After the Heimlich maneuver successfully dislodges an object, the person who choked should be evaluated by a medical provider, even if they feel fine. The force of abdominal thrusts can cause internal injuries that aren’t immediately obvious, and small pieces of the object may still be lodged in the airway. Here’s what to do in the minutes, hours, and days that follow.
Get a Medical Evaluation, Even Without Symptoms
The Merck Manual recommends that all patients who receive abdominal thrusts be evaluated by a medical provider, regardless of how they feel afterward. The evaluation serves two purposes: confirming the obstruction was completely removed and checking for damage caused by the object itself or by the force of the thrusts.
If the person has any of these symptoms after the object comes out, they need prompt medical attention:
- Difficulty breathing or wheezing
- Trouble swallowing
- Throat pain
- Abdominal pain
- Chest pain
These symptoms can indicate that part of the object is still in the airway or that the thrusts caused internal injury. Don’t wait to see if they improve on their own.
Why the Maneuver Itself Can Cause Injury
Abdominal thrusts deliver sudden, forceful pressure just below the ribcage. That force is what makes them effective, but it can also damage nearby structures. The most commonly reported complications are rib fractures and perforations of the stomach or esophagus. Rarer injuries include splenic rupture, liver damage, diaphragmatic herniation, and tears to the intestinal lining or major blood vessels.
Many of these injuries don’t produce immediate, dramatic symptoms. A cracked rib might feel like general soreness. A small tear in the esophagus can initially cause only mild discomfort when swallowing. That’s why a medical checkup matters even when the person says they feel okay. A doctor can use imaging, typically a CT scan for abdominal concerns or a chest X-ray for rib injuries, to rule out damage that’s hard to detect from the outside.
Watch for Signs of a Remaining Obstruction
Sometimes the Heimlich maneuver dislodges the main piece of food or object, but a smaller fragment stays behind in the airway. This is easy to miss in the relief of the moment. Signs that something may still be stuck include a persistent wheeze (particularly one that sounds the same with every breath), noisy or high-pitched breathing, reduced breath sounds on one side of the chest, or a cough that won’t go away.
A lingering foreign body can also lead to a secondary lung infection called postobstructive pneumonia. If part of the airway stays partially blocked, bacteria can build up behind it. This doesn’t happen right away, which is why monitoring over the next several days is important.
Monitor for Aspiration Pneumonia
During a choking episode, small particles of food, liquid, or saliva can slip into the lungs. This is called aspiration, and many people don’t realize it happened. The infection that follows, aspiration pneumonia, can develop days or even weeks later.
In the days after a choking incident, watch for these symptoms:
- Fever
- Shortness of breath or new wheezing
- Coughing up blood or pus
- Chest pain
- Unusual fatigue
- Bad breath
Because the timeline is so delayed, people often don’t connect these symptoms to the choking event. If someone develops a cough with fever a week or two after choking, aspiration pneumonia should be on the radar.
Help the Person Through the Stress Response
Choking is terrifying. Even after the airway is clear, both the person who choked and the person who performed the maneuver can experience an acute stress response. This can look like rapid breathing, pale or clammy skin, nausea, dizziness, shaking, or feeling mentally foggy and agitated.
Have the person sit down in a comfortable position. Speak calmly. Offer water in small sips once you’re confident they can swallow without difficulty. Keep them warm if their skin feels cool or clammy. These reactions typically pass within minutes to an hour, but they can be intense in the moment, especially for children or elderly individuals who choked.
Some people develop anxiety around eating after a choking episode, particularly with foods similar to what caused the incident. In children, this can show up as food refusal or visible fear at mealtimes. If this persists beyond a few days, it’s worth addressing with a healthcare provider.
What to Do If the Object Didn’t Come Out
If the Heimlich maneuver doesn’t clear the airway and the person loses consciousness, call emergency services immediately if you haven’t already. Lower the person to the ground and begin CPR. Each time you open the airway to give breaths, look into the mouth for the object and remove it if you can see it. Do not do a blind finger sweep, as this can push the object deeper.
If the person is still conscious but the object hasn’t come out after several cycles of thrusts, keep going. Continue abdominal thrusts and call for emergency help. Current American Heart Association guidelines support continued abdominal thrusts as the standard approach. Suction-based anti-choking devices exist, but they’re only recommended when standard techniques aren’t working or aren’t feasible.
A Quick Checklist for Rescuers
- Immediately after: Confirm the person is breathing normally. Stay with them and keep them calm.
- Within the hour: Get them to a doctor or emergency room for evaluation, even if they feel fine.
- First 24 hours: Watch for worsening abdominal pain, chest pain, difficulty swallowing, or blood in saliva or vomit.
- First 1 to 2 weeks: Monitor for fever, persistent cough, or shortness of breath, which could signal aspiration pneumonia.
The Heimlich maneuver saves lives, but the moment the object comes out isn’t the end of the story. A medical evaluation catches the complications that adrenaline masks, and knowing what to watch for in the following days helps you respond quickly if something develops.