CPR and Choking: The First Few Minutes That Decide Everything
First Aid & Emergency

CPR and Choking: The First Few Minutes That Decide Everything

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Cardiac arrest survival falls by roughly 7 to 10 percent for every minute without CPR. Ambulances rarely arrive within that window. The person standing nearest is the treatment.

This is a reference, not a substitute for a hands-on course. If you have never done one, do one. They take a few hours.

Recognising cardiac arrest

The person is unresponsive and not breathing normally.

The most commonly missed sign is agonal breathing: occasional gasping, snoring or gurgling sounds in the first minutes. It looks like breathing and it is not. If someone is unresponsive and only gasping, start CPR.

Do not spend time checking a pulse. Lay rescuers are unreliable at it, and the delay costs lives.

Adult CPR

  1. Check for danger to yourself first
  2. Check response: shout and shake the shoulders
  3. Shout for help and ask a specific person to call emergency services and fetch an AED. Pointing at someone works better than a general appeal
  4. Open the airway: head tilt, chin lift
  5. Check breathing for no more than 10 seconds: look, listen, feel
  6. Start compressions:

– Heel of one hand on the centre of the chest, lower half of the breastbone, other hand on top, fingers interlocked – Arms straight, shoulders directly above the hands – Push hard: 5 to 6 cm deep in an adult – Push fast: 100 to 120 per minute – Allow full recoil between compressions; leaning on the chest prevents the heart refilling – Minimise interruptions

  1. Hands-only CPR is recommended for untrained rescuers. Continuous compressions with no rescue breaths. It is far better than nothing and better than hesitant mouth-to-mouth
  2. If trained and willing: 30 compressions to 2 breaths
  3. Swap rescuers every two minutes if someone else is available, because quality falls rapidly with fatigue
  4. Continue until the person shows signs of life, an AED instructs you to stop, or professional help takes over

A compression rate of 100 to 120 matches the beat of many familiar songs; find one you know and use it.

Using an AED

Automated external defibrillators are designed for untrained users. Turn it on and follow the spoken instructions.

  • Expose the chest, dry it if wet
  • Place pads as shown on the diagrams, usually upper right chest and lower left side
  • Stand clear while it analyses and when shocking
  • Resume compressions immediately after a shock
  • Shave excessive chest hair if a razor is included; remove medication patches; avoid placing pads directly over a pacemaker
  • For children, use paediatric pads or settings if available; adult pads are acceptable if not

The device will not shock a rhythm that does not need it, so it cannot harm someone by mistake.

Choking in a conscious adult or child over one year

Mild obstruction, meaning the person can cough, speak or breathe: encourage them to keep coughing. Do nothing else. Coughing is more effective than anything you can do.

Severe obstruction, meaning they cannot speak, cough or breathe, may clutch the throat, go silent, turn blue:

  1. Five back blows: lean them forward, support the chest with one hand, and deliver five sharp blows between the shoulder blades with the heel of your hand
  2. Five abdominal thrusts: stand behind, place a fist thumb-side in above the navel and below the breastbone, grasp with the other hand, pull sharply inward and upward
  3. Alternate five and five until the obstruction clears or the person becomes unresponsive
  4. If they become unresponsive, lower them to the floor, call emergency services and start CPR, checking the mouth for a visible object before each set of breaths

Anyone who has received abdominal thrusts should be medically assessed afterwards for internal injury.

Choking in an infant under one year

Never use abdominal thrusts on an infant.

  1. Lay the infant face down along your forearm, head lower than the body, supporting the jaw
  2. Five back blows between the shoulder blades with the heel of your hand
  3. Turn the infant face up along your other forearm
  4. Five chest thrusts: two fingers on the lower half of the breastbone, sharp compressions
  5. Alternate until cleared or the infant becomes unresponsive, then start infant CPR and call for help

What never to do

  • Do not perform blind finger sweeps. You push the object deeper. Only remove what you can clearly see and easily grasp
  • Do not give water to a choking person
  • Do not slap the back of someone who is coughing effectively
  • Do not hold a choking person upside down
  • Do not delay calling for help while you try remedies

Children’s CPR differences

  • Give five initial rescue breaths before compressions, because respiratory causes predominate in children
  • Compress to about one third of chest depth
  • One or two hands for a child, two fingers or two thumbs encircling for an infant
  • Ratio of 15 compressions to 2 breaths for two trained rescuers

Legal and practical concerns

Fear of liability stops bystanders from acting. In India, the Good Samaritan guidelines and subsequent legislation protect bystanders who help in good faith. A person in cardiac arrest is, without intervention, dying. Ribs sometimes crack during effective CPR; that is an accepted consequence, not a failure.

Prepare in advance

Save the emergency number. Know where the nearest AED is at work, in your building and in your gym. Take a certified course, and persuade your workplace to run one.

This is general guidance, not a replacement for certified training. Techniques are best learned with hands-on practice and are updated periodically.