The sensation of food becoming lodged in the throat is often immediately alarming, but it is important to distinguish between two different medical scenarios. True choking occurs when a foreign object completely blocks the trachea, or windpipe, preventing air from reaching the lungs and making it impossible to speak, cough, or breathe effectively. Conversely, food impaction happens when a food bolus becomes stuck in the esophagus, the muscular tube leading to the stomach. While impaction can cause chest discomfort and the inability to swallow saliva, the person can generally still breathe, which is the key difference when determining the appropriate response.
Immediate Actions if You Are Alone
If you find yourself alone and suddenly unable to speak or breathe, the first action is to try and cough forcefully. A forceful cough utilizes residual air in the lungs to create sudden pressure, which may be sufficient to dislodge the obstruction. If coughing fails and you have a complete airway blockage, you must quickly perform the self-Heimlich maneuver.
To administer abdominal thrusts, make a fist with one hand and place the thumb side against your abdomen, positioned just above the navel and below the rib cage. Grasp the fist firmly with your other hand, then press inward and upward with a series of rapid, strong thrusts. This leverages the air remaining in the lungs to create a burst of pressure that can expel the lodged item.
If you are unable to generate enough force with your hands alone, use a sturdy, fixed object like the back of a chair or a countertop. Position your upper abdomen over the object, ensuring the pressure point is above your navel, and then lean forward hard and fast. Using your body weight applies the necessary force to compress the diaphragm and push the obstruction out.
Techniques for Assisting a Conscious Adult
When assisting an adult who is choking, first confirm the complete obstruction by asking, “Are you choking?” If the person cannot speak, cough, or make noise, immediately proceed with the “five-and-five” approach: a combination of back blows and abdominal thrusts. This sequence should be alternated until the item is cleared or the person becomes unresponsive.
To deliver back blows, stand slightly to the side and behind the person, placing one arm across their chest for support. Bend the person forward at the waist. Using the heel of your free hand, deliver five separate, firm blows between the shoulder blades to create pressure that can dislodge the obstruction.
If back blows are ineffective, immediately perform five abdominal thrusts (the Heimlich maneuver). Stand directly behind the person, wrapping your arms around their waist and tilting them slightly forward. Place the thumb side of a fist against the person’s abdomen, positioning it above the navel and below the breastbone. Grasp your fist with your other hand, then deliver five quick, forceful thrusts inward and upward in a J-shape motion. Continue alternating five back blows and five abdominal thrusts until the airway is clear.
Identifying When to Seek Emergency Medical Care
While an airway obstruction requires immediate intervention, a non-life-threatening food impaction in the esophagus has different markers for seeking professional help. A person with an esophageal impaction may experience chest pain, gagging, or a persistent sensation of fullness, but they can still move air and speak. Emergency services must be contacted immediately if the person becomes unconscious or if the Heimlich maneuver fails to clear a tracheal obstruction.
For an esophageal impaction, call for emergency medical attention if the lodged food causes severe difficulty breathing or if the person is unable to swallow their own saliva. The inability to manage secretions, resulting in excessive drooling, strongly indicates a complete esophageal blockage requiring urgent care. Persistent impaction also carries the risk of esophageal damage, such as pressure necrosis or perforation, making timely medical intervention necessary.
In a hospital setting, medical professionals may initially administer medications, such as glucagon, to relax the esophageal muscles and allow the food to pass. If this is unsuccessful, the definitive treatment is often an emergency endoscopy. During this procedure, a flexible tube is inserted to either gently push the food bolus into the stomach or to grasp and remove the item through the mouth.
Reducing Future Risk
Preventing future incidents often begins with simple behavioral modifications during meals. The most common cause of impaction is eating too quickly or swallowing inadequately chewed food. Taking small bites and chewing thoroughly until the food is a soft, uniform consistency significantly reduces the risk of a blockage. Also, avoid talking or laughing while food is in your mouth, as this can inadvertently cause food to enter the windpipe.
For those who experience recurrent incidents, the cause may be rooted in an underlying anatomical or functional issue within the esophagus. Conditions like gastroesophageal reflux disease (GERD), strictures, or eosinophilic esophagitis can narrow the food pipe, making it more prone to impaction. Ill-fitting dentures can also impair the chewing process, contributing to larger food pieces being swallowed.
If an impaction occurs, even if it resolves spontaneously, a follow-up appointment with a gastroenterologist is warranted to investigate these potential underlying conditions. Diagnosing and treating an underlying esophageal pathology, such as through dilation or medication, is the most effective long-term strategy for minimizing future risks. Staying hydrated by drinking water with meals also helps moisten the food bolus, aiding its passage down the esophagus.