Choking can be caused by any of the following:

• Eating too fast, not chewing food well, or eating with dentures that do not fit well
• Foods such as food chunks, hot dogs, popcorn, peanut butter, sticky or gooey food (marshmallows, gummy bears, dough)
• Drinking alcohol (even a small amount of alcohol affects awareness)
• Being unconscious and breathing in vomit
• Breathing in small objects (young children)
• Injury to the head and face (for example, swelling, bleeding, or a deformity can cause choking)
• Swallowing problems after a stroke
• Enlarged tonsils or tumors of the neck and throat
• Problems with the esophagus (food pipe or swallowing tube)

When an older child or adult is choking, they will often grab their throat with the hand. If the person does not do this, look for these danger signs:

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

First ask, "Are you choking? Can you speak?" Do not perform first aid if the person is coughing forcefully and is able to speak. A strong cough can dislodge the object. Encourage the person to keep coughing to dislodge the object.

If the person cannot speak or is having a hard time breathing, you need to act fast to help the person. You should perform repeated cycles of 5 back blows followed by 5 abdominal thrusts, until the object comes out or the person becomes unconscious. In pregnant or obese people, chest thrusts should be done instead of abdominal thrusts.

To perform back blows:

• Stand behind the person. For a child, you may have to kneel.
• Wrap one arm around to support the person's upper body. Lean the person forward until the chest is about parallel to the ground.
• Use the heel of your other hand to deliver a firm blow between the person's shoulder blades.
• Check if the object is dislodged.
• Continue to give a total of 5 back blows.

To perform abdominal thrusts (Heimlich maneuver):

• Stand behind the person and wrap your arms around the person's waist. For a child, you may have to kneel.
• Make a fist with one hand. Place the thumb side of your fist just above the person's navel, well below the breastbone.
• Grasp the fist tightly with your other hand.
• Make a quick, upward and inward thrust with your fist.
• Check if the object is dislodged.
• Continue to give a total of 5 abdominal thrusts.

FOR PREGNANT OR OBESE PEOPLE

• Wrap your arms around the person's CHEST.
• Place your fist on the MIDDLE of the breastbone between the nipples.
• Make firm, backward thrusts.
• Continue to give a total of 5 chest thrusts.

Keep performing rounds of 5 back blows and 5 abdominal thrusts (or chest thrusts for pregnant and obese people) until the object is dislodged or the person loses consciousness.

IF THE PERSON FAINTS OR LOSES CONSCIOUSNESS

• Shout for help. Tell someone to call 911 or the local emergency number.
• Carefully place the person on a firm and flat surface. 
• Begin CPR. Check for an object in the mouth before giving breaths. Chest compressions may help dislodge the object. Abdominal thrusts are for a conscious choking victim. Chest compressions are for an unconscious choking victim.
• If you see something blocking the airway and it is loose, try to remove it. If the object is lodged in the person's throat, do not try to grasp it. This can push the object farther into the airway. If you can see the object in the mouth, it may be removed.
• Continue giving CPR and checking for the object in the mouth until medical help arrives or the person starts breathing on their own.

After removing the object that caused the choking, keep the person still and get medical help. Anyone who is choking should have a medical exam. Complications can occur not only from the choking, but also from the first aid measures that were taken.

Avoid making the situation worse by following these tips:

• Do not interfere if the person is coughing forcefully, is able to speak, or is able to breathe in and out adequately. But, be ready to act right away if the person's symptoms get worse.
• Do not force open the person's mouth to try to grasp and pull out the object if the person is conscious. Perform abdominal thrusts and back blows to try to expel the object.

Seek medical help right away if you find someone unconscious.

When the person is choking:

• Tell someone to call 911 or the local emergency number while you begin first aid and CPR.
• If you are alone, shout for help and begin first aid and CPR.

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

In the days following a choking episode, contact the provider right away if the person develops:

• A cough that does not go away
• Fever
• Difficulty swallowing or speaking
• Shortness of breath
• Wheezing

The above signs may indicate:

• The object entered the lung instead of being expelled
• Injury to the voice box (larynx)

To prevent choking:

• Eat slowly and chew food thoroughly.
• Cut large pieces of food into easily chewable sizes.
• Discourage talking, laughing, or playing while food is in the mouth.
• Make sure dentures fit properly.
• Do not drink too much alcohol before or during eating.
• Keep small objects away from young children.

Abdominal thrusts - adult or child over 1 year; Heimlich maneuver - adult or child over 1 year; Choking - back blows - adult or child over 1 year

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Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.