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Abdominal thrusts

Choking - Heimlich maneuver

Choking is when someone is having a very hard time breathing because food, a toy, or other object is blocking the throat or windpipe (airway).

A choking person's airway may be blocked so that not enough oxygen reaches the lungs. Without oxygen, brain damage can occur in as little as 4 to 6 minutes. Rapid first aid for choking can save a person's life.

Abdominal thrusts is an emergency technique to help clear someone's airway.

• The procedure is done on someone who is choking and also conscious.
• Most experts do not recommend abdominal thrusts for infants less than 1 year old. There are different instructions for helping infants under 1 year old who are choking.
• You can also perform the maneuver on yourself.

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First Aid

First ask, "Are you choking? Can you speak?" Do not perform first aid if the person is coughing forcefully and is able to speak. A strong cough can often dislodge the object.

If the person cannot speak or is having a hard time breathing, you need to act fast to help the person. You should perform repeated cycles of 5 back blows followed by 5 abdominal thrusts, until the object comes out or the person becomes unconscious. In pregnant or obese people, chest thrusts should be done instead of abdominal thrusts.

To perform back blows:

• Stand behind the person. For a child, you may have to kneel.
• Wrap one arm around to support the person's upper body. Lean the person forward until the chest is about parallel to the ground.
• Use the heel of your other hand to deliver a firm blow between the person's shoulder blades.
• Check if the object is dislodged.
• Give 5 back blows.

To perform abdominal thrusts (Heimlich maneuver):

• If the person is sitting or standing, position yourself behind the person and reach your arms around their waist. For a child, you may have to kneel.
• Place your fist, thumb side in, just above the person's navel (belly button).
• Grasp the fist tightly with your other hand.
• Make quick, upward and inward thrusts with your fist.
• If the person is lying on their back, straddle the person facing the head. Push your grasped fist upward and inward in a movement similar to the one above.
• Check if the object is dislodged.
• Give 5 abdominal thrusts.

FOR PREGNANT OR OBESE PEOPLE

• Wrap your arms around the person's CHEST.
• Place your fist on the MIDDLE of the breastbone between the nipples.
• Make firm, backward thrusts.
• Give 5 rounds chest thrusts.

You may need to repeat the procedure several times before the object is dislodged. If repeated attempts do not free the airway, shout for help. Tell someone to call 911 or the local emergency number.

If the person loses consciousness, start CPR. Abdominal thrusts are for a conscious choking victim. Chest compressions are for an unconscious choking victim.

Related Information

References

American Heart Association website. Highlights of the 2025 American Heart Association guidelines for CPR and ECC. cpr.heart.org/-/media/CPR-Files/2025-documents-for-cpr-heart-edits-posting/Resuscitation-Science/252500_Hghlghts_2025ECCGuidelines.pdf?sc_lang=en. Accessed February 10, 2026.

Easter JS. Pediatric resuscitation. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 158.

Goodloe JM, Soulek J. Foreign bodies. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 51.

Haas NL, Kurz MC. Adult resuscitation. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 5.

Hewett Brumberg EK, Douma MJ, Alibertis K, et al. American Heart Association and American Red Cross. 2024 American Heart Association and American Red Cross guidelines for first aid. Circulation. 2024;150(24):e519-e579. PMID: 39540278 pubmed.ncbi.nlm.nih.gov/39540278/.

Joyner BL Jr, Dewan M, Bavare A, et al, eds. Part 6: Pediatric basic life support: 2025 American Heart Association and American Academy of Pediatrics guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2025 Oct 21;152(16_suppl_2):S424-S447. PMID: 41122891 pubmed.ncbi.nlm.nih.gov/41122891/.

Kleinman ME, Buick JE, Huber N, et al. Part 7: Adult basic life support: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2025;152(16_suppl_2):S448-S478. PMID: 41122888 pubmed.ncbi.nlm.nih.gov/41122888/.

Rose E. Pediatric upper airway obstruction and infections. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 162.

Review Date: 2/17/2026  

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