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30,000+ Students Sucessfully Trained Annually
30,000+ Students Sucessfully Trained Annually
A choking emergency can happen anytime, to anyone, and anywhere, often without warning. Knowing how to recognize the signs and respond quickly can make all the difference. In this guide, the term “adult” generally refers to a person who is 18 years of age or older. Adult foreign body airway obstruction occurs when an object, such as food or another item, becomes lodged in the airway and blocks the normal flow of air into the lungs. The blockage may be partial or complete, making it difficult or impossible for the person to breathe, speak, or cough. Common signs include sudden choking, inability to talk, noisy breathing, weak coughing, and the universal choking sign of clutching the throat. Because a blocked airway can quickly become life-threatening, recognizing the symptoms and providing immediate first aid are essential to restore breathing and prevent serious complications.
The Adult Foreign-Body Airway Obstruction Algorithm developed by the American Heart Association as part of Adult Basic Life Support (BLS) provides a clear, step-by-step approach for recognizing and treating choking emergencies in adults. It helps rescuers quickly assess whether the airway is partially or completely blocked and guides them in choosing the correct intervention, such as encouraging effective coughing, performing abdominal thrusts, or starting CPR (Cardiopulmonary Resuscitation) if the person becomes unresponsive. By following this structured process, rescuers can respond confidently, reduce delays in treatment, and improve the chances of safely clearing the airway while waiting for advanced medical assistance if needed.
Note: This adult foreign-body airway obstruction algorithm guideline remains valid for the period 2025–2030.
Knowing what to do during a choking emergency can help you act quickly and with confidence. This step-by-step guide explains each part of the adult foreign body airway obstruction algorithm in simple words so you can respond safely and provide the right care.
Before helping someone who is choking, make sure the area is safe for both you and the person. Look for any dangers, such as moving traffic, fire, electrical hazards, or anything else that could put you at risk. You cannot provide effective first aid if you become injured yourself. Once you are sure the scene is safe, approach the person calmly and prepare to assess their condition.
Check the person for signs of severe foreign body airway obstruction (FBAO). These signs include a weak or absent cough, inability to speak, a change in skin color such as bluish lips or face (cyanosis), altered mental status, and apnea or no breathing. These symptoms indicate that the airway may be seriously blocked and immediate action is needed. If these signs are absent, proceed to Step 3. If these signs are present, proceed to Step 4.
If the person is coughing forcefully and can still breathe or speak, encourage them to keep coughing. A strong cough is the body's best way to remove an object from the airway without assistance. Do not give back blows or abdominal thrusts at this stage because they may make the obstruction worse. Continue to watch for signs of severe FBAO, and if the person's condition worsens, return to Step 2 and reassess.
If the person shows signs of severe FBAO, activate the emergency response system immediately or ask someone nearby to call for emergency medical services. Early activation ensures that advanced medical help is on the way while you provide first aid. Do not delay calling for help, especially if the person's condition is getting worse or they are unable to breathe.
Check whether the adult is responsive by speaking loudly and gently tapping their shoulders. If the person responds by talking, moving, or opening their eyes, they are still responsive, and you should proceed to Step 6. If there is no response, the person has become unresponsive, and you should immediately proceed to Step 7.
If the adult is responsive and has severe FBAO, begin repeated cycles of 5 back blows (slaps) followed by 5 abdominal thrusts. For patients in the late stages of pregnancy, or when you cannot safely wrap your arms around the person's abdomen, use 5 chest thrusts instead of abdominal thrusts. Continue alternating these actions until the object is expelled or the adult becomes unresponsive. If the object is expelled, continue to monitor the person until advanced care arrives. Then return to Step 5 to reassess the person's responsiveness.
If the adult becomes unresponsive, begin CPR immediately and continue until advanced care arrives. Start with chest compressions, following the Adult Basic Life Support Algorithm. Before giving rescue breaths, quickly check the mouth for any visible object and remove it only if you can clearly see it. Do not perform a blind finger sweep because it may push the object deeper into the airway. Continue CPR until emergency medical personnel take over or the person begins to respond.
In short, the Adult Foreign Body Airway Obstruction Algorithm provides a clear and practical approach for responding to a choking emergency. By recognizing the signs early and following each step in the correct order, you can act quickly and provide the right care until emergency medical services arrive. Remember to stay calm, assess the person’s condition carefully, and use the recommended first aid techniques based on their level of responsiveness. Learning and practicing this algorithm before an emergency happens can help you respond with greater confidence and may even save a life during a critical emergency.
Want to build your confidence with hands-on practice? Same Day CPR offers BLS Certification through blended learning that combines online coursework with hands-on skill training, helping you prepare for emergencies.
