Why YSK:
Despite choking being an emergency, until recently there has been limited high-quality evidence to guide bystanders on the most effective way to help. Techniques like abdominal thrusts (formerly known as the Heimlich maneuver), back blows and chest compressions or thrusts have existed since the mid-1900s but, until recently, recommendations were largely based on case reports rather than rigorous scientific data. This evidence gap is dangerous.
Bystander response is the primary driver of a choking person’s outcome, so ensuring people know the safest and most effective way to care for a choking person can save lives.
Please see the article for the full piece, it’s not long.
Article authors:
- Cody Dunne - Emergency Medicine Physician and PhD Candidate, University of Calgary
- Andrew McRae - Associate Professor, Departments of Emergency Medicine and Community Health Sciences, University of Calgary
- Khara Sauro - Associate professor, Cumming School of Medicine, Department of Surgery, University of Calgary
If you need more motivation to open the article, here is an interesting fact:
New research suggests back blows cleared choking obstructions in 72 per cent of cases, superior to both abdominal thrusts (59 per cent) and chest thrusts (27 per cent).
Now tell me what to do when I swallow a too-large piece of potato that is also still hot, and am having a near-death experience while it’s slowly making its way down.
Learn to be ok with taking the L and spit food that is too hot back out of your mouth instead of swallowing. Also, test the temperature with smaller bits that will cool inside your mouth easier before going for a big bite.
Spray liquid nitrogen directly down your throat
I remember health class around 1993 we were watching a filmstrip from the 70s or early 80s, and the filmstrip told us to do the back blows before performing the Heimlich maneuver. Our health teacher then paused the video and told us NOT to do the back blows, because new research had found that back blows are more likely to push the obstruction further inwards.
I’m glad they had it right in the filmstrip!
Great, now I can’t wait to E.Honda the shit out of someone’s back.
From Hundred Hand Slap to a variation of his forward P throw…
The more eyes the better and this seems to be the recommendation:
If an adult or child can still cough, cry or speak clearly, then they are still able to clear the obstruction themselves. Get them to lean forward while encouraging them to cough forcefully.
If the person goes quiet, cannot speak or cry, or can only weakly cough, you want to start with five strong back blows first. With the person bent forward at their hips, deliver firm glancing blows between their shoulder blades using the heel of your hand up to five times.
If the obstruction does not clear, switch to abdominal thrusts. Continue alternating five back blows and five abdominal thrusts until the obstruction is cleared or the person becomes unconscious.
I’m still looking for what to do if I’m alone and something happens.
The article also uses the text “In the updated guidelines, our Canadian study was cited to inform this critical change, and was the only study directly comparing different choking techniques.” to link here:
https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/adult-basic-life-support
But I see no mention of any of these directions there. If someone does, let me know where I’m scanning over.
Edit: Failing at adding an underline to signal the actual link while having the URL readable.
Edit: Added the preceding “then they are still able to clear the obstruction themselves” paragraph that I’d mostly scanned over when reading the article
It’s something I’ve thought about a bunch and the strategy I’ve come up with is:
If your breath is blocked, hold your breath at first and stay calm. Trying to breathe in could wedge it farther in. And trying to breathe out will likely move it, but gravity might just drop it back where it was only with less air in your lungs, which you need to help dislodge the obstruction. Panicking will make you more likely to waste your chance at getting it without needing to fall on something and potentially break ribs (or fail and die). You’ll probably have to suppress your cough reflex. I’ve never done this before and have no idea how much conscious control one would have in that moment and I’m also someone who trained myself to be able to suppress coughs (to avoid embarrasing bong hits lol).
Lean forward, the farther the better, to the point where loose food in your throat will just fall out your mouth. Then cough, if you make it also a growl, you can add more force, as you don’t want to half-ass this. Your air might still be limited.
You should be able to feel if you’re making any progress. If you are, keep at it, if not, switch to the “fall on something to knock the wind out of you” strategy, still keeping your mouth angled down and add a cough as it impacts.
If that fails, make a big ruckus. I’ve told my daughter that if she starts choking and can’t speak to get my attention, knock dishes onto the floor to get my attention. If you’re completely alone in your home, throw a pot out your window before running out your front door. Try to be efficient with your time and energy. Dial 911 and hope they send someone and don’t assume a prank call or a kid when no one responds.
I’m still looking for what to do if I’m alone and something happens.
This video is surprisingly entertaining and covers:
- You can’t talk to 911 (or equivalent) if you’re chocking
- Ideally go where people might see you
- How to try to dislodge what you’re chocking on if no-one helps
Back when I was in Boy Scouts, we learned how to do abdominal thrusts, and how to do it to yourself. You make the same hand shape (IIRC, one hand clasped over the other with your thumb knuckles forming a triangle into the abdomin), and place your hand in the back of a chair (assuming you’re near a chair, which is likely). You then press yourself into it.
the extra information is pretty important too… afaik most remediation for choking should be avoided early on because it’s actually fairly likely the person can clear the obstruction themselves, but if you time a thrust with their breath it can be very bad, and actually cause them to suck the object further in when they gasp for air
not a doctor or anyone with medical training, but i heard it at some point and it kinda makes sense
I agree with your callout on specific info. Disagree with the sentiment because the article is long and I missed that info in the first pass because most of the article talks about the research (and doesn’t seem to link accurately). I’ll add the preceding paragraph that you mentioned. Thanks
If you’re alone. Call 911 (or your regions equivalent) and wait outside for emergency services. Keep trying to cough while you wait. If you see anyone flag them down but don’t go searching for people. I know you’re looking for a self heimlich but your safest bet is to keep trying to cough and to wait for emergency services or for other help to come along. Getting the thrust you need to clear your airway, especially while starved for oxygen, is not guaranteed. So if you ever find yourself in that situation call for help. If you start choking and you’re a healthy adult you’ll have 3 to 5 minutes of consciousness. Use it wisely.
I had to wait 45 minutes for an ambulance when I thought I was about to die. You’ll fall unconscious within 5 minutes. Die within the next 5. Even if you manage to make the call, they won’t know what the hell is wrong with you because you can’t talk. Learning to save yourself in that situation is extremely important, because actual first responders won’t make it there on time.
that seems… atypical? in australia at least, the average response time for a code 1 (most critical) emergency is 15-16min depending on the state
which is still super problematic for complete obstruction (your 5+5min might even be too high for a complete obstruction)
but 45min would make the ambulance service as a whole basically a useless concept
Depends on where you are. I’m a stone’s throw from the ambulance. I can quite literally see it out my back window. Most people in the city I live in will see an ambulance within 10 minutes of the call. Contrast that with where I lived a couple of years ago, and 45 minutes might be the earliest, and up to 90 minutes at the most. We had one ambulance for ~20,000 people in a 1,000 square mile area. If ambulance one was called out, a second ambulance was rolled from the next area over to just the edge of ours. I’d say that situation was pretty typical for 5-10% of the people in my greater geographical area, i.e., if you lived outside of a big city.
The only times I’ve been a bit worried have been eating chicken that I could get down with water so not really the same thing but sometimes I’ve it’s gotten difficult enough I’ve wondered if I’ll need a bit of help, but that’s not really choking or close to blackout. Unfortunately the times I remember I’ve been alone, in an apartment building 10+ floors up in a foreign country. Agreed the safest bet is others but based on those situations I think there are times where it’s tough to guarantee another person will see you and I was aiming to learn what my last resort should be.
I’m still looking for what to do if I’m alone and something happens.
You can do abdominal thrusts on yourself, or you can use something like the back of a chair or a railing to rest your fists on and use your body weight to basically perform the same action
I had a surreal experience once. I was at a busy, casual restaurant at a booth, sitting across from my wife. There was a lady eating alone at a booth a little way behind my wife, and I noticed she looked kind of distressed - looking around like she was trying to catch a waiter - but she seemed to be getting more panicked looking and her face didn’t look right. I got up and went over and said “Are you chocking?” and she looked at me with big eyes and nodded. I asked if she wanted me to try and help and she said yes and stood up. I never learned how to do the Heimlich except from TV shows, but seemed worth a try, so I did what I remembered, and she coughed up a piece of chicken. She looked really embarrassed and said “Thank you.” I said I was glad to help and went back to my seat. No one in the place noticed a thing except for my wife.
I have the exact opposite experience. I was waiting tables at place with a stage and 500 seats, lights are out, I notice a woman is choking and I went for the heimlich, successfully dislodged something as the house lights were brought on and 500 people are staring at us.
Oh, wow. What did people do, applaud?
Right after the comedian said “well that was fucking crazy”
I could not have gotten out of that room fast enough
What did the person you helped say?
Nothing at all. Likely in shock or embarrassed or something. Her daughter thanked me quite a bit and I asked if I could grab her a water or something, I grabbed her a water, still nothing, they left after the water
Funny enough a coworker told me “you’re not supposed to do the heimlich anymore”
Funny enough a coworker told me “you’re not supposed to do the heimlich anymore”
Which is funny because in both your story and mine it worked.
Yeah, it’s effective, definitely more risk of damage apparently. Was kind of violent when i did it, larger shorter lady so I had to like pick her up in order to effectively pull in the right spot, I know there was probably bruising and whatnot.
I’ll end up starting with the back if I ever end up doing it again, but ol reliable will be there if I need it.
holy shit! pretty calm, glad it was chill, but you totally saved their life!!
Funny, when I sat back down, my wife just calmly said, “Did you just save that woman’s life?” It was weird, we just went back to eating and never really talked about it again except when someone would mention the Heimlich and my wife would tell the story.
That was too awkwardly casual of everyone. I would’ve at least given you a high five!
We’re such weird creatures. That woman was choking to death and she was too shy to ask for help and too embarrassed after to say much of anything.
Might have been shock on her part. I choked in a restaurant before on a peppermint and my mom saved me with abdominal thrusts but I was really shaken up afterwards from how scary it got and couldn’t really react much for a while afterwards
Same for the person I performed the heimlich on, I found it odd at the time and her daughter thanked me profusely, it was surreal. I also remember being terrified on hurting her as well as potentially being sued if I had, she was a bigger lady and really short so I had her like fully off the ground squeezing the absolute fuck out of her
What a world where I have to have that thought while trying to help
Yeah it’s quite the experience, you can’t breathe and that’s freaking you out and then you’re just airborne all the sudden and something flies out of you and then you suddenly aren’t dying anymore. It’s a trip but damn I’m glad my mom was able to react to it cos the choking part was horrifying. I’m sure the person you saved feels the same way that you were there to react to it, even if in the moment they seemed a bit dissociated.
thankfully all i do is blow backs. everytime i see someone i make sure to blow their back. im just back blowing nonstop. i saw your mother at the market last week and blew her back.
Thank you for your service
Not all heroes wear capes!
I’m just over here saving my wife’s life on the regular.
But if they did, they’d billow majestically thanks to this good Samaritan.
Fuck me I was about to question why you see so many choking people 🤣🤣
Finally, a YSK post that actually is a YSK.
Interesting. I was eating at a restaurant with my mom a few years ago and she accidentally inhaled a piece of food which had the same diameter as her esophagus. It was terrifying. She just pointed at her throat and had this look on her face like she knew she was going to die. She stood up, turned around, and I did what I thought was the heimlich maneuver. I must’ve done it right, or got lucky, but it worked flawlessly. The food came flying out. I guess we’re in that 59%.
The same thing happened to my son. Luckily I had first aid training and actually knew how to do the Heimlich. I didn’t know that you were supposed to do back blows first though. When I learned, they just told me to go straight for the Heimlich.
Hol up, the maneuver formerly known as Heimlich??
Was Heimlich canceled? First I’ve seen this.
https://en.wikipedia.org/wiki/Abdominal_thrusts
See the History section here for some controversies. From what I remember, there is disagreement on whether he asked for the name to be changed or if institutions changed it first
This is interesting because CPR/first aid classes specifically teach (taught) that back blows are harmful and cause obstructions to get lodged lower in the airway except for very young people who you can turn upsidedownish. Time to rethink. Love it!
Since when? Current Resus Council (UK) guidelines are for back blows first. You make sure the person is bending over forwards first.
Specifically… Right up until they changed it just last year.
Things like this and CPR get changed more often than a lot of people would expect (which is also to say most people never know it changes) but it all gets changed based on what seems like it has the best outcome based on the information\data at hand. Usually there’s one or two adjustments every decade. Make some changes and then see if odds improve over the course of years.
When giving the back blows, you should have the person bend over first.
That’s misinformation sponsored by heimlich himself
I was taught the same as a part of nurse training - maybe I was given outdated information, I don’t know. Bu t of course I was surprised by the article
My most recent bls cpr recert talked about back blows, and said chest thrusts before abdominal thrusts.
Chest thrusts as in chest compressions? Like when the heart stops? What if the heart is still beating??
No, not chest compressions, though that IS what you go to if they don’t stop choking, and then become unconscious (because not breathing is a direct path to not beating). Again, I’ll refer to the wikipedia article someone else has posted in these comments, but chest ‘thrusts’ are similar to the abdominal thrust, but your hands are placed higher, around the rib cage rather than just under it as with the heimlich/abdominal.
I really hope it’s about Heimlich, not really thrusts :)
“Are you choking? Here comes the punch!”
Evidence says begin with back blows
I don’t think I can push enough air out to make a difference - even from the back.
Interesting because all of my first aid instructions say not to slap people on the back. Why should I believe this over instructors and doctors?
because the article says this is the first actual study that’s been done… doctors and first aid instructions go by the best information they have, and prior to this their information is little better than a hunch
Despite choking being an emergency, until recently there has been limited high-quality evidence to guide bystanders on the most effective way to help. Techniques like abdominal thrusts (formerly known as the Heimlich maneuver), back blows and chest compressions or thrusts have existed since the mid-1900s but, until recently, recommendations were largely based on case reports rather than rigorous scientific data.
I recently took a first air course. I was told abdominal thrusts were the first course of action. If the person is obese and you can’t get your arms around them, you should try back blows first. You have the person bend over and give them hard palm strikes in the back, not slaps. If you still can’t get the obstruction out, the last option is chest compressions, but that’s likely to break ribs in the process.
Chest compressions is for when the heart stops, and actually won’t do anything for choking. Abdominal thrusts, where you put pressure on the diaphragm (not the ribs) is for choking. Also, if you do chest compressions for a stopped heart, you’re going to break a few ribs. Unless you’re doing it wrong.
You can read the wikipedia about the abdominal thrusts that another comment linked. There’s a line in there about heimlich not being ‘scientific’ in his pushing of the abdominal thrusts and denigration of back blows.
The sources for this are also instructors and doctors, OP listed them. It sounds like this is new research and best prescribes may be in the process of changing if further research bears these findings out.
Well, yeah. Is this just listing the first air procedure for choking? Something we’ve been doing for fuck long?
There is disagreement and outdated advice on what to do / not to do. First aid is time-sensitive so having a discussion about updated guidelines can be helpful :)
Yeah my first aid training through American Red Cross mandated 5 back blows
https://www.redcross.org/take-a-class/resources/learn-first-aid/adult-child-choking
The NHS also recommends doing this
Not to be “that guy” but for me it really depends on who is choking. Some people I could see choking and my response would be to calmly finish my meal and in my head hope that they expire before I lose my appetite due to their horrible death rattle.
Probably not gonna death rattle with no air movement so no worries there
