Unconscious Adult Choking

Video 34 of 41
3 min 36 sec
English, Español
English, Español

This unconscious adult choking lesson is for situations where you find a person who is unconscious, and you suspect they became unresponsive due to an airway obstruction.

Ideally, either you or a bystander witnessed the victim choking before they went unconscious. Through further assessment, you find that the patient has a pulse but isn't breathing normally. Any attempts to deliver a rescue breath have failed, most likely due to an obstruction.

In this scenario, you would treat this patient as an unconscious adult choking victim. The method of care will closely resemble performing CPR, however there are subtle differences to pay attention to.

How to Provide Care

As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy.

  • Assess the patient to make sure he or she is not breathing normally and is unconscious.
  • Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. Then go right into chest compressions.
  • Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum.
  • Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper bodyweight to supply the force for the chest compressions, and count as you perform them.

Pro Tip #1: To maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm.

Remember to make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart.

  • Conduct compressions that go 2-2.4 inches deep (or 1/3 the depth of the victim's chest) and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.
  • Perform 30 chest compressions.

Warning: Once you perform a chest compression, make sure you allow for full recoil of the chest cavity. You want to allow the chest to come all the way back to the neutral position before performing another compression.

Pro Tip #2: There are no complications when performing chest compressions on a pregnant woman, as you're not near the womb and baby when doing them. Proceed as you would for any other adult patient.

  • Lift the victim's chin and tilt his or her head back slightly.
  • Look inside their mouth. See if any obstructions came loose from the chest compressions. If you see something, sweep it out using your finger. If you don't, continue with the following steps.
  • Breathe into the rescue mask and wait for the chest to rise and fall. If the chest doesn't rise, reposition the head and chin and try again. If the second breath also doesn't result in a chest rise, go right back into your 30 chest compressions.
  • Look in their mouth again after the 30 chest compressions. If you see an object, sweep it out and try two more rescue breaths.
  • If the rescue breaths go in this time – causing the chest to rise and fall – check for a carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse.
  • If you detect a pulse but there are still no signs of normal breathing, continue to perform one rescue breath every five seconds for two minutes.
  • After two minutes, reassess for a pulse and check again for normal breathing.
  • If you still detect a pulse and the patient still isn't breathing normally, continue with one rescue breath every five seconds for two minutes. If you do not detect a pulse, go into full CPR – 30 chest compressions followed by two rescue breaths.
  • Continue until help arrives, an AED arrives, or the victim is responding positively and breathing normally.

A Word About High Quality CPR

It's important to understand what constitutes high quality CPR, as performing CPR correctly will give the victim the best chance of survival.

High Quality CPR

  • Performing chest compressions at a rate of 100-120 per minute
  • Compressing to a depth of at least 2 inches but not exceeding 2.4
  • Allowing for full recoil after each compression
  • Minimizing pauses in compressions
  • Ventilating adequately – two breaths after 30 compressions, with each breath delivered over one second, and each causing the patient's chest to rise

Low Quality CPR

  • Compressing at a rate slower than 100 per minute or faster than 120 per minute
  • Compressing to a depth of less than two inches or greater than 2.4 inches
  • Leaning on the chest between compressions or performing compressions while not directly over the victim's heart
  • Interrupting compressions for greater than 10 seconds
  • Providing excessive ventilation – too many breaths or breaths with excessive force

Warning: Once you begin CPR, it's important not to stop. If you must stop, do so for no more than 10 seconds. Reasons to discontinue CPR include more advanced medical personnel taking over for you, seeing obvious signs of life and the patient breathing normally again, an AED being available and ready to use, or being too exhausted to continue.