The universal sign
A choking adult typically grabs their throat with one or both hands (the universal choking sign), cannot speak or cough forcefully, and may turn red or blue. If the person can cough forcefully or speak, encourage them to keep coughing. Do not intervene with thrusts while they can still clear the airway on their own.
If they cannot speak, cannot cough effectively, and are not getting air, act immediately.
Abdominal thrusts for adults
Stand behind the person and wrap your arms around their waist. Make a fist with one hand and place it thumb-side against the abdomen, above the navel and below the ribcage. Grasp the fist with the other hand and thrust inward and upward in a quick, firm motion.
Repeat until the object is expelled or the person becomes unconscious. Each thrust should be a distinct, deliberate motion, not a squeeze.
For pregnant individuals or very large people where you cannot reach around the waist, use chest thrusts instead: place your fist on the center of the breastbone and thrust straight backward.
Transition to CPR
If the person becomes unconscious, lower them carefully to the ground, call 911 if not already done, and begin CPR. Each time you open the airway to give a breath, look in the mouth. If you see the object, remove it. Do not perform blind finger sweeps.
The chest compressions of CPR can dislodge an obstruction just as effectively as abdominal thrusts. Continue CPR until the object is cleared, the person resumes breathing, or emergency services arrive.
- Can speak or cough forcefully? Encourage coughing, do not intervene
- Cannot speak or breathe: abdominal thrusts, fist above navel, inward and upward
- Pregnant or very large: chest thrusts on the breastbone instead
- Unconscious: begin CPR, check mouth each time you open the airway
- No blind finger sweeps
- Choking First Aid — American Red Cross choking response procedures.