Management of Foreign Body Airway Obstruction (Choking)

A Foreign Body Airway Obstruction (FBAO) is a life-threatening emergency. Chest thrusts or back blows are effective for relieving airway obstruction in conscious adults and children with low risk of harm.

Assess Severity

The simplest way to assess severity of an airway obstruction is to assess for effective cough.

Effective Cough (Mild airway obstruction)

The person with an effective cough should be given reassurance and encouragement to keep coughing to expel the foreign material. If the obstruction is not relieved the rescuer should call an ambulance.

Ineffective cough (Severe airway obstruction)

Conscious person

If the person is conscious send for an ambulance and perform up to 5 sharp, back blows with the hand in the middle of the back between the shoulder blades. Check to see if each back blow has relieved the airway obstruction. The aim is to relieve the obstruction with each blow rather than to give all five blows. An infant may be placed in a head downwards position prior to delivering back blows, i.e., across the rescuer’s lap.

If back blows are unsuccessful the rescuer should perform up to 5 chest thrusts. To perform chest thrusts, identify the same compression point as for CPR and give up to 5 chest thrusts. These are similar to chest compressions but sharper and delivered at a slower rate. The infant should be placed in a head downwards and on their back across the rescuer’s thigh, while children and adults may be treated in the sitting or standing position.

With each chest thrust, check to see whether the airway obstruction has been relieved. The aim is to relieve the obstruction rather than deliver all 5 chest thrusts. If the obstruction is still not relieved and the person remains responsive, continue alternating 5 back blows with 5 chest thrusts.

To perform chest thrusts, identify the same compression point as for CPR and give up to 5 chest thrusts. These are similar to chest compressions but sharper and delivered at a slower rate.

  • The infant should be placed in a head downwards position on their back across the rescuer’s thigh, while children and adults may be treated in the sitting or standing position
  • If the obstruction is still not relieved and the person remains responsive, continue alternating 5 back blows with 5 chest thrusts
  • If the person becomes unresponsive a finger sweep can be used if solid material is visible in the airway Call an ambulance and start CPR.

Unconscious person

If the person is unresponsive and not breathing normally, follow Basic Life Support Flowchart.