In partial airway obstruction, the patient will be able to breathe and cough, although there may be a ‘crowing’ noise (stridor) as air passes through a narrowed space. Usually, the patient can clear a small foreign body by coughing and, although the breathing may be noisy, air can still enter and leave the lungs. At this stage, it is important to avoid giving back blows which may cause a foreign body to move and become a total obstruction.

Symptoms and signs – Not all may be present

• Partial airway obstruction:
  • breathing laboured, gasping or noisy
  • some air escaping from the mouth
  • patient coughing or making a ‘crowing’ noise
  • extreme anxiety or agitation
• Total airway obstruction:
• the person will be unable to effectively cough, breathe or speak, with no air movement
• the person will be making obvious efforts to breathe with in-drawing of spaces between the ribs and above the collarbones
• the person may be clutching the throat with both hands (the universal sign for choking)

Partial airway obstruction

How you can help

Never use back blows on a person who is able to cough effectively or breathe. 

Ask the patient ‘are you choking?’ to determine whether their airway is completely blocked. If they are unable to answer or make noise, treat them as a total airway obstruction.

If they can answer or breathe:

1.    Reassure and encourage the patient

• Stay with the patient until full recovery has occurred.  
• Encourage the patient to cough and expel the foreign body. 

If the obstruction is not relieved – call for 111 an ambulance.

Total airway obstruction

How you can help

Call 111 for an ambulance.

1.    If the patient is conscious, give up to 5 back blows 

• With an adult or child, standing or sitting (and leaning forward), and using the heel of one hand, give the back blows between the patient’s shoulder blades. 
• Check between each back blow to see if the item has been dislodged.
• Place a baby face down on your lap for the back blows. Ensure you support the baby’s head. Give firm back blows, checking between each to see if the item is dislodged.

2.    If unsuccessful, give up to 5 chest thrusts

• With an adult or child, standing or sitting, wrap both arms around the patient, at chest level. 
• Place one fist with the thumb side against the middle of the breastbone. 
• Grasp that fist with your other hand and give up to 5, separate, inward and upward thrusts. 
• Check between each chest thrust to see if the item has been dislodged.
• Place a baby face upwards on a firm surface and give up to 5 sharp chest thrusts just below the nipple line, checking between each thrust.

The back blows and chest thrusts are given separately with a check after each one to see if the obstruction has been relieved. 

3.    If the obstruction has not been relieved 

• Ensure an ambulance has been called.
• Continue alternating back blows and chest thrusts until the ambulance arrives. 
• If the person becomes unresponsive and is not breathing normally, begin CPR.

A patient who is unresponsive and not breathing normally

How you can help

1. Call 111 for an ambulance.
2. Quickly check the mouth
   • Use your fingers to remove any visible solid obstruction.
3. Begin CPR
   • Begin CPR and continue until the ambulance arrives.

There may be some resistance to inflations at first until the object has been dislodged.

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