Knowledge Base

Choking (Foreign Body Airway Obstruction)

Knowledge Base

title: "Choking (Foreign Body Airway Obstruction)"

Choking (Foreign Body Airway Obstruction)

Key Facts

ANZCOR Algorithm: Alternate 5 back blows with 5 chest thrusts until obstruction clears or patient becomes unconscious.

Warning

Abdominal thrusts (Heimlich manoeuvre) are NO LONGER recommended by ANZCOR due to reports of life-threatening complications including ruptured viscera.

Recognition

Mild Obstruction (Effective Cough)

  • Can speak, cry, or cough
  • Able to breathe
  • Management: Encourage coughing, do NOT intervene

Severe Obstruction (Ineffective Cough)

  • Cannot speak or only in whispers
  • Silent cough or no cough
  • Cannot breathe, cyanosis
  • May be clutching throat (universal choking sign)
  • Management: Immediate intervention required
Clinical Pearl

Ask: "Are you choking?" If they can answer verbally → mild obstruction, encourage coughing. If they cannot speak or nod yes → severe obstruction, intervene immediately.

Algorithm - Conscious Adult/Child

1. Call for help
2. Give up to 5 BACK BLOWS
   - Stand behind/beside patient
   - Support chest with one hand
   - Deliver sharp blows between shoulder blades
   - Check after each blow if obstruction cleared

3. If unsuccessful → 5 CHEST THRUSTS
   - Same hand position as CPR
   - Sharp, deliberate thrusts (not compressions)
   - Slower rate than CPR
   - Check after each thrust

4. Alternate back blows and chest thrusts
   - Continue until: obstruction clears, or
   - Patient becomes unconscious

If Patient Becomes Unconscious

Warning

Unconscious choking victim → Start CPR immediately (ANZCOR Guideline 8)

  • Lower to ground carefully
  • Call ambulance if not done
  • Begin chest compressions
  • Each time you open airway, look for visible object
  • Remove only if clearly visible (no blind finger sweeps)

Technique Details

Back Blows

  1. Stand to the side and slightly behind
  2. Support chest with one hand, lean patient forward
  3. Deliver up to 5 sharp blows between shoulder blades with heel of hand
  4. Aim: Dislodge object with each blow, not just complete 5

Chest Thrusts

  1. Stand behind patient, arms around chest
  2. Place fist (thumb side) on lower half of sternum
  3. Grasp fist with other hand
  4. Pull sharply inward and upward
  5. Alternatively: Patient supine, hands as for CPR, sharp thrusts
Clinical Pearl

Why chest thrusts, not abdominal thrusts? ANZCOR reviewed evidence showing similar effectiveness but significantly fewer complications with chest thrusts compared to abdominal thrusts.

Special Populations

Infants (< 1 year)

1. Place infant face-down on your forearm/thigh
2. Support head (keep head lower than chest)
3. Give 5 BACK BLOWS between shoulder blades

4. Turn infant face-up
5. Give 5 CHEST THRUSTS
   - Two fingers on lower sternum
   - Sharp downward thrusts

6. Alternate until clear or unconscious
7. If unconscious → infant CPR
Warning

Never use abdominal thrusts in infants - risk of liver/spleen injury is high.

Pregnant or Obese Patients

  • Use chest thrusts only (not back blows from behind)
  • Hands positioned on middle of sternum
  • Stand behind, arms under armpits, around chest

Wheelchair Users

  • May need to perform from front or side
  • Chest thrusts from front may be easier
  • Consider patient positioning for back blows

Blind Finger Sweeps

Warning

ANZCOR recommends AGAINST blind finger sweeps - risk of pushing object deeper or causing trauma.

Only remove objects that are clearly visible in the mouth.

After Successful Relief

  • Assess for ongoing respiratory distress
  • Consider medical review if:
    • Abdominal thrusts were used
    • Chest thrusts caused pain
    • Persistent cough or difficulty swallowing
    • Any concerns about incomplete removal

Sources

Test Your Knowledge

SBAeasychokingFBAOairway
A 60-year-old man at a restaurant suddenly stands up clutching his throat. He cannot speak and is making no sound when trying to cough. What is your first action?
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SBAeasychokingFBAOairway
After 5 back blows, a choking patient is still unable to breathe or speak. What is the next step according to ANZCOR guidelines?
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SBAmediumchokingFBAOBLS
A choking victim becomes unconscious during your attempts to relieve the obstruction. What should you do?
Press 1-4 to answer • Sign in for personalized questions & progress tracking

Related Topics

See also: Basic Life Support (BLS), Airway Emergency, Advanced Life Support (ALS)