Choking in a bedridden patient: what to do step by step

Choking — obstruction of the airway by food or a foreign object — is especially dangerous in a bedridden patient. Lying on the back and frequent difficulty swallowing both raise the risk, while standing abdominal thrusts cannot be used in bed. The first minutes are held by whoever is next to them. Here is what to do, step by step.

First of all: call 112

The moment you realise someone is choking, call 112 right away and put it on speaker so your hands are free. Do this for both mild and complete obstruction: a mild obstruction can turn complete at any moment, and you want the call already active and help on the way. Nothing guarantees you'll have time to call later.

Recognise the severity

The key question is one: can they cough or speak?

• If they can cough, speak or breathe, even with difficulty, it's a mild (partial) obstruction.
• If they cannot cough, speak or breathe, it's a complete obstruction and you act at once.

Mild obstruction (conscious and coughing)

• Encourage forceful coughing. It's the most effective way to clear the object.
• Turn them onto their side — don't leave them on their back. On the side, gravity helps the object or fluid come out rather than fall deeper into the lung.
• Don't give water and don't put your fingers blindly into their mouth — you may push the object deeper.

Complete obstruction (conscious, but cannot cough, speak or breathe)

You have already called 112. Because standing abdominal thrusts cannot be used in bed, proceed as follows.

Back blows:

• If the patient can sit up and support themselves, help them to sit on the edge of the bed, leaning slightly forward.
• If they cannot sit up, turn them onto their side, facing you, and support their chest with one hand.
• In both cases, give up to 5 firm blows between the shoulder blades with the heel of your hand. The blows are sharp and straight — not a sweeping, scooping upward motion, which has been linked to cervical spine injuries.

Chest thrusts (instead of abdominal):

• If the back blows don't work, turn the patient onto their back. Lying down, abdominal thrusts are difficult and dangerous, so apply 5 chest thrusts instead.
• Place the heel of your hand on the lower half of the sternum (as in CPR compressions, but slower and sharper), to create an artificial cough.

Alternate:

• Keep alternating: 5 back blows (on the side) and 5 chest thrusts (on the back), until the object comes out or they lose consciousness.

If they lose consciousness

• Update 112 on the change: the crew set out for a choking and will now find a cardiac arrest.
• Start CPR immediately, on the bed. Don't move the patient to the floor.
• Begin with 30 chest compressions.
• Before the rescue breaths, open the mouth and check. Only if the foreign object is visible and within reach, remove it carefully with a finger. If nothing is visible, don't put your fingers in.
• Give 2 rescue breaths and continue the 30:2 cycle until the ambulance arrives or normal breathing returns.

What not to do

• Don't leave them on their back while choking; the side position is safer.
• Don't give water.
• Don't do a blind finger sweep of the mouth.

Remember one thing

In a bedridden patient, two things change compared with someone standing: you call 112 straight away, and in place of abdominal thrusts you use chest thrusts. Side position for the back blows, on the back for the chest thrusts, and CPR on the bed if they lose consciousness.

This article is for information only and does not replace hands-on training.