Synopsis
Recognise complete and partial foreign-body airway obstruction across ages, deliver correct immediate choking care, and arrange definitive bronchoscopic removal without delay.
- A sudden choking event followed by inability to speak, ineffective cough, stridor, cyanosis or collapse is a clinical diagnosis requiring action before tests.
- An effective cough and audible speech indicate airflow: encourage coughing, observe continuously and avoid manoeuvres that might convert partial obstruction to complete obstruction.
- For a conscious adult with ineffective cough, give up to five back blows then up to five abdominal thrusts, repeating according to the current RCUK algorithm.
Key red flags
The person can vocalise, breathe and cough forcefully despite distress. Encourage coughing and be ready to escalate immediately if the cough weakens, speech disappears or consciousness changes.
Investigation priorities
Separate effective airflow from life-threatening obstruction.
Management branches
A conscious adult cannot speak or cough effectively after a sudden choking event.
- Ask if they are choking, call for help and give up to five firm back blows, checking after each attempt.
- If obstruction persists, give up to five abdominal thrusts; use chest thrusts for pregnancy or when the abdomen cannot be encircled.
Choking history, focal signs or recurrent same-site infection without current complete obstruction.
Key medicines
High-concentration oxygenGive the highest available concentration during critical hypoxaemia or resuscitation, then titrate to the appropriate saturation target once reliable.
Inhaled salbutamolUse the current acute wheeze protocol only when clinically important bronchospasm persists alongside definitive foreign-body assessment and removal.