1. Roll the person onto the back on a hard surface, keeping the back in a straight line while firmly supporting the head and neck. Expose the person's chest.
2. Open the person's mouth with your thumb and index finger, placing your thumb over the tongue and your index finger under the chin. If the object is visible and loose, remove it. If the person is older than age 8, sweep two fingers from one side of the throat to the other to attempt to remove the object.
3. Lift the person's chin while tilting the head back to move the tongue away from the windpipe.
4. Place your ear close to the person's mouth and watch for chest movement. For 5 seconds look, listen, and feel for breathing.
5. If the person is breathing, give first aid for unconsciousness.
6. If the person is not breathing, begin rescue breathing. Maintain the head position, close the person's nostrils by pinching them with your thumb and index finger, and cover the person's mouth tightly with your mouth. Give two slow, full breaths with a pause in between.
7. If the person's chest does not rise, reposition the head and give two more breaths.
8. Open the person's mouth with your thumb and index finger. If the object is visible and loose, remove it.
9. If the object is removed, but the person has no pulse, begin CPR with chest compressions. If no object is visible, begin CPR.
10. If the person starts having convulsions or seizures, give first aid for this problem.
After removing the object that caused the choking, keep the person still and get medical help. Anyone who is choking should have a medical examination, because complications can arise not only from the choking, but also from the first aid measures that were taken.
Do NOT try to grasp an object that is lodged in the person's throat. This may push it farther down the airway. If you can see the object in the mouth, it may be removed.
Do NOT begin the chest compressions of CPR (if heartbeat has stopped) until the airway is cleared.
Call immediately for emergency medical assistance if
Seek medical help right away if someone is found unconscious.
When the person is choking:
Tell someone to call 911 or the local emergency number while you begin first aid/CPR.
If you are alone, shout for help and begin first aid/CPR.
Eat slowly and chew food completely.
Don't drink too much alcohol before or during eating.
Keep small objects away from young children.
Make sure dentures fit properly.
Manno M. Pediatric respiratory emergencies: Upper airway obstruction and infections. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 166.
Thomas SH, Brown DFM. Foreign bodies. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 57.
Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington, Clinic. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.