Expansion
Mild or severe, decided by whether the patient can cough effectively
Expansion
Assess the severity by asking “are you choking?”
- Mild (effective cough): the patient can speak, cough and breathe. Encourage coughing and observe. Do nothing else
- Severe (ineffective cough): cannot speak, silent or wheezy, cyanosis, decreasing consciousness
Adults and children over 1 year, severe obstruction
- Five back blows between the scapulae with the heel of the hand, leaning the patient forward
- Five abdominal thrusts
- Alternate the two, reassessing after each
If the patient becomes unconscious: lower them to the ground, call the arrest team and begin CPR, starting with chest compressions, which generate higher airway pressures than abdominal thrusts.
Infants under 1 year: five back blows then five chest thrusts. Never abdominal thrusts, because the liver is relatively large and unprotected.
Afterwards: anyone who has received abdominal thrusts should be assessed for internal injury, and a persistent cough, difficulty swallowing or a sensation of something stuck suggests a retained foreign body needing bronchoscopy or endoscopy.