Choking and airway obstruction: a case-based approach

The case: choking at dinner

Raj, 58, is eating dinner with his family when he suddenly stops talking, clutches his throat and looks panicked. At first he is coughing forcefully and his face is red. His wife asks, "Are you choking?" and he nods, unable to speak. This is the key moment. A person who can still cough, speak or breathe has a mild, or partial, blockage. A person who cannot speak, whose cough becomes silent or weak, or who cannot breathe, has a severe blockage that needs immediate first aid. Recognising the difference guides everything that follows, so the first job is to stay calm and quickly work out how bad it is.

Mild choking: let the cough work

If the person can cough, speak or breathe, the blockage is mild. The airway is not fully blocked and a strong cough is the most effective way to clear it — better than anything a bystander can do. Encourage them to keep coughing and stay with them. Do not slap their back or put your fingers in their mouth, as this can push the object deeper or turn a mild blockage into a severe one. Only remove an object from the mouth if you can clearly see it and reach it easily. Reassure them and watch closely. If the coughing weakens, they go quiet, or they cannot breathe, treat it as severe choking straight away.

Severe choking: back blows and abdominal thrusts

In our case, Raj's cough goes silent and he cannot breathe. This is severe choking and needs action now. UK guidance says to give up to five sharp back blows: lean the person forwards and strike firmly between the shoulder blades with the heel of your hand. Check after each one to see if the blockage clears. If back blows fail, give up to five abdominal thrusts: stand behind, place a fist just above the navel, grasp it with your other hand and pull sharply inwards and upwards. Alternate five back blows with five abdominal thrusts. Someone should call 999 if the blockage does not clear quickly.

If the person collapses

If Raj becomes unresponsive, lower him carefully to the floor and call 999 immediately, putting the phone on speaker so the ambulance service can guide you. Begin CPR: chest compressions and, if trained and willing, rescue breaths. The pressure of chest compressions can help dislodge the object. Keep going, following the emergency operator's instructions, until help arrives or the person recovers. Do not stop to repeatedly check the mouth; only remove an object you can clearly see. This is why hands-on training matters — practising CPR and choking first aid builds the confidence to act. Every minute without oxygen counts, so early 999 and early CPR are lifesaving.

After choking and staying safe

Anyone who has had abdominal thrusts should be checked by a doctor, as thrusts can occasionally injure internal organs. Even after a blockage clears, seek medical advice if the person has a lingering cough, difficulty swallowing, or a feeling that something is still stuck, as a fragment may remain. To reduce future risk, encourage eating slowly, cutting food into small pieces, chewing well, and not talking or laughing with a full mouth. Take special care with young children, older people and anyone with swallowing difficulties. Grapes, nuts and small hard foods are common culprits in children. Prevention and preparation together make choking far less dangerous.