obstruction with severe obstruction. An effective cough should be encouraged and monitored.
- Do not give water as an obstruction-removal treatment or perform blind finger sweeps.
- An infant's chest thrusts for responsive choking and chest compressions during CPR are different interventions; reassess responsiveness and use the appropriate procedure.
A diner who began choking can still speak and cough forcefully. In the AHA 2025 overview, which response is appropriate?
Encourage coughing, observe closely, and reassess if the cough or breathing worsens
Immediately perform repeated abdominal thrusts despite the effective cough
Immediately deliver back blows despite the effective cough
Give water to dissolve the obstruction
Under AHA 2025, which sequence is recommended for a responsive 7-month-old infant with severe choking?
Continuous abdominal thrusts
Alternate 5 back blows with 5 chest thrusts using the heel of one hand, supporting the head and keeping it lower than the chest
Probe the throat with a blind finger sweep
Hold the infant by the ankles and shake
A patient with severe choking becomes unresponsive. What does the AHA 2025 overview recommend next?
Perform a blind finger sweep
Give five breaths before any compressions
Lower the patient to a firm, flat surface and start CPR beginning with chest compressions
Continue standing abdominal thrusts
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