Conscious Adult Choking Rescue: AHA-Compliant Back Blows and Abdominal Thrusts

Per American Heart Association (AHA) 2020 Guidelines for severe foreign-body airway obstruction (FBAO) in responsive adult:

Sequence

1. Verify Severity: Universal choking sign (hands to neck), unable to speak/cough/breathe. Ask "Are you choking?"
2. Call for Help / Activate EMS: If alone, perform maneuvers first 2 min, then call.
3. Abdominal Thrusts (Heimlich) — Primary for Adults:
   • Stand behind; wrap arms around waist.
   • Fist thumb-side on midline, above navel, below xiphoid.
   • Grasp fist; quick upward thrusts (5).
   • Repeat until object expelled or patient unresponsive.
4. If Abdominal Thrusts Not Feasible (Pregnancy, Obesity): Chest Thrusts — hands on lower sternum, same motion.

Back Blows: Alternative/Adjunct

AHA: Abdominal thrusts preferred. Back blows acceptable if trained; may be used first in some protocols (Red Cross: 5 back blows → 5 abdominal thrusts). Both generate intrathoracic pressure.

If Patient Becomes Unresponsive

• Lower to floor; call 911 (if not done).
• Start CPR: 30 compressions → look in mouth → remove visible object → 2 breaths.
• Continue until object removed, breathing returns, or EMS takes over.

Do not perform blind finger sweeps. Post-event medical evaluation mandatory.