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Lesson

Foreign-Body Airway Obstruction

10 min Airway & Breathing

Objective: Tell mild from severe choking, run the 2025 back-blow then thrust cycle, and switch to CPR the moment they become unresponsive.

Why This Is Hard

Bystanders want the Heimlich immediately. Mild obstruction just needs a cough. Severe obstruction needs a sequence — and the 2025 AHA adult and pediatric BLS updates start with back blows, not abdominal thrusts alone. If you freeze on an old “thrusts only” habit, you are a guideline behind.

On this truck
  • You already are EMS. Do not wait for “the ambulance.” Clear the airway where they stand, then package.
  • Restaurant, daycare, and car-seat calls: you work in the space you have. Late pregnancy gets chest thrusts, not abdominal thrusts.
  • When they go unresponsive, it is CPR with a look in the mouth before breaths — not a blind finger sweep, and not a long scene for a Magill safari unless you can see the object and are trained.
Say out loud
  • Mild (can cough/speak) — encourage cough, do not slap a working cough
  • Severe — weak/absent cough, cannot speak, cyanosis, panic
  • Responsive adult/child: 5 back blows, then 5 abdominal thrusts; repeat
  • Unresponsive: CPR, look in the mouth before breaths — no blind finger sweeps

Mild vs Severe (Education)

  • Mild: effective cough, can speak or cry, moving air. Stay close. Encourage coughing. Reassess for progression.
  • Severe: silent or nearly silent, cannot speak, weak or absent cough, cyanosis, declining mentation. Treat now. Activate EMS if you are the bystander; you already are EMS.

AHA 2025 Sequence (Responsive)

  • Adults and children: repeated cycles of 5 back blows (slaps) followed by 5 abdominal thrusts until the object is expelled or the patient becomes unresponsive. Back blows first is the 2025 change for consistency and observational clearance data.
  • Late pregnancy or you cannot encircle the abdomen: chest thrusts instead of abdominal thrusts.
  • Infants: repeated cycles of 5 back blows and 5 chest thrusts with the heel of one hand. No abdominal thrusts in infants — injury risk.

When They Go Unresponsive

  • Start CPR, beginning with compressions. Do not pause for a long “is it still in there?” debate.
  • Each time you open the airway for breaths, look for a visible object and remove it if you can see it. No blind finger sweeps — you can pack it deeper.
  • If you are the ALS crew arriving to an unresponsive FBAO, laryngoscopy and Magill forceps are in many protocols — only if you are trained and authorized, and only when you can actually see the object. BVM and compressions still come first if they are pulseless.

Field Pitfalls

  • Abdominal thrusts on a coughing patient who is still moving air.
  • Abdominal thrusts on an infant.
  • Blind finger sweeps.
  • Forgetting chest thrusts in late pregnancy.

Practice

60-second drill

Partner fires: steak-house adult silent and grabbing the throat; toddler coughing loudly; infant silent and turning blue; adult who slumps during your thrusts. Name the next action in one sentence.

Related: Effective BVM Ventilation, Pediatric Airway Differences.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.

1. AHA 2025 care for a responsive adult with severe FBAO is:
2. For a responsive infant with severe FBAO:
3. If the choking patient becomes unresponsive you should:
4. A patient who can cough loudly and speak has:
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