SYNTHETIC DEMONSTRATION — no real student or patient. Not a medical device.

Urgent & emergency

Someone Is Choking: Heimlich Maneuver Steps Right Now

If a choking person cannot speak, cough forcefully, or breathe, their airway is completely blocked. Call 911 and alternate 5 firm back blows between the shoulder blades with 5 upward abdominal thrusts (the Heimlich maneuver) until the object comes out. If the person loses consciousness, begin CPR. Infants under 1 need a different technique — back blows and chest thrusts, not abdominal thrusts.

Can they cough? That tells you what to do first

If the person is coughing loudly and can still speak, encourage them to keep coughing hard. A strong, forceful cough is the most effective way to dislodge a partial blockage — it generates much higher airway pressure than any external maneuver. Do not perform back blows or abdominal thrusts while the cough is strong.

Watch closely: if the cough weakens, becomes silent, or the person can no longer speak or make any sound, the obstruction is becoming complete. Begin back blows and abdominal thrusts immediately. The transition from partial to complete obstruction can happen in seconds.

Complete obstruction: back blows and abdominal thrusts (adults and children over 1)

Call 911 first, or have someone else call while you act. Current American Heart Association guidelines 1 recommend alternating 5 back blows with 5 abdominal thrusts:

1. Stand behind the person and lean them slightly forward. 2. Give 5 firm back blows with the heel of your hand between the shoulder blades. 3. Make a fist with one hand just above the navel and below the ribs. Cover it with your other hand. 4. Thrust sharply inward and upward — 5 times. 5. Alternate 5 back blows and 5 abdominal thrusts until the object comes out or the person loses consciousness.

For a person who is pregnant or has obesity, place your hands on the center of the chest (lower half of the sternum) rather than the abdomen — this is called a chest thrust. The alternating back blow and abdominal thrust technique is also used for children over 1 year, scaled to the child's size 13.

If the person becomes unconscious

Lower them carefully to the ground. Call 911 if not already done. Begin CPR: 30 chest compressions in the center of the chest, then 2 rescue breaths if trained. Before giving rescue breaths, look in the mouth — if you can see the object, remove it. Do not perform blind finger sweeps into the throat. Continue CPR until the object is out or emergency services arrive. The 2025 AHA guidelines 1 confirm that chest compressions during CPR can help dislodge a foreign body, making CPR the correct next step once the person is unconscious.

Infants under 1 year: a different technique

Never use abdominal thrusts on an infant. The abdominal organs of an infant are proportionally larger and more vulnerable to injury. The 2025 AHA/AAP pediatric guidelines 2 recommend:

1. Hold the infant face-down along your forearm, supporting the head below the body. 2. Give 5 back blows between the shoulder blades with the heel of your hand. 3. Turn the infant face-up and give 5 chest thrusts with two fingers on the center of the chest, just below the nipple line. 4. Check the mouth after each set — only remove an object you can clearly see. 5. Repeat until the object comes out or the infant becomes unconscious. Call 911 immediately.

If you are choking and alone

Call 911 first if at all possible — put the phone on speaker so the dispatcher can guide you. Then attempt self-rescue. Make a fist and press it firmly into your upper abdomen, just above the navel, driving inward and upward 3. Alternatively, drive your upper abdomen forcefully against a hard edge like a chair back or countertop edge — the hard surface acts as your fist and can generate significant upward pressure. Keep attempting, alternating between fist thrusts and the hard surface, until the object dislodges.

After the object comes out: should you still be seen?

Even when an object is expelled and the person feels fine, a clinician evaluation is reasonable. An object may shift into a lower airway segment or lung rather than fully coming out of the body. Continued symptoms — chest discomfort, persistent coughing, trouble swallowing, shortness of breath, or a sense that something is still stuck — mean the person should be evaluated promptly 3.

For any person who lost consciousness or required CPR, emergency evaluation is mandatory regardless of apparent recovery. Imaging such as a chest X-ray can confirm the airway is fully clear and rule out aspiration into the lungs.

Common questions

What is the difference between back blows and the Heimlich maneuver?

Back blows and abdominal thrusts (the Heimlich maneuver) are used together, alternating in sets of 5. Back blows use the heel of the hand between the shoulder blades; abdominal thrusts use a fist pressed sharply inward and upward just above the navel. Current guidelines recommend alternating both techniques rather than one alone.

Can you do the Heimlich maneuver on an infant?

No. Abdominal thrusts should never be used on an infant under 1 year. Instead, use alternating back blows and chest thrusts — a different technique suited to an infant's body. Call 911 immediately.

When should someone be seen by a clinician after choking?

Any significant choking event warrants evaluation, even if the person feels fine. If the person lost consciousness, CPR was performed, or there are any lingering symptoms — chest pain, cough, difficulty swallowing — seek care promptly. Imaging can confirm the airway is clear and that no object has shifted into the lungs.

Should I do the Heimlich differently for a pregnant person?

Yes. When someone is pregnant or has obesity, abdominal thrusts are not safe. Move your hands to the lower half of the breastbone and perform chest thrusts instead. The technique is otherwise the same: firm inward-and-upward pressure, in sets of 5, alternating with 5 back blows.

Call 911 now if any of these are present

  • —The person cannot speak, cry, or make any sound
  • —The person cannot cough or their cough is silent and weak
  • —The person cannot breathe or is gasping
  • —Lips, face, or fingernails are turning blue
  • —The person is clutching their throat — the universal choking signal
  • —The person loses consciousness

Call 911 immediately — or have someone else call while you begin first aid. Do not leave the choking person alone. The 911 dispatcher will stay on the line and guide you step by step. Begin back blows and abdominal thrusts now; do not wait for help to arrive.

This article is general health information only, not personalized medical advice. Choking is a medical emergency. Call 911 immediately and begin first aid — do not delay action to read.

References

  1. 1.Kleinman ME, et al. (2025). Part 7: Adult Basic Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. doi:10.1161/CIR.0000000000001369 ✓Back blow and abdominal thrust alternation technique for adult choking; CPR role in dislodging obstruction
  2. 2.Joyner BL Jr, et al. (2025). Part 6: Pediatric Basic Life Support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. doi:10.1161/CIR.0000000000001370 ✓Back blow and chest thrust technique for infant choking; no abdominal thrusts for infants under 1 year
  3. 3.American Heart Association (2025). Updated CPR Guidelines Tackle Choking Response, Opioid-Related Emergencies and a Revised Chain of Survival. American Heart Association Newsroom. link ✓Self-rescue abdominal thrusts when choking alone; guidance for conscious adults and children: alternate five back blows and five abdominal thrusts until the object is expelled or the person becomes unresponsive; if unresponsive, start CPR

3 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.