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Lesson

Foreign-Body Airway Obstruction

10 min Airway & Breathing Skip to quiz

Objective: Tell mild choking apart from severe choking. For a severe adult or child, give 5 back blows, then 5 abdominal thrusts. For an infant, give 5 back blows and 5 chest thrusts, not abdominal thrusts. Start cardiopulmonary resuscitation (CPR) the moment they become unresponsive.

Why this matters

Bystanders want abdominal thrusts right away. Mild obstruction only needs a cough. Severe obstruction needs a sequence.

For a responsive adult or child, start with 5 back blows, then 5 abdominal thrusts. Do not use abdominal thrusts alone. If you stay with an old thrusts-only habit, you are behind the 2025 guideline.

Key points
  • You are already the EMS crew. Do not wait for another ambulance. Clear the airway where the patient is, then move them.
  • In a restaurant, a daycare, or a car seat, work in the space you have. Late pregnancy gets chest thrusts, not abdominal thrusts.
  • When the patient becomes unresponsive, start CPR and look in the mouth before breaths. Do not do a blind finger sweep. Use Magill forceps only if you can see the object and you are trained.
Verbalize
  • This patient can cough or speak. That is mild obstruction. I am encouraging the cough. I am not striking a patient who is moving air.
  • This patient has a weak or absent cough, cannot speak, looks blue, or is panicking. That is severe obstruction.
  • This is a responsive adult or child. I am giving 5 back blows, then 5 abdominal thrusts, and I am repeating that cycle.
  • This is a responsive infant. I am alternating 5 back blows and 5 chest thrusts. I am not using abdominal thrusts.
  • This patient is unresponsive. I am starting CPR. I will look in the mouth before breaths. I will not do a blind finger sweep.

Clinical sequence

  1. Mild choking means the patient can cough or speak. Stay close and let them cough. Do not strike a patient who is still moving air.
  2. Severe choking in a responsive adult or child gets cycles of 5 back blows, then 5 abdominal thrusts, until the object comes out or the patient becomes unresponsive. In late pregnancy, or if you cannot get your arms around the abdomen, use chest thrusts instead of abdominal thrusts.
  3. A responsive infant gets cycles of 5 back blows and 5 chest thrusts. Alternate them. Never use abdominal thrusts on an infant.
  4. If the patient becomes unresponsive, start cardiopulmonary resuscitation (CPR), beginning with compressions. Look in the mouth before each breath. Do not do a blind finger sweep. Use Magill forceps only if you can see the object and you are authorized.

Mild vs Severe

  • Mild means an effective cough, the ability to speak or cry, and air that is moving. Stay close. Encourage coughing. Watch for worsening. A loud cough is not proof that the obstruction cannot get worse.
  • Severe means silent or nearly silent, unable to speak, a weak or absent cough, blue skin, or becoming less alert. Treat now. If you are a bystander, call EMS. If you are the crew, you are already there.
Back blows land between the shoulder blades while the person leans forward. The circled hand is bracing the chest. Back blows
Abdominal thrusts: a fist in the midline of the upper abdomen, just above the navel, thrusting upward. Abdominal thrusts
Chest thrusts land on the lower half of the sternum, the same area as chest compressions. Chest thrusts
The pictures mark the adult landmarks. Blows land between the shoulder blades. The circled hand in that drawing is only bracing the chest. Abdominal thrusts use a fist just above the navel. A responsive adult or child with severe choking gets 5 back blows, then 5 abdominal thrusts. Back blows come first. Repeat that cycle. Hold a responsive infant with the head lower than the chest: 5 back blows, then 5 chest thrusts with the heel of one hand on the lower sternum. Never use abdominal thrusts on an infant. In late pregnancy, or when you cannot reach around the abdomen, use chest thrusts in the same place as chest compressions. If the patient becomes unresponsive, start CPR and look in the mouth before each breath. Do not do a blind finger sweep. If the patient can cough or speak, stay close and do not strike them. Abdominal-thrust and chest-thrust drawings by the U.S. Army Medical Department, public domain, via Wikimedia Commons. Back-blow drawing by Trakotako, Wikimedia Commons, CC BY-SA 4.0. Cropped and contrast adjusted. The adapted back-blow image is also CC BY-SA 4.0.

If They Are Still Awake

  • For adults and children, back blows come first. That is the 2025 sequence. Then give abdominal thrusts. Repeat the cycle until the object comes out or the patient becomes unresponsive.
  • For late pregnancy, or if you cannot reach around the abdomen, use chest thrusts instead of abdominal thrusts.
  • For infants, use the heel of one hand for the chest thrusts. Do not use abdominal thrusts. They can injure the abdomen.

When They Go Unresponsive

  • Start CPR, beginning with compressions. Do not stop for a long debate about whether the object is still there.
  • Each time you open the airway for a breath, look for an object you can see and remove it. Do not do a blind finger sweep. You can push the object deeper.
  • If you are the advanced life support crew and the patient is unresponsive from foreign-body airway obstruction (FBAO), many protocols allow laryngoscopy and Magill forceps. Use them only if you are trained and authorized, and only when you can see the object. If there is no pulse, bag-valve-mask breaths and compressions still come first.

Common errors

  • Giving abdominal thrusts to a coughing patient who is still moving air.
  • Giving abdominal thrusts to an infant.
  • Doing a blind finger sweep.
  • Forgetting chest thrusts in late pregnancy.

Practice

One-minute check

Your partner gives four cases: a silent adult in a restaurant grabbing the throat, a toddler coughing loudly, a silent infant turning blue, and an adult who collapses during your thrusts. Name the next action for each 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

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

1. Current care for a responsive adult with severe FBAO (choking) 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:
← OPA & NPA Adjuncts Pediatric Airway Differences →