Not every episode of choking requires back blows or abdominal thrusts.

Signs that air is still moving

The obstruction may be partial when the person can:

• Cough forcefully
• Speak or answer questions
• Cry out
• Breathe between coughs
• Make clear sounds

If the person has a strong, effective cough, encourage them to continue coughing. Stay close and watch carefully because a partial obstruction can become complete.

Do not perform abdominal thrusts simply because someone is coughing. An effective cough is the body’s natural mechanism for expelling the object.

Signs of severe choking

Suspect a severe or complete airway obstruction when the person:

• Cannot speak or answer
• Cannot breathe normally
• Has a silent or very weak cough
• Makes high-pitched or minimal breathing sounds
• Clutches their throat
• Becomes pale, blue or grey around the lips
• Appears frightened or confused
• Begins losing consciousness

A choking person may be unable to say what is happening. Ask clearly: “Are you choking?” If they cannot answer but signal yes, begin first aid immediately.

The American Red Cross identifies an inability to cough, speak or breathe effectively as a reason to provide immediate choking care.

Step 1: Encourage coughing when it is effective

If the person can cough forcefully, encourage them to keep coughing.

Do not give them food, water or medication. Drinking water will not push an object out of the airway and could make the situation more difficult.

Continue watching for signs that the cough is becoming silent or ineffective. If the person stops moving air, transition immediately to active first aid.

Step 2: Give up to five back blows

If the person cannot cough, speak or breathe effectively:

1. Stand behind them and slightly to one side.
2. Place one hand across their upper chest for support.
3. Help them lean well forward.
4. Using the heel of your other hand, give a firm blow between the shoulder blades.
5. Check whether the object has been expelled.
6. Repeat as necessary, up to five times.

Leaning the person forward is important because it allows the loosened object to move toward the mouth instead of travelling farther down the airway.

Each back blow should be a separate attempt. You do not need to deliver all five if the object comes out earlier.

Step 3: Give up to five abdominal thrusts

If five back blows do not clear the airway, proceed to abdominal thrusts:

1. Stand directly behind the person.
2. Put your arms around their waist.
3. Make a fist with one hand.
4. Position the thumb side of the fist above the navel and below the breastbone.
5. Grasp the fist with your other hand.
6. Pull sharply inward and upward.
7. Repeat up to five times, checking after each thrust.

The movement should be quick and deliberate. Avoid placing pressure directly on the ribs or at the bottom of the breastbone.

The Red Cross recommends alternating five back blows and five abdominal thrusts for a responsive adult with severe choking until the object is expelled or the person becomes unresponsive.

Observational research involving 1,947 foreign-body airway obstruction cases reported that abdominal thrusts successfully removed the obstruction in approximately 46.6% of cases. Earlier intervention and preserved consciousness were associated with better outcomes. The study is available through PubMed.

This does not mean that abdominal thrusts always work. Emergency medical assistance remains essential when the obstruction is not cleared promptly.

Step 4: Call emergency services

Ask another person to call emergency services while you begin first aid.

If nobody else is available, use your phone’s speaker mode if possible so that you can continue helping while speaking with the emergency dispatcher.

Tell the dispatcher:

• That an adult is choking
• Whether the person is conscious
• Whether they can breathe or speak
• Your precise location
• Which first-aid actions you have already attempted

Continue alternating five back blows and five abdominal thrusts until:

• The object is expelled
• The person begins breathing effectively
• The person becomes unconscious
• Emergency professionals take over

Follow the dispatcher’s instructions, as emergency protocols and telephone numbers vary by country.

When abdominal thrusts should not be used

Standard abdominal thrusts are not appropriate for every person.

Pregnant person

Do not apply pressure to the abdomen of someone who is visibly pregnant. Chest thrusts are generally used instead.

Position your hands on the lower half of the breastbone and deliver firm inward thrusts while avoiding the abdomen.

Person with a larger body size

If you cannot encircle the person’s waist or correctly position your fist, chest thrusts may be used instead of abdominal thrusts.

Infant under one year

Never perform abdominal thrusts on an infant. Infants require a different combination of back blows and chest thrusts. Seek emergency guidance immediately.

Wheelchair user

Lock the wheelchair brakes if possible. Back blows may be delivered while supporting the person in a forward-leaning position. Depending on accessibility and body position, chest thrusts may be more practical than abdominal thrusts.

What to do if the person becomes unconscious

If the person collapses:

1. Lower them carefully to the floor.
2. Call emergency services or ensure that someone has called.
3. Begin cardiopulmonary resuscitation if the person is not breathing normally.
4. Start with chest compressions.
5. Use an automated external defibrillator if one is available.
6. Continue until the person shows signs of life or trained help takes over.

Before giving rescue breaths, look inside the mouth. Remove an object only if you can see it clearly and reach it safely.

Never perform a blind finger sweep

Do not place your fingers into the person’s mouth when you cannot see the object. A blind sweep may push the obstruction deeper into the airway or damage delicate tissues.

During CPR, chest compressions may generate enough pressure to dislodge the foreign object. Continue following the emergency dispatcher’s instructions.

What not to do during a choking emergency

Several intuitive reactions can delay effective care or worsen the obstruction.

Do not give water

Water cannot pass through a completely blocked airway. Attempting to make the person drink wastes critical time and may create an additional aspiration risk.

Do not hang the person upside down

This is not a recommended adult choking procedure and may cause a fall or other injury.

Do not repeatedly reach into the mouth

Only remove an object when it is clearly visible and easy to grasp.

Do not slap an upright person randomly

Back blows should be delivered between the shoulder blades while the person is supported and leaning forward.

Do not leave the person alone

Even if they initially have an effective cough, remain nearby until normal breathing returns. Their condition can deteriorate rapidly.

Do not delay calling for help

If back blows and abdominal thrusts do not rapidly clear the obstruction, emergency medical assistance is necessary.

After the object comes out

The emergency is not necessarily over when the person starts breathing again.

Back blows and abdominal thrusts can cause injuries, including bruising or damage to the ribs and internal organs. A fragment of food or another foreign object may also remain in the airway.

Medical assessment is particularly important if:

• Abdominal or chest thrusts were performed
• The person lost consciousness
• Breathing remains noisy or difficult
• Coughing continues
• They experience chest or abdominal pain
• Their voice sounds different
• They have difficulty swallowing
• They are elderly or medically vulnerable

NHS first-aid guidance recommends medical review after choking interventions because injuries or residual material may remain in the respiratory tract.

Reducing the risk of adult choking

Choking frequently occurs while eating, particularly when a person is distracted, speaking, laughing or consuming alcohol.

Risk can be reduced by:

• Cutting food into manageable pieces
• Chewing thoroughly before swallowing
• Avoiding talking or laughing with food in the mouth
• Sitting upright while eating
• Limiting alcohol during meals
• Ensuring dentures fit correctly
• Following prescribed texture modifications when swallowing problems exist
• Seeking assessment for repeated coughing or choking during meals

Older adults and people with neurological conditions, previous strokes, dementia, muscle weakness or swallowing disorders may have a higher risk of airway obstruction.

Repeated choking episodes should not be treated as ordinary accidents. They may indicate dysphagia—a swallowing disorder requiring professional assessment.

The essential sequence to remember

When an adult appears to be choking:

1. Ask if they are choking.
2. Encourage forceful coughing if it is effective.
3. Give up to five back blows if they cannot breathe or speak.
4. Give up to five abdominal thrusts if back blows fail.
5. Call emergency services.
6. Alternate back blows and thrusts.
7. Begin CPR if the person becomes unresponsive and is not breathing normally.

Reading instructions is useful, but practical training is more effective for building confidence. Consider completing an accredited first-aid and CPR course and refreshing your skills regularly.

Sources

• American Red Cross — Adult and Child Choking: Symptoms and First Aid
• NHS — First Aid Guidance
• World Health Organization — International Medical Guide for Ships
• PubMed — Effectiveness of the Abdominal Thrust Maneuver for Airway Obstruction
• PubMed — Adult Basic Life Support and Cardiopulmonary Resuscitation Quality

This content is intended for general first-aid education and does not replace emergency medical advice or hands-on certified training.