What is the proper procedure for performing the Heimlich maneuver on someone who is choking?

Heimlich Maneuver: Proper Procedure for Choking

For a conscious adult or child over 1 year with complete airway obstruction, perform alternating cycles of 5 back slaps followed by 5 abdominal thrusts (Heimlich maneuver) until the object is expelled or the victim becomes unresponsive. 1

Initial Assessment

Determine if the obstruction is partial or complete:

• Partial obstruction: The victim can cough, make sounds, or breathe with wheezing—encourage continued coughing and do not interfere 1
• Complete obstruction: The victim cannot speak, breathe, or cough, often grips their throat with their hand, and will lose consciousness if untreated 1

Technique for Adults and Children Over 1 Year

Back Slaps (Perform First)

If the victim is standing or sitting:

• Stand to the side and slightly behind the victim 1
• Support their chest with one hand and lean them well forward so dislodged objects exit the mouth rather than descend further 1
• Deliver up to 5 sharp slaps between the shoulder blades with the heel of your other hand 1
• The goal is to relieve obstruction with each slap, not necessarily to give all five 1

If the victim is lying down:

• Kneel beside them and roll them onto their side facing you 1
• Support their chest with your thigh 1
• Give up to 5 sharp slaps between the shoulder blades with the heel of your hand 1

Abdominal Thrusts (Heimlich Maneuver)

If the victim is standing or sitting:

• Stand behind the victim and place both arms around their upper abdomen 1
• Ensure the victim is bending well forward 1
• Make a fist and place it between the umbilicus (navel) and xiphisternum (bottom of breastbone) 1
• Grasp your fist with your other hand 1
• Pull sharply inward and upward to dislodge the object 1

If the victim is lying on the ground:

• Turn them onto their back if necessary 1
• Kneel astride them 1
• Place the heel of one hand between the umbilicus and xiphisternum, avoiding pressure on the ribs 1
• Place your other hand on top of the first 1
• Thrust sharply downward and toward the victim's head 1
• Give up to 5 thrusts if necessary 1

Alternating Sequence

Continue alternating 5 back slaps with 5 abdominal thrusts until:

• The object is expelled 1
• The victim becomes unresponsive 1
• After each cycle, check the mouth and remove any visible object (never perform blind finger sweeps) 1, 2
• Attempt 2 rescue breaths at the end of each series 1

Special Considerations for Infants (Under 1 Year)

Never perform abdominal thrusts on infants—they can damage the relatively large and unprotected liver: 1, 3

Instead, use this sequence:

• Deliver 5 back blows (slaps) with the infant prone and head lower than torso 1, 3
• Follow with 5 chest compressions (similar to cardiac compressions but more vigorous) 1, 3
• Continue alternating until the object is expelled or the infant becomes unresponsive 1, 3

If the Victim Becomes Unresponsive

Immediately transition to CPR—do not check for a pulse: 1, 2

• Begin with 30 chest compressions 1, 2
• After 30 compressions, open the airway and look for the foreign body 1, 2
• If you see the object, remove it—never perform blind finger sweeps 1, 2
• Attempt 2 rescue breaths 1, 2
• Continue cycles of 30 compressions and 2 breaths 1, 2
• After 2 minutes of CPR, activate emergency medical services if not already done 1, 2
• Loss of consciousness may relax laryngeal muscles and allow air passage 1

Self-Administration Techniques

If you are choking and alone, you can perform self-administered abdominal thrusts: 4

• Use the same hand position on your own abdomen and thrust inward and upward 4
• Alternatively, lean your upper abdomen forcefully against a firm object like a chair back or table edge—this "chair thrust" technique produces higher intrathoracic pressures than standard maneuvers 4

Critical Pitfalls to Avoid

Technique errors that reduce effectiveness or cause harm:

• Do not interfere if the victim can still cough effectively—coughing generates higher airway pressures than any maneuver 1
• Never perform blind finger sweeps, as they can push the object deeper into the airway 1, 2
• Avoid applying pressure over the ribs themselves or the xiphoid process during abdominal thrusts 1
• Do not perform abdominal thrusts on infants under 1 year due to risk of visceral rupture 1, 3
• Never abandon effective CPR to attempt improvised airway procedures you are not trained to perform 2

Potential complications requiring medical evaluation:

• All patients who receive abdominal thrusts should be examined by a physician, as serious complications can occur including gastric rupture, surgical emphysema, pneumomediastinum, and pneumopericardium 5, 6
• Incorrect technique or excessive force increases complication risk 6