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Obstructed Airway - Choking in the Conscious Adult

Overview, Causes, & Risk Factors

Choking in a conscious adult may occur when the upper airway, usually the throat or wind pipe, is blocked by an object or irritation.

What are the causes and risks of the injury?

Choking is more likely if a person:

swallows large, poorly chewed pieces of food

drinks too much alcohol

wears poorly fitting dentures

talks or laughs while eating

Symptoms & Signs

What are the signs and symptoms of the injury?

Signs and symptoms of choking in a conscious adult include:

difficulty breathing or lack of breathing

inability to move air in or out of the lungs through the mouth or nose

face and extremities turning blue

clutching the throat or chest

If the choking episode is left untreated, unconsciousness or death may follow.

Diagnosis & Tests

How is the injury recognized?

A choking person will usually grab his or her throat or chest. He or she will appear to be distressed and may panic. The person's mouth will be open, but he or she will not be able to speak, breathe, or cough.

Prevention & Expectations

What can be done to prevent the injury?

In many cases, choking can be prevented by:

cutting food into small pieces and chewing slowly

avoiding laughing and talking while chewing

drinking alcohol only in moderation

wear properly fitting dentures

Treatment & Monitoring

What are the treatments for the injury?

Without oxygen, the brain can begin to die within 4 to 6 minutes. Rapid first aid for choking can save a life. The best way to help a conscious adult who is choking is by using the Heimlich maneuver. The procedure is done by causing an artificial cough to expel the object from the airway.

This Heimlich maneuver should not be done unless the person cannot breathe or is turning blue and is definitely choking. The Heimlich maneuver can be done with the person standing, sitting, or lying down. It may be necessary to repeat the procedure many times.

Performing the Heimlich maneuver with the person sitting or standing

Stand behind the person with arms wrapped around the waist.

Make a fist with one hand.

Place the thumb side of the fist against the person's abdomen just above the navel but well below the breastbone.

Grasp the fist with the other hand and press the fist into the person's abdomen with a quick upward thrust.

Give up to 5 upward thrusts. Repeat until the object pops out or the person becomes unconscious.

Each thrust should be a separate and distinct movement.

Performing the Heimlich maneuver with the person lying down

Place the person face up.

While kneeling, straddle the person's thighs. Place the heel of one hand against the person's abdomen in the middle, slightly above the navel and well below the breastbone.

Place the second hand directly on top of the first.

Press the abdomen with a quick upper thrust.

Performing the Heimlich maneuver on an obese person or pregnant woman

Stand behind the person with arms directly under the person's armpits and circle the chest.

Place the thumb side of the fist in the middle of the person's breastbone, taking care to avoid the xiphoid process. The xiphoid process is at the lower end of the breastbone.

Grab the fist with the other hand and perform backward thrusts until the object pops out or the person becomes unconscious.

Performing the Heimlich maneuver on oneself

make a fist with one hand

place the thumb side on the abdomen above the navel and well below the breastbone

grasp the fist with the other hand and press inward and upward with a quick motion

If these steps don't work, a person should quickly lean over a firm surface, such as the back of a chair, side of a table, or porch railing. Several thrusts may be needed to clear the airway.

Do not try to remove an object from a conscious person's mouth. This could push the object further into the throat.

If the person becomes unconscious, begin first aid for choking in the unconscious adult.

What are the side effects of the treatments?

The Heimlich maneuver can cause vomiting, injuries to internal organs, or broken ribs. Vomiting can be a problem if the vomited material is caught in the airway and inhaled into the lungs.

What happens after treatment for the injury?

It is important for a person who has choked to obtain medical care from a healthcare professional. Occasionally, an object will enter the lung instead of being expelled. This can cause coughing, wheezing, or aspiration pneumonia.

Attribution

Author:James Broomfield, MD
Date Written:
Editor:Ballenberg, Sally, BS
Edit Date:12/31/00
Reviewer:Eileen McLaughlin, RN, BSN
Date Reviewed:07/05/01