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- So now, in this scene, our conscious adult choking has gone unconscious. We've lowered the patient down to the floor carefully, using good ergonomics ourselves, protecting the patient's head and protecting them from trauma from them crashing to the floor. If we've not already called 911 or called the code, now is the time to do so. Once they're on the floor, we go straight into our chest compressions. You may notice that we have actually put on gloves, because I know I'm gonna be trying to pull an object out of the mouth, if I've actually gotten one up and into the mouth. So, it's a good time to put your gloves on, if you haven't already, and have a CPR shield available and ready to use with a one-way valve. Keeping note here, that when we do these chest thrusts, or chest compressions, we're gonna be going to a depth of two to 2.4 inches deep and we're gonna do it at a rate between 100 and 120 times per minute. We're gonna give our first 30 chest compressions. Elbows locked, leaning over the victim's chest, using our upper body weight to do the chest compressions. One and two and three and four and five and six and seven and eight and nine and 10, 11 and 12 and 13 and 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30. After my 30 chest compressions, I head tilt, chin lift. I open up the mouth. I look in the oral cavity to see if I've gotten anything up out of the airway. I don't see anything, so I'm not gonna do a blind finger sweep. I cover their nose and mouth with my CPR shield, and I attempt a rescue breath. I try the breath, nothing goes in, no chest rise and fall. I reposition their head and neck and try again. No breath goes in, no chest rise and fall. So I continue with another 30 compressions, at the same depth, at the same rate. After these 30 compressions, I go back, I look in the mouth, but this time I see something. So I reach in, I pull the object out. And I attempt a rescue breath. Let's see if we're successful. First breath goes in, second breath goes in. If the patient is not breathing normally at this point, not responsive, I go straight into my next 30 compressions. If the patient remains unresponsive, not breathing normally, I'm gonna do 30 compressions, followed by two rescue breaths. And then I keep doing this, 30 compressions to two rescue breaths, until EMS arrives, help arrives, an AED arrives, or the victim becomes responsive and begins breathing normally on their own.
In this lesson, we'll cover how to help an adult choking victim who is unconscious. In our fictional scenario, the adult victim went unconscious while you were trying to help them.
The method of care will closely resemble performing CPR, which you recently learned, however, there are subtle differences to pay attention to.
How to Provide Care
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on, and that you have your rescue shield handy.
- Help lower the victim to the ground or floor, so they don't fall and injure themselves. Pay extra attention to supporting their head and neck.
- Call 911 and activate EMS if you haven't already done so.
- Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum.
- Stand or kneel directly over the victim's chest. Lock your elbows and use only your upper body weight to supply the force for the chest compressions, and count as you perform them.
Pro Tip #1: To maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm.
Remember to make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart.
- Conduct compressions that go 2-2.4 inches deep (or 1/3 the depth of the victim's chest) and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.
- Perform 30 chest compressions.
Warning: Once you perform a chest compression, make sure you allow for full recoil of the chest cavity. You want to allow the chest to come all the way back to the neutral position before performing another compression.
Pro Tip #2: There are no complications when performing chest compressions on a pregnant woman, as you're not near the womb and baby when doing them. Proceed as you would for any other adult patient.
- Lift the victim's chin and tilt his or her head back.
- Look inside their mouth. See if any obstructions came loose from the chest compressions. If you see something, sweep it out using your finger. If you don't, continue with the following steps.
- Grab the rescue shield and place it over the victim's mouth and nose.
- Pinch the victim's nose and open their mouth.
- Deliver a rescue breath and watch for the victim's chest to rise. If the chest doesn't rise, reposition the head and chin and try again. If the second breath also doesn't result in a chest rise, go right back into your 30 chest compressions.
- Look in their mouth again after the 30 chest compressions. If you see an object, sweep it out and try two more rescue breaths.
- If the rescue breaths go in this time – causing the chest to rise and fall – reassess the victim for signs of breathing normally and/or responsiveness.
Pro Tip #3: Let's assume your compressions were able to dislodge the obstruction and you got it out of the victim's mouth. At this point, either they're breathing normally and becoming more responsive, or they're not. If not, continue to perform 30 compressions to two rescue breaths.
Continue to perform CPR until EMS arrives, an AED is located, someone equally trained relieves you, or the victim becomes responsive and begins breathing normally again.
How You can Increase the Effectiveness of CPR
It's important to understand what constitutes high-quality CPR, as performing CPR correctly will give the victim the best chance of survival. With that in mind, here are two lists (cheat sheets) to use when practicing CPR – one list of what to do and what of what NOT to do.
What is High-Quality CPR?
- Performing chest compressions at a rate of 100-120 per minute
- Compressing to a depth of at least 2 inches but not exceeding 2.4 (for adults)
- Allowing for full recoil after each compression
- Minimizing pauses in compressions
- Ventilating adequately – two breaths after 30 compressions, with each breath delivered over one second, and each causing the victim's chest to rise
What is Low-Quality CPR?
- Compressing at a rate slower than 100 per minute or faster than 120 per minute
- Compressing to a depth of less than two inches or greater than 2.4 inches
- Leaning on the chest between compressions or performing compressions while not directly over the victim's heart
- Interrupting compressions for greater than 10 seconds
- Providing excessive ventilation – too many breaths or breaths with excessive force