An adult choking

This walk-through contains the answers. It is here to read the situation without playing it, to print it, and to keep the page useful without JavaScript.

Scene 1 · Opening

Sunday evening, six people round the table. Your mother-in-law is telling a story with her mouth full.

She stops in the middle of a sentence, gets up all at once, and brings both hands to her throat.

Scene 2 · The question

She is coughing. A real cough, loud, coming from deep down. She can still make a noise.

Everyone has stood up and nobody is moving.

What do you do?

• Right move : I ask her “are you choking?”, I settle her however she feels best, and I encourage her to cough.
  Her cough is the best thing happening at this table : If she can speak, shout or cough, the blockage is PARTIAL: you settle her in the position she feels best in, you encourage her to cough, you get medical advice and you watch her closely. You do not hit her.
• Mistake : I give her five good hard blows on the back straight away.
  You have just stopped the one thing that was working : Back blows are for a COMPLETE blockage, when the person can no longer speak, shout, cough or make any sound at all. While the cough is working, you let it do its job.
• Not the best choice : I signal to her to put her arms in the air, I have seen that somewhere.
  Her arms are up. She is still coughing. : You have seen it somewhere, yes. The guidance has not seen it anywhere. Put her arms down and watch her cough: that is exactly what she needs to be doing.

Scene 3 · Not a sound

The cough dies away. She opens her mouth, she is thrashing about, and nothing at all is coming out.

She can no longer speak, or shout, or cough.

This has just changed. What do you do?

• Right move : I step to her side, I lean her forward with a hand supporting her chest, and I strike between the shoulder blades.
  The blockage is complete: you clear it : Mouth open, thrashing about, not a sound left: that is the picture of a complete blockage. One hand supports the chest so the object does not go further down, the other one strikes.
• Mistake : I get her to drink a big glass of water to wash it down.
  Nothing can go down: the way through is blocked : Water has no more room than air. What the guidance asks for is back blows, then abdominal thrusts. Drinking appears in no first aid procedure at all.
• Mistake : I call 15 and wait to be told what to do.
  The dispatcher is going to tell you to strike, and you will have lost that time : With a complete blockage, the action comes BEFORE the call: somebody else round the table can call for help while you are striking. There were six of you here.

Scene 4 · Between the shoulder blades

You are at her side, slightly behind. Your left hand holds her chest, she is leaning forward.

Your right hand is open, heel first.

How do you strike?

• Right move : One to five firm blows between the shoulder blades, with the heel of my open hand, and I check after each one.
  The food has come out : One to five firm blows between the shoulder blades, with the heel of the open hand. Each blow is trying to set off a cough. After every one, you look: if the object has been thrown clear, you stop.
• Mistake : I hit as fast and as hard as I can, without counting and without looking.
  Five at most, and you look between each one : The guidance says one to five blows, and to check after each one whether things are back to normal. Striking blind means carrying on when the airway may already be clear.
• Mistake : I go straight to abdominal thrusts, they work better.
  Thrusts come AFTER the blows : Abdominal thrusts are used after a series of five back blows has failed. The order is not a preference: it is the procedure.

Scene 5 · If it will not shift

Picture the other ending, the one where the five blows did nothing. That is the one you need to have rehearsed.

Five blows, no effect. What do you do?

• Right move : Five abdominal thrusts, then I alternate five blows and five thrusts for as long as it holds.
  Alternate, and never stop : If the blows have no effect, five abdominal thrusts at most. If the problem still is not solved, you alternate five back blows and five abdominal thrusts.
• Mistake : I keep going with back blows, one after another, until it comes out.
  Five blows with no effect, and you change what you are doing : The procedure runs on: blows, then thrusts, then alternating. Sticking with something that has just failed five times burns the seconds that are left.
• Mistake : I lay her on her back and start pressing on her chest straight away.
  She is still conscious: this is not that action : The chest compressions of resuscitation come when the casualty LOSES consciousness. While she is on her feet and conscious, you alternate back blows and abdominal thrusts.

Scene 6 · If she loses consciousness

The other ending again: her legs give way.

She loses consciousness in your arms. What do you do?

• Right move : I lower her gently to the floor, I call for help immediately, and I start thirty chest compressions.
  Lay her down, call, resuscitate : Lay the casualty gently on the floor and call for help immediately, then start resuscitation with thirty chest compressions. Keep going until help arrives or until she starts breathing normally again.
• Mistake : I hold her up and carry on with the abdominal thrusts.
  An unconscious person goes on the floor : Losing consciousness changes the procedure: you lay her down gently, you call, and you move to chest compressions. Holding her upright stops you doing either.
• Mistake : I put her on her side in the recovery position and wait.
  The recovery position assumes she is breathing : Here the way through is blocked: she is not breathing. What the guidance asks for is resuscitation, starting with thirty chest compressions, once you have called.

Scene 7 · The crew

Go back to the first ending, the good one: the food came out on the third blow, she coughed, she got her breath back, she sat down again.

The crew comes anyway, because somebody called while you were striking. They examine her, they talk to her, they write down what happened.

Nobody at that table will ever know whether she would have died. That is exactly why you practise.