Choking is a blockage of the upper airway by food or other objects.  This blockage prevents a person from breathing effectively and complete blockage of the airway can lead to death.  When the airway is completely blocked, oxygen cannot enter the lungs.  The brain is extremely sensitive to this lack of oxygen and begins to die within four to six minutes.  It is during this time that first aid (Heimlich maneuver) must take place, because irreversible brain death occurs in as little as ten minutes. 

            First aid consists of performing the Heimlich maneuver by the following steps:

  • First ask, “Are you choking?  Can you speak?”  DO NOT perform first aid if the person is coughing forcefully and able to speak – a strong cough can dislodge the object.
  • Stand behind the person and wrap your arms around the person’s waist.
  • Make a fist with one hand.  Place the thumb side of your fist just above the person’s naval, well below the breastbone.
  • Grasp the fist with your other hand.
  • Make quick, upward and inward thrusts with your fist.
  • Continue these thrusts until the object is dislodged or the victim loses consciousness.
  • If the victim does lose consciousness, lower the person to the floor, call 911 and begin CPR.  If you happen to see something blocking the airway, try to remove it.

There are two things you DO NOT want to do, which includes interfering if the person is coughing, able to speak or is able to breathe in and out adequately.  Likewise, if the person is conscious, you do not want to try to grasp and pull out the object.

            I remember I had just moved into a really nice apartment back in 1982.  I had my grandmother over for dinner one night and I decided on pork chops – she loved them.  She was 82 years of age at the time.  I had never actually performed the Heimlich maneuver before, but sure enough she choked on the chop and I had to dislodge the meat.  It scared me to death, but I was so glad I knew what to do in this situation.  My grandmother actually started to turn blue; she could not speak and she was not coughing.  I asked if she was choking and she nodded yes.  I don’t believe she knew the universal sign for choking, which, unfortunately many people do not know.  Although she was fine after the piece of chop dislodged, I did manage to break two of her lower ribs.

            Choking can often be prevented in adults by cutting food into small pieces, chewing slowly, avoiding laughing and talking while chewing and swallowing and by avoiding excessive alcohol before and during meals. As far as children go, keep marbles, beads, balloons, coins and other small objects out of reach.  Prevent the child from walking, running or playing while they have food and/or toys in their mouth.  Finally, always supervise mealtimes with young children.

            Choking accounts for nearly 3,000 deaths each year.  The universal sign for choking is simply covering your neck with your hand/hands.  It is important for all persons to recognize and know how to handle choking both in the home and in restaurants and other public places.  The emergency procedure, Heimlich maneuver, is responsible for saving thousands of lives each year. 


Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington, Clinic, updated 7/8/2009


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