Adults: Conscious Victim
1. Choking is indicated by the Universal Distress Signal (hands clutching the throat).

2. If the victim can speak, cough or breathe, do not interfere.

If the victim cannot speak, cough or breathe, give abdominal thrusts (the Heimlich maneuver).

Reach around the victim’s waist. Position one clenched fist above navel and below rib cage. Grasp fist with other hand. Pull the clenched fist sharply and directly backward and upward under the rib cage 6 to 10 times quickly.

In case of extreme obesity or late pregnancy, give chest thrusts. Stand behind victim. Place thumb of left fist against middle of breastbone, not below it. Grab fist with right hand. Squeeze chest 4 times quickly.

3. Continue uninterrupted until the obstruction is relieved or advanced life support is available. In either case, the victim should be examined by a physician as soon as possible.

If Victim Becomes Unconscious
1. Position victim on back, arms by side.

2. Shout for “Help”. Call 9-1-1 or the local emergency number.

3. Perform finger sweep to try to remove the foreign body.

4. Perform rescue breathing. If unsuccessful, give 6-10 abdominal thrusts (the Heimlich maneuver).

5. Repeat sequence: perform finger sweep, attempt rescue breathing, perform abdominal thrusts, until successful.

6. Continue uninterrupted until obstruction is removed or advanced life support is available. When successful, have the victim examined by a physician as soon as possible.

7. After obstruction is removed, begin the ABC’s of CPR, if necessary.

Conscious Infant (Under 1 year old)
1. Support the head and neck with one hand. Straddle the infant face down over your forearm, head lower than trunk, supported on your thigh.

2. Deliver four back blows, forcefully, with the heel of the hand between the infantO~s shoulder blades.

3. While supporting the head, immediately sandwich the infant between your hands and turn onto its back, head lower than trunk.

4. Using 2 or 3 fingers (see illustration for finger position), deliver four thrusts in the sternal (breastbone) region. Depress the sternum 1/2 to 1 inch for each thrust. Avoid the tip of the sternum.

5. Repeat both back blows and chest thrusts until foreign body is expelled or the infant becomes unconscious.

ALTERNATE METHOD: Lay the infant face down on your lap, head lower than trunk and firmly supported. Perform 4 back blows. Turn infant on its back as a unit and perform 4 chest thrusts.

Unconscious Infant
1. Shout for help. Call 9-1-1 or the local emergency number.

2. Perform tongue-jaw lift. If you see the foreign body, remove it.

3. Attempt rescue breathing.

4. Perform the sequence of back blows and chest thrusts as described for conscious infant.

5. After each sequence of back blows and chest thrusts, look for the foreign body and, if visible, remove it.

6. Attempt rescue breathing. Repeat steps 4 and 5.

7. If foreign body is removed and victim is not breathing, begin the ABC’s of CPR.

Conscious Child (Over 1 year old)
To dislodge an object from the airway of a child:

  * Perform abdominal thrusts (the Heimlich maneuver) as described for adults. Avoid being overly forceful.

Unconscious Child (Over 1 year old)
If the child becomes unconscious, continue as for an adult except:

  * Do not perform blind finger sweep in children up to 8 years old. Instead, perform a tongue-jaw lift and remove foreign body only if you can see it.

{Note: Abdominal thrusts are not recommended in infants. Blind finger sweeps should not be performed on infants or small children.}