By: Dr. Madeleine S. Herman, MD, MPH
Not much is scarier than choking. Choking occurs when a object lodges in the windpipe, blocking the flow of air.
The universal sign for choking is hands clutched to the throat.
If the person doesn't give the signal, look for these indications:
Inability to talk
Squeaky sounds when trying to breathe
Skin, lips and nails turning blue or dusky
Loss of consciousness
If the person is able to cough forcefully, the person should keep coughing. If the person is choking and can't talk, cry or laugh forcefully, then the Heimlich maneuver may be your next step.
To perform abdominal thrusts (Heimlich maneuver) on someone else:
Stand behind the person. Place one foot slightly in front of the other for balance. Wrap your arms around the waist. Tip the person forward slightly. If a child is choking, kneel down behind the child.
Make a fist with one hand. Position it slightly above the person's navel.
Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust — as if trying to lift the person up.
Perform between six and 10 abdominal thrusts until the blockage is dislodged.
If you're the only rescuer, perform abdominal thrusts before calling 911 or your local emergency number for help. If another person is available, have that person call for help while you perform first aid.
If the person becomes unconscious, perform standard cardiopulmonary resuscitation (CPR) with chest compressions and rescue breaths.
To perform abdominal thrusts (Heimlich maneuver) on yourself:
Place a fist slightly above your navel.
Grasp your fist with the other hand and bend over a hard surface — a countertop or chair will do.
Shove your fist inward and upward.
To clear the airway of a pregnant woman or obese person:
Position your hands a little bit higher than with a normal Heimlich maneuver, at the base of the breastbone, just above the joining of the lowest ribs.
Proceed as with the Heimlich maneuver, pressing hard into the chest, with a quick thrust.
Repeat until the food or other blockage is dislodged. If the person becomes unconscious, follow the next steps.
To clear the airway of a choking infant younger than age 1:
Assume a seated position and hold the infant facedown on your forearm, which is resting on your thigh. Support the infant's head and neck with your hand, and place the head lower than the trunk.
Thump the infant gently but firmly five times on the middle of the back using the heel of your hand. The combination of gravity and the back blows should release the blocking object. Keep your fingers pointed up to avoid hitting the infant in the back of the head.
Turn the infant faceup on your forearm, resting on your thigh with the head lower than the trunk if the infant still isn't breathing. Using two fingers placed at the center of the infant's breastbone, give five quick chest compressions. Press down about 1 1/2 inches, and let the chest rise again in between each compression.
Repeat the back blows and chest thrusts if breathing doesn't resume. Call for emergency medical help.
Begin infant CPR if one of these techniques opens the airway but the infant doesn't resume breathing.
To prepare yourself for these situations, learn the Heimlich maneuver and CPR in a certified first-aid training course.