Aid a conscious person with an upper airway obstruction.

Given a simulated conscious casualty (standing or sitting) with an upper airway obstruction.

Score a GO on the performance checklist.

STP 21-1-SMCT, Soldier's Manual of Common Tasks: Skill Level 1.

FM 21-11, First Aid for Soldiers.

An upper airway obstruction (blockage) occurs when an object enters a person's trachea (windpipe) and obstructs airflow. The blockage can be caused by food, blood clots or loose teeth resulting from a head injury, vomitus (regurgitated stomach contents) which has been inhaled, or objects such as buttons. The blockage must be expelled or removed and breathing restored. A blockage that stops breathing or greatly reduces the amount of air that can be inhaled and exhaled can quickly lead to unconsciousness and death.

A person with an airway obstruction will automatically begin to cough or at least try to cough. In addition, he will probably clutch his throat. This clutching action is natural, but it has also been adopted as the universal distress signal for choking. This sign alerts other people that the problem is an airway obstruction rather than another problem such as a heart attack.

If the person with an obstruction can speak or cough forcefully, he has a partial blockage with good air exchange. (A partial blockage means that the airway is not completely blocked and air can still get to and from the person's lungs. Good air exchange indicates that the person can still inhale and exhale enough air to carry on all life processes.) A person may have good air exchange even though he makes a high-pitched sound between coughs.

If the person has a weak cough, makes high-pitched noises (like crowing) while inhaling, or has a bluish tint around his lips and fingernail beds, he has a partial blockage with poor air exchange. A person with poor air exchange is not inhaling enough air to continue carrying on all life processes. If the person is not helped, he will become unconscious and die.

CAUTION: If you cannot decide whether a conscious casualty has good or poor air exchange, tell him to speak to you. If he does not speak, assume he has an obstructed airway.

If the person's airway is completely blocked, he can neither inhale nor exhale (no air exchange occurring). This means he cannot speak at all. Quick action is needed to clear the airway.

Encourage a person with good air exchange to keep coughing until the obstruction is coughed up. Do not interfere with his efforts. Do not leave the person since "good" air exchange can rapidly deteriorate to "poor" air exchange or complete blockage, either of which can result in unconsciousness and death. Be prepared to administer manual thrusts should his condition worsen.

If a person has poor air exchange or a complete blockage, call for help and begin administering manual thrusts. If possible, send someone to seek medical help.

If the person has significant abdominal injuries, is noticeably pregnant, or has a waist that is too large to encircle, administer chest thrusts. Otherwise administer abdominal thrusts.

CAUTION: The manual thrusts presented in this lesson are used with a conscious casualty who is sitting or standing. If the casualty becomes unconscious or is lying down, administer the modified thrusts described in Lesson 3. Back blows are no longer used to dislodge an airway obstruction in an adult.

Stand behind the casualty, insert your arms under his arms, and wrap your arms around his waist.

Make a fist with one hand and place the thumb side of your fist on the midline of the casualty's abdomen slightly above his navel (belt buckle) and well below the bottom tip of his breastbone.

Grasp your fist with your other hand.

Press your fists into the casualty's abdomen using a quick inward and upward motion, then relax the hold. Each thrust should be a separate and distinct movement delivered with the intent of dislodging and expelling the object causing the blockage.

Continue administering abdominal thrusts at a rate of one thrust every 4 or 5 seconds until the obstruction is expelled or the casualty becomes unconscious.

If the casualty loses consciousness, call for help again, move backward, and lower the casualty onto the ground so that he is in a supine (on his back) position. (Procedures for the following actions can be found in Lesson 3, Perform Mouth-To-Mouth Resuscitation.) Open the casualty's mouth and perform a finger sweep. Then open the casualty's airway, administer two full breaths, and evaluate the effectiveness of your ventilations. If the airway is still blocked, perform modified abdominal thrusts, administer finger sweeps, and administer two full breaths until the obstruction is expelled or removed and the airway is open. Once the airway is open, check for breathing. If the casualty is not breathing on his own, check his carotid pulse. If a pulse is present, continue mouth-to-mouth resuscitation.

Stand behind the casualty, place your arms under his armpits, and encircle his chest. Make a fist with one hand and place the thumb side on the center of the casualty's breastbone (sternum).

Grasp your fist with your other hand.

Thrust inward so the sternum is depressed about 1 1/2 to 2 inches; then relax the hold.

CAUTION: If the casualty is a child (8 years old or less), the sternum should be depressed only 1 to 1 1/2 inches.

Continue administering chest thrusts at a rate of one thrust every 4 or 5 seconds until the obstruction is expelled or the casualty becomes unconscious. Each thrust should be a separate and distinct movement.

If the casualty loses consciousness, call for help, move backward, and lower the casualty onto the ground so that he is in a supine (on his back) position. (Procedures for the following actions can be found in Lesson 3, Perform Mouth-To-Mouth Resuscitation.) Open the casualty's mouth and perform a finger sweep. Then open the casualty's airway, administer two full breaths, and evaluate the effectiveness of your ventilations. If the airway is still blocked, perform modified chest thrusts, administer finger sweeps, and administer two full breaths until the obstruction is expelled or removed and the airway is open (two full breaths administered successfully). Once the airway is open, check for breathing. If the casualty is not breathing on his own, check his carotid pulse. If a pulse is present, continue mouth-to-mouth resuscitation.

Team up with two other persons. Practice administering abdominal and chest thrusts while the third person observes and grades you using the performance checklists. DO NOT apply full force to the simulated casualty when performing manual thrusts.