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Choking - unconscious adult or child over 1 year

Definition

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).

Alternative Names

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

Causes

Choking may be caused by:

  • Eating too fast, not chewing food well, or eating with dentures that do not fit well
  • 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
  • Enlarging tonsils or tumors of the neck and throat
  • Problems with the esophagus (food pipe or swallowing tube)

Symptoms

Symptoms of choking when a person is unconscious include:

  • Bluish color to the lips and nails
  • Inability to breathe

First Aid

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 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. 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

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.

When to Contact a Medical Professional

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 does not go away
  • Pneumonia and fever
  • Shortness of breath
  • Wheezing

These could be signs that the object entered the lung instead of being expelled

Prevention

To prevent choking:

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

References

American Red Cross. First Aid/CPR/AED Participant's Manual. 2nd ed. Dallas, TX: American Red Cross; 2014.

Berg RA, Hemphill R, Abella BS, et al. Part 5: Adult basic life support: 2010 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(18 Suppl 3):S685-S705. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20956221.

Berg MD, Schexnayder SM, Chameides L, et al. Part 13: Pediatric basic life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(18 Suppl 3):S862-S875. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20956229.

Cukor J, Manno M. Pediatric respiratory emergencies. In: Marx J, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 168.

Thomas SH, Goodloe JM. Foreign bodies. In: Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 60.


Review Date: 4/12/2015
Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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