When giving abdominal thrusts to a choking adult, you stand behind the person, wrap your arms around their waist, and deliver quick inward-and-upward thrusts just above the navel. The 2025 American Heart Association guidelines recommend alternating five back blows with five abdominal thrusts, repeating the cycle until the object is expelled or the person becomes unresponsive.
This technique works by forcing the diaphragm upward, which rapidly increases pressure inside the chest cavity. That sudden burst of pressure mimics a powerful cough, pushing trapped air up through the airway and, ideally, launching the lodged object out.
How to Know Thrusts Are Needed
Not every choking episode calls for abdominal thrusts. If a person is coughing forcefully, their airway is only partially blocked, and their own cough is the best tool for clearing it. Encourage them to keep coughing and don’t intervene physically.
Abdominal thrusts become necessary when the person can’t cough, can’t speak, or can’t breathe. You may notice them clutching their throat with both hands (the universal choking sign), turning red or blue in the face, or making high-pitched wheezing sounds. Silence is actually more alarming than noise: if no air is moving at all, the blockage is complete and you need to act immediately.
Exact Hand Placement and Technique
Stand directly behind the person and wrap both arms around their waist. Make a fist with one hand, thumb side in, and place it just above the person’s navel but well below the breastbone. Grab that fist with your other hand. Then press into the abdomen with a quick, upward thrust, as if you’re trying to lift the person off the ground. Each thrust should be a distinct, forceful motion, not a squeeze.
A common mistake is placing the fist too high. If your hands land on the breastbone or rib cage, you lose the mechanical advantage of compressing the abdomen and risk breaking ribs. Too low, near the hip bones, and there’s not enough soft tissue to generate the pressure needed. The sweet spot is the soft area between the navel and the bottom of the rib cage.
The Five-and-Five Method
Current guidelines call for a five-and-five approach. Start with five back blows: lean the person slightly forward, then strike firmly between the shoulder blades with the heel of your hand. If the object doesn’t come out, switch to five abdominal thrusts using the technique above. Alternate between the two until either the object is expelled or the person loses consciousness.
If the person becomes unresponsive, lower them carefully to the ground and call emergency services if you haven’t already. Begin chest compressions as you would for CPR. Each time you open the airway to give a breath, look into the mouth. If you can see the object, try to remove it. Don’t blindly sweep a finger through the mouth, as this can push the object deeper.
When You’re Choking Alone
You can perform abdominal thrusts on yourself. Place your fist just above your navel, grab it with the other hand, and drive it inward and upward. If your own thrusts aren’t generating enough force, lean over a hard surface like the back of a chair, a countertop, or a railing. Position the edge against your upper abdomen and press your body weight into it sharply. Repeat until the object clears.
Modifications for Pregnant or Larger Adults
Standard abdominal thrusts aren’t appropriate for someone who is pregnant or whose abdomen you can’t reach your arms around. In these cases, switch to chest thrusts. Stand behind the person and place your fist against the center of the breastbone, not on the lower ribs. Deliver firm, backward thrusts. The goal is the same: increase pressure in the chest cavity to force air up through the blocked airway. The back-blow portion of the five-and-five cycle stays the same.
Possible Injuries From Thrusts
Abdominal thrusts are safe and effective overall, but they involve real force applied to a vulnerable part of the body. A literature review of reported complications found 37 cases of injury, with abdominal injuries being the most common (17 cases), particularly stomach rupture. Injuries to the aorta accounted for another 10 cases. These complications occur mainly in elderly adults, whose tissues are more fragile. Younger adults occasionally experience pancreatic injuries.
Improper hand placement increases the risk. Thrusting too high can damage the ribcage or the organs it protects. Thrusting with too much lateral force rather than a clean inward-and-upward motion can traumatize surrounding tissues. None of this means you should hesitate during a real choking emergency. A blocked airway is fatal within minutes; the risk of not acting far outweighs the risk of a complication.
Why Medical Follow-Up Matters
Even after the object comes out and the person feels fine, a medical evaluation is a good idea. Abdominal thrusts can cause internal bruising or small tears that don’t produce symptoms right away. The object itself may have scratched or damaged tissue on the way down or on the way back up. There’s also a chance that small fragments remain lodged deeper in the airway.
Any lingering symptoms after the rescue, including difficulty breathing, throat pain, trouble swallowing, chest pain, or abdominal soreness, warrant prompt medical attention. But even without symptoms, having a provider confirm that the airway is fully clear and that no internal damage occurred gives both you and the person you helped real peace of mind.