An airway obstruction may be partial or complete for a conscious or unconscious person. A partial airway obstruction may progress to a complete airway obstruction within seconds. A complete obstruction is commonly referred to as choking.
Signs and symptoms
Lifesavers need to be able to assess the signs of partial or complete airway obstructions for both conscious and unconscious persons.
After asking the person if they are choking, look for non-verbal responses from a person indicating that a partial airway obstruction has progressed to a complete one. For example:
- nodding their head in response to your question
- pointing to their throat
- showing the universal choking sign — namely clutching their throat.
Management
Partial airway obstruction
- Reassure the person.
- Encourage them to keep coughing to expel any foreign material.
- Reassure and monitor the person until they recover, or the partial airway obstruction progresses to a complete one.
Complete airway obstruction
- Send for help, additional resources (AED) and request an ambulance.
- Place the person in the appropriate position to begin treatment:
- adult or child — bent forward while in a sitting or standing position.
- infant — head downward position and on their front across your thigh.
- Perform up to five sharp back blows:
- In an upward motion using the heel of your dominant hand in the middle of the person’s back between their shoulder blades.
- Quickly assess the person’s airway after each back blow for signs of the foreign material’s removal and normal breathing.
- Place the person in the appropriate position to progress the treatment:
- adult or child — lying down on their back
- infant — head downward position and on their back across your thigh.
- Perform up to five sharp chest thrusts (compressions):
- At the centre of the person’s chest.
- Quickly assess the person’s airway after each chest thrust for signs of the foreign material’s removal and normal breathing.
- Continue to perform five back blows followed by five chest thrusts in a rapid sequence until the foreign body is removed, or the person becomes unresponsive.
Note
- The aim of the back blows and chest thrusts is to gradually relieve the airway obstruction. You may not need to perform all five of them.
- Chest thrusts are the same as chest compressions for CPR, but they are performed more forcefully and at a slower rate.
- Do NOT thrust the person’s abdominal area (the Heimlich manoeuvre) as this can cause internal injury or vomiting.
- If the person becomes unconscious:
- Make sure that you send for help immediately.
- Look for any foreign material in their airway and clear it by using your fingers to remove it or sweep it away.
- Start CPR.
- There may be some resistance from an airway obstruction when providing rescue breaths. If you blow the obstruction into the lower airways in your efforts to resuscitate the person, hospital staff can later remove the obstruction.
- Refer to the latest ARC Guideline for Breathing to learn more.
