Obstructed Airway

Conscious Victims

A person may be choking if they:

  • desperately grab at their neck
  • cannot speak or cry out
  • face turns blue from lack of oxygen

The initial action if you suspect choking is to clearly ask the victim “Are you choking?”

If the victim can reply verbally, you should not undertake any physical contact, but do encourage the victim to cough.

Treatment for adults and children

  • Encourage the victim to cough – some victims are in so much panic they require encouragement to cough
  • Deliver up to 5 hard blows with the heel of your hand to the centre of the victims back between the shoulder blades.
  • If the object has still not been removed, and the victim is still choking, you should perform up to five abdominal thrusts.
    • The rescuer stands behind and to the side of the victim and wraps their arms around the victim’s sides, underneath the victim’s arms
    • One hand is made into a fist and placed, thumb side in, flat against the victim’s upper abdomen, below the ribs but above the navel
    • The other hand grabs the fist and directs it in a series of upward thrusts until the object obstructing the airway is expelled
    • The thrusts should not compress or restrict the ribcage in any way.
    • If you’re not able to compress the victim’s diaphragm due to their size or pregnancy, then perform the thrusts at the chest.
  • Continue a cycle of back blows and abdominal thrusts until the blockage is removed, or the victim becomes unconscious (see below for action when unconscious)

Abdominal thrusts are performed only on conscious adult or child victims with a severe airway obstruction.

Show Me Video>>Adult Choking

  • Abdominal thrusts should never be performed on someone who can still cough, breathe, or speak – encourage them to cough instead.
  • If the victim loses consciousness, call 911

Obstructed Airway for Infants

For infants, a severe obstruction may be accompanied by a high-pitched, crow-like sound which is not present in adults or children. This is due to the incomplete formation of the infant’s airway.

Instead of abdominal thrusts, alternate 5 chest thrusts with 5 back blows:

Show Me Video>>Infant Choking

  • Hold the infant with the head in your hand, and the spine along your forearm and the head below the rest of the body
  • Compress the chest 5 times as you would for infant CPR
  • Switch the infant to your other forearm, so their chest is now against the arm
  • Perform 5 back blows, keeping the infant’s head below the rest of the body
  • Continue until the obstruction is cleared, or the infant goes unconscious

Unconscious Victims

Send a bystander to call 911 if possible.

  • Rescuers alone with an adult victim should call an ambulance immediately.
  • Rescuers alone with a child or infant victim should call an ambulance after about 2 minutes.

Commence a primary assessment, starting with Airway.

It is highly likely that the patient will not be breathing if they are unconscious as a result of airway obstruction, so you should be prepared to commence CPR if this is the case. You should continue to attempt to put breaths in to the patient, even if they appear to not be reaching the lungs.

Anaphylactic Shock

Anaphylaxis is a life-threatening medical emergency because of rapid constriction of the airway, often within minutes of exposure to the allergen. It is commonly triggered by insect stings and foods such as shellfish or peanuts. Call for help immediately

Recognition

  • Hives or rash all over accompanied by itchiness
  • Swelling or puffiness of the lymph nodes, especially around the neck and mouth
  • Swelling of the airway and tongue
  • Difficulty breathing, wheezing or gasping

Treatment

  • Call EMS (911) immediately
  • If available, administer an antihistamine to decrease swelling
  • Encourage the victim to breathe slowly; calm them
  • The victim should rest until EMS arrives
  • Monitor ABCs and begin CPR if required

Administering an EpiPen

Regional Note
Administering an EpiPen is not legal in all jurisdictions without proper training and certification.

EpiPens are the most common form of epinephrine auto-injectors, and are designed for ease of use. There are instructions in the tube with the auto-injector, but you should know how to use one ahead of time. They’re designed to inject through clothes, so you don’t have to remove the victim’s pants – even if they’re wearing a heavy material like denim. Whenever possible, the victim should inject themselves, but if they’re unable to do so, you may be legally permitted to inject the victim.

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