Choking - unconscious adult or child over 1 year

Choking may be caused by:

• Eating too fast, not chewing food well, or eating with dentures that do not fit well
• Foods such as food chunks, hot dogs, popcorn, peanut butter, sticky or gooey food (marshmallows, gummy bears, dough)
  
• 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 a deformity can cause choking)
• Swallowing problems caused by a stroke or other brain disorders
• Enlarged tonsils or tumors of the neck and throat
• Problems with the esophagus (food pipe or swallowing tube)

Symptoms of choking when a person is unconscious include:

• Bluish color to the lips and nails (cyanosis)
• Inability to breathe

Tell someone to call 911 or the local emergency number while you begin first aid and CPR.

If you are alone, shout for help and begin first aid and CPR.

1. Roll the person onto their 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 you can see an object and it is loose, remove it.
3. If you do not see an object, open the person's airway by lifting the chin while tilting the head back.
4. Place your ear close to the person's mouth and watch for chest movement. Look, listen, and feel for breathing for 5 seconds
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. If the chest still does not rise, the airway is likely blocked, and you need to start CPR with chest compressions. The compressions may help relieve the blockage.
9. Do 30 chest compressions, open the person's mouth to look for an object. If you see the object and it is loose, remove it.
10. If the object is removed, but the person has no pulse, begin CPR with chest compressions.
11. If you do not see an object, give two more rescue breaths. If the person's chest still does not rise, keep going with cycles of chest compressions, checking for an object, and rescue breaths until medical help arrives or the person starts breathing on their own.

If the person starts having seizures (convulsions), 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. This is because the person can have complications 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.

Seek medical help right away if someone is found unconscious.

In the days following a choking episode, contact a doctor right away if the person develops:

• A cough that doesn't go away
• Fever
• Difficulty swallowing or speaking
• Shortness of breath
• Wheezing

The above signs may indicate:

• The object entered the lung instead of being expelled
• Injury to the voice box (larynx)

To prevent choking:

• Eat slowly and chew food completely.
• Cut large pieces of food into easily chewable sizes.
  
• Do not drink too much alcohol before or during eating.
• Keep small objects away from young children.
• Make sure dentures fit properly.

Choking - unconscious adult or child over 1 year; First aid - choking - unconscious adult or child over 1 year; CPR - choking - unconscious adult or child over 1 year

American Red Cross. First Aid/CPR/AED Participant's Manual. 2nd ed. Dallas, TX: American Red Cross; 2016 www.pdfdrive.com/american-red-cross-first-aidcpraed-d128296673.html. Accessed February 20, 2023.

Duff JP, Topjian AA, Berg MD, et al. 2019 American Heart Association focused update on pediatric basic life support: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Pediatrics. 2020;145(1):e20191358. PMID: 31727861 pubmed.ncbi.nlm.nih.gov/31727861/.

Easter JS. Pediatric resuscitation. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 158.

Goodloe JM, Soulek J. Foreign bodies. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 51.

Haas NL, Kurz MC. Adult resuscitation. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 5.

Kleinman ME, Goldberger ZD, Rea T, et al. 2017 American Heart Association focused update on adult basic life support and cardiopulmonary resuscitation quality: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2018;137(1):e7-e13. PMID: 29114008 pubmed.ncbi.nlm.nih.gov/29114008/.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.