Choking is when someone cannot breathe because food, a toy, or other object is blocking the throat or windpipe (airway).

This article discusses choking in adults or children over age 1 who have lost alertness (are unconscious).

Heimlich maneuver - unconscious adult or child over 1 year

Choking may result from a complete or partial blockage of the airway.

• A complete blockage is a medical emergency.
• A partial blockage can quickly become life threatening if the person cannot properly breathe.

Without oxygen, permanent brain damage can occur in as little as 4 - 6 minutes. Rapid first aid for choking can save a life.

Choking may be caused by:

• Eating too fast, failing to chew food well enough, or eating with poorly fitting dentures
• Drinking alcohol (even a small amount of alcohol affects awareness)
• Being unconscious and breathing in vomit
• Breathing in or swallowing small objects (young children)
• Injury to the head and face (for example, swelling, bleeding, or deformity can cause choking)

Symptoms of choking include:

• Bluish color to the lips and nails
• Inability to breathe
• Inability to talk
• Lack of alertness (unconsciousness)

Occasionally an object will enter the lung. This is called aspiration. While the person may appear to improve and breathe normally, in a few days symptoms may develop, such as:

• Persistent cough
• Pneumonia
• Wheezing

If this happens, get medical help right away.

1. Roll the person onto the back on a hard surface, keeping the back in a straight line while firmly supporting the head and neck. Expose the person's chest.

2. Open the person's mouth with your thumb and index finger, placing your thumb over the tongue and your index finger under the chin. If the object is visible and loose, remove it. If the person is older than age 8, sweep two fingers from one side of the throat to the other to attempt to remove the object.

3. Lift the person's chin while tilting the head back to move the tongue away from the windpipe.

4. Place your ear close to the person's mouth and watch for chest movement. For 5 seconds look, listen, and feel for breathing.

5. If the person is breathing, give first aid for unconsciousness.

6. If the person is not breathing, begin rescue breathing. Maintain the head position, close the person's nostrils by pinching them with your thumb and index finger, and cover the person's mouth tightly with your mouth. Give two slow, full breaths with a pause in between.

7. If the person's chest does not rise, reposition the head and give two more breaths.

8. Open the person's mouth with your thumb and index finger. If the object is visible and loose, remove it.

9. If the object is removed, but the person has no pulse, begin CPR with chest compressions. If no object is visible, begin CPR.

10. If the person starts having convulsions or seizures, give first aid for this problem.

After removing the object that caused the choking, keep the person still and get medical help. Anyone who is choking should have a medical examination, because complications can arise not only from the choking, but also from the first aid measures that were taken.

Do NOT try to grasp an object that is lodged in the person's throat. This may push it farther down the airway. If you can see the object in the mouth, it may be removed.

Do NOT begin the chest compressions of CPR (if heartbeat has stopped) until the airway is cleared.

Seek medical help right away if someone is found unconscious.

When the person is choking:

• Tell someone to call 911 or the local emergency number while you begin first aid/CPR.
• If you are alone, shout for help and begin first aid/CPR.

• Eat slowly and chew food completely.
• Don't drink too much alcohol before or during eating.
• Keep small objects away from young children.
• Make sure dentures fit properly.

Manno M. Pediatric respiratory emergencies: Upper airway obstruction and infections. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 166.

Thomas SH, Brown DFM. Foreign bodies. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 57.