Choking: How Many Abdominal Thrusts to Use
Short answer
When someone is choking and cannot breathe, perform abdominal thrusts in repeated cycles of five until the object blocking the airway is expelled or the person becomes unconscious. Continue thrusts without a fixed limit, pausing only to check if the airway is clear. If unconsciousness happens, call emergency services immediately and begin CPR.
What Are Abdominal Thrusts and Why Are They Used?
Abdominal thrusts, commonly called the Heimlich maneuver, are a first aid technique used to clear airway obstructions when a person is choking and cannot breathe. The procedure involves applying a sudden, upward pressure to the abdomen, just above the navel, forcing air out of the lungs to expel the object blocking the airway.
To perform abdominal thrusts, you stand behind the choking person, wrap your arms around their waist, place a fist above their belly button, and grasp it with your other hand. Then, deliver quick, inward and upward thrusts. This action creates enough pressure to dislodge the blockage in the windpipe.
This technique is life-saving because a blocked airway prevents oxygen from reaching the lungs and brain. Without oxygen, a person can lose consciousness within minutes and suffer brain damage or death. Abdominal thrusts are used when the person cannot speak, cough forcefully, or breathe — signs of a severe blockage.
How Do Abdominal Thrusts Work? A Clear Example
Imagine your coworker suddenly clutches their throat while eating lunch and cannot speak or cough. They show panic and are gasping silently, a clear sign of choking.
Here is what you would do:
- Stand behind your coworker and place your arms around their waist.
- Make a fist with one hand and place it just above their navel, below the ribcage.
- Grasp your fist with your other hand.
- Pull sharply inward and upward with a quick thrust.
- Repeat this five times in a row.
After five thrusts, check if your coworker can breathe or cough. If not, repeat another set of five. You continue this cycle until the object is expelled or they become unconscious.
For example, if after two sets (10 thrusts) the person suddenly coughs and breathes, you have successfully cleared their airway. If no relief, keep going while someone calls emergency services.
This shows that abdominal thrusts are repeated as needed; there is no fixed number. Persistence is critical.
Why Does the Number of Abdominal Thrusts Matter?
Understanding how many abdominal thrusts to perform is crucial because it balances effectiveness with safety. Too few thrusts may fail to clear the airway, risking loss of oxygen and unconsciousness. Too many, or overly forceful thrusts, can cause injuries like bruises, broken ribs, or damage to internal organs.
The recommended approach is performing abdominal thrusts in sets of five. After each set, pause briefly to ask the person:
- “Can you breathe?”
- “Can you cough?”
- “Can you speak?”
If they say yes or show signs of relief, stop. If not, continue with another five thrusts.
This method is practical because it gives you a chance to monitor the choking person’s status without wasting time. For instance, if a person can cough or speak after 7 thrusts, you avoid unnecessary continued force.
If the person becomes unconscious during the process, stop thrusts and immediately call 911, then start CPR.
How Many Abdominal Thrusts Should You Perform? Step-by-Step Instructions
There is no maximum number of abdominal thrusts to give. The goal is to keep trying until the airway clears or professional help arrives. Here is a clear step-by-step guide you can follow:
- Identify choking: The person cannot speak, cough weakly or not at all, and struggles to breathe.
- Call for help: Ask someone nearby to dial 911. If alone, call emergency services yourself if possible.
- Position yourself: Stand behind the choking person and wrap your arms around their waist.
- Hand placement: Make a fist with one hand and place it slightly above the navel and below the ribcage.
- Grasp your fist: Hold your fist firmly with your other hand.
- Perform thrusts: Pull sharply inward and upward five times in quick succession.
- Check for relief: After five thrusts, ask if the person can breathe or cough.
- Repeat if necessary: If they cannot breathe, repeat steps 6 and 7 until the object is expelled.
- If unconscious: If the person loses consciousness, call 911 (if not already called) and begin CPR immediately.
For example, you might perform five thrusts, ask “Can you breathe now?” If no response, perform five more, and so on. Keep repeating with minimal delay until the blockage clears.
What Other Choking First Aid Techniques Are Commonly Confused with Abdominal Thrusts?
People sometimes confuse abdominal thrusts with other methods used to relieve choking. Knowing the differences helps you respond properly:
- Back Blows: These are firm slaps between the shoulder blades. Back blows are often the first step, especially for children or adults who can still cough weakly. You give up to five back blows, then move to abdominal thrusts if the airway is still blocked. Learn more in how many back blows to give.
- Chest Thrusts: Used for pregnant or very obese individuals when abdominal thrusts might cause harm. Chest thrusts involve pressing inward on the middle of the chest instead of the abdomen.
- CPR (Cardiopulmonary Resuscitation): If the choking person becomes unconscious, start CPR immediately. Chest compressions may help expel the object and keep oxygen flowing. See how many compressions to breaths in first aid CPR.
Knowing when to switch between these techniques is just as important as performing them correctly.
What Should You Do After the Abdominal Thrusts?
Once the airway is clear and the person can breathe, cough, or speak, take these steps:
- Stay with the person: Monitor their breathing and alertness for at least several minutes.
- Encourage medical evaluation: Even if they feel fine, recommend they see a healthcare provider to check for injuries or breathing difficulties.
- Watch for symptoms: Be alert for chest pain, coughing, or trouble swallowing, which may indicate internal injury.
- If unconsciousness occurs later: Call emergency services immediately and begin CPR.
It is important to avoid leaving a person alone after a choking incident because airway swelling or delayed complications can occur.
How Can You Safely Learn to Perform Abdominal Thrusts?
The most reliable way to learn abdominal thrusts safely is by taking a certified first aid or CPR course through organizations like the American Red Cross or American Heart Association. These courses provide:
- Hands-on practice for abdominal thrusts, back blows, and CPR.
- Guidance on how much force to use.
- How to help infants, children, pregnant or obese persons.
- When to call emergency services.
- How to stay calm and act confidently.
If a course is not immediately available, you can study trusted instructional videos and guides like how to treat choking effectively. However, hands-on training is strongly recommended to build skill and confidence.
Quick Reference Table: Performing Abdominal Thrusts Safely
| Step | Action | Tips to Remember |
|---|---|---|
| 1 | Stand behind choking person | Support their torso with your arms |
| 2 | Make a fist and place above navel | Thumb side against abdomen, avoid ribs |
| 3 | Grasp fist with other hand | Keep fingers away from ribs |
| 4 | Pull inward and upward | Use quick, firm thrusts |
| 5 | Give 5 thrusts | Perform in rapid succession |
| 6 | Check if person can breathe or cough | Ask clearly: “Can you breathe now?” |
| 7 | Repeat if no relief | Keep going until airway clears or help arrives |
| 8 | If unconscious, call 911 & start CPR | Begin chest compressions and rescue breaths |
Following these steps carefully improves the chance of saving a choking person.
Frequently asked questions
Can abdominal thrusts cause injury if done too hard?
Yes, abdominal thrusts can cause bruising, broken ribs, or internal injury if performed too forcefully or incorrectly. However, when someone is choking and cannot breathe, the risk of injury is outweighed by the urgent need to clear the airway.
How do you perform abdominal thrusts on a choking baby?
Do not perform abdominal thrusts on infants under one year old. Instead, alternate five gentle back blows with five chest thrusts using two fingers on the center of the infant’s chest. See [what to do if a baby is choking](#r2) for detailed steps.
What should you do if you are choking alone?
Try to perform abdominal thrusts on yourself by placing a fist above your navel and pressing it forcefully against a firm surface such as the back of a chair or countertop. If possible, call 911 immediately.
When should you stop giving abdominal thrusts?
Stop as soon as the person can breathe, cough forcefully, or speak. If the person becomes unconscious, stop thrusts and begin CPR immediately.
What is the difference between back blows and abdominal thrusts?
Back blows are firm slaps between the shoulder blades used first to try to dislodge an object. Abdominal thrusts apply inward and upward pressure on the abdomen for when back blows fail or choking is severe.