While choking on dinner, a person has a weak cough, faint inspiratory stridor, and cyanosis around the lips. What should you do first?

• A. Place him in a supine position and open his airway.
• B. Encourage him to cough as forcefully as he can.
• C. Stand behind him and administer abdominal thrusts.
• D. Deliver up to five back blows and reassess him.

Answer: (C)

This situation tests the need to relieve a severe airway obstruction in an alert adult using abdominal thrusts (the Heimlich maneuver). When someone has a weak cough, inspiratory stridor, and blue lips, air isn’t getting through, so you must act quickly to dislodge the object. Abdominal thrusts from behind sharply increase airway pressure, which can pop the blockage out and restore airflow. To do this, stand behind the person, wrap your arms around their waist, place a fist just above the navel with the other hand over it, and deliver quick upward thrusts.

Placing the person on their back to open the airway wouldn’t remove the blockage and could delay relief. Encouraging them to cough isn’t enough once ventilation is compromised and cyanosis is present. While back blows can be used in some protocols, abdominal thrusts directly target the obstruction and are the most effective immediate action for an adult with a severe choking incident. If the person becomes unresponsive, call for help and start CPR, checking the mouth for and removing any visible object if possible.