A choking person's airway may be completely or partially blocked. A complete blockage is an urgent medical emergency. A partial obstruction can quickly become life threatening if the person loses the ability to breathe in and out sufficiently.

Without oxygen, permanent brain damage can occur in as little as 4 minutes. Rapid first aid for choking can save a life.

• Eating too fast, failing to chew food well enough, or eating with improperly fitted dentures
• Alcohol consumption (even a small amount of alcohol affects awareness)
• Unconscious or stuporous persons may inhale vomited material
• Small objects inhaled by young children
• Trauma to the head and face (swelling or blood can cause choking)

The universal distress signal for choking is grabbing the throat with the hand.

Other danger signs include:

• Inability to speak
• Weak, ineffective coughing
• Noisy breathing or high-pitched sounds while inhaling
• Difficulty breathing
• Bluish skin color
• Loss of consciousness if blockage is not cleared

How to perform the Heimlich maneuver:

1. First ask, "Are you choking? Can you speak?" DO NOT perform first aid if the person is coughing forcefully and able to speak -- a strong cough can dislodge the object.
2. Stand behind the person and wrap your arms around the person's waist.
3. Make a fist with one hand. Place the thumb side of your fist just above the person's navel, well below the breastbone.
4. Grasp the fist with your other hand.
5. Make quick, upward and inward thrusts with your fist.
6. Continue these thrusts until the object is dislodged or the victim loses consciousness.

IF THE PERSON LOSES CONSCIOUSNESS

• Lower the person to the floor.
• Call 911 -- or tell someone to call 911.
• Begin CPR.
• If you see something blocking the airway, try to remove it.

FOR PREGNANT OR OBESE PEOPLE

1. Wrap your arms around the person's CHEST.
2. Place your fist on the MIDDLE of the breastbone between the nipples.
3. Make firm, backward thrusts.

• DO NOT interfere if the person is coughing forcefully, able to speak, or is able to breathe in and out adequately. However, be ready to act immediately if the person's symptoms worsen.
• DO NOT try to grasp and pull out the object if the person is conscious.

When the person is choking:

• Tell someone to call 911 while you begin first aid.
• If you are alone, shout for help and begin first aid.

After the object is successfully dislodged, the person should see a doctor because complications can arise.

In the days following a choking episode, contact a doctor immediately if the person develops symptoms of wheezing, persistent cough, or pneumonia. These could indicate that the object entered the lung instead of being expelled.

• Eat slowly and chew food thoroughly.
• Make sure dentures fit properly.
• Don't drink too much alcohol before or during eating.
• Keep small objects away from young children.

Murray, JF. Textbook of Respiratory Medicine. 3rd Ed. Philadelphia, PA: Saunders; 2000.

Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th Ed. St. Louis, MO: Mosby; 2002.