Choking, severe bleeding and injury

Effective coughing determines the choking response

Sudden inability to speak, breathe, or cough effectively, especially while eating, suggests severe foreign-body obstruction. Do not wait for blue skin. If coughing remains forceful and breathing is possible, encourage coughing and observe closely; do not force water or blindly probe the throat. Coughing itself creates expulsive airflow, while unnecessary intervention can cause harm. For severe obstruction, immediately direct someone to call; alone, use speakerphone while providing care.

The AHA 2025 adult algorithm uses five back blows followed by five abdominal thrusts for responsive adults and children over about one year. Support the chest, lean the person forward, and strike between the shoulder blades with the hand heel. From behind, position a fist above the navel and below the sternum, grasp it, and thrust inward and upward. Check after each action and stop when relieved. In late pregnancy or when the abdomen cannot be encircled, substitute five chest thrusts.

See the AHA adult demonstration, child demonstration, and separate child algorithm. Choose the correct age group; viewing does not replace manikin practice.

No abdominal thrusts for infants; unresponsiveness changes care

For severe obstruction in an infant under about one year, support the head and neck, position face down along the forearm or thigh with the head below the chest, and give five back blows between the shoulder blades. Support the turn onto the back, keeping the head lower, and give five chest thrusts on the sternum with the heel of one hand. Repeat according to AHA/AAP 2025. Do not use abdominal thrusts, suspend or shake the infant, or mix the older two-finger method with the updated hand-heel method. Avoid the lowest sternum and pressure on the throat.

If a person of any age becomes unresponsive, lower them safely, ensure help is called, and start CPR with compressions, breaths, and AED use as in lesson 86. When opening the airway for breaths, remove only a clearly visible accessible object; never sweep blindly. Five thrusts for responsive choking are not a CPR cycle. Continue observation after relief and obtain medical assessment after abdominal or chest thrusts.

The AHA also provides an official infant-choking demonstration page to accompany the infant pathway and supervised training.

Apply sustained direct pressure to severe bleeding

Continuous heavy flow, spurting, rapidly pooling blood, or pallor, clamminess, dizziness, and reduced responsiveness indicate potentially life-threatening bleeding. Smaller losses can endanger infants and young children; do not delay to estimate milliliters. Ensure safety and call immediately. Use accessible gloves or a barrier, but do not delay pressure while seeking perfect supplies. Locate the source, cover it with gauze or a clean cloth, and press firmly and continuously.

Repeatedly lifting the original dressing can disrupt clot formation. If blood soaks through, retain it and, if needed, add one layer rather than building a thick ineffective stack. Continue until bleeding stops, an appropriate tourniquet controls it, or another rescuer takes over. Do not pull out an embedded object; press around and support it. Keep the person warm, monitor breathing and response, and do not have them walk or take food or drink. See Red Cross life-threatening external bleeding.

Tourniquets are for life-threatening limb bleeding

An appropriate commercial tourniquet can control life-threatening bleeding from an arm or leg, particularly when direct pressure is insufficient. Trained rescuers should apply it promptly according to its instructions; inexperienced rescuers should maintain pressure and seek dispatcher guidance. A tourniquet is not a universal cord for neck, torso, or minor wounds. Position it about 5–7.5 cm toward the heart from the wound, avoiding the wound and joints. Tighten the strap; for a windlass device, turn until bleeding stops and secure the rod against unwinding.

If bleeding continues despite correct maximal tightening, a second device may be placed nearer the heart than the first, again avoiding a joint. Record the application time and report it to emergency staff. Do not intermittently loosen or remove it. Pain does not justify releasing control of dangerous blood loss. Red Cross tourniquet instructions support these steps. Wound packing requires specific training; chest and abdominal cavities are not spaces to pack independently.

Prevent secondary harm in burns and head injury

For a thermal burn, remove the heat source and cool the area under cool running water for 20 minutes, starting promptly. Remove nearby jewelry and clothing that is not stuck; do not tear away adherent material. Keep the rest of the body warm, especially in children. Avoid ice, oils, toothpaste, and bursting blisters. After cooling, cover loosely with nonadherent material. Large, deep, facial, chemical, and electrical burns require urgent medical assessment rather than being treated as minor thermal injuries.

After head injury, difficulty waking, seizures, one-sided weakness, or abnormal speech or walking requires an emergency call. Vomiting, anticoagulant use, or continuing symptoms also warrants prompt clinical advice. Do not ask someone with possible neck or back injury to stand and test walking, and do not attempt fracture reduction. Minimize movement except for safety, airway protection, or CPR. NHS burns and NHS head injury explain cooling and referral conditions.

Reasoning through three different responses

In a restaurant, an adult coughs loudly, an infant cannot make a sound, and a kitchen worker has continuously spurting arm bleeding. One universal maneuver is inappropriate. Encourage and observe the adult’s effective cough; the infant needs immediate back blows and chest thrusts with an emergency call; the worker needs sustained direct pressure and an appropriate tourniquet. Assign separate people to call, retrieve supplies, and observe, reporting multiple casualties and their dangers. Avoid one rescuer rushing between people while every intervention is interrupted.

If the infant becomes unresponsive, change from responsive-choking care to CPR. If the adult’s cough becomes ineffective, escalate immediately. First aid follows changing conditions rather than declaring success after a fixed number of actions. Relief still requires observation and handover. Practice must use suitable manikins and training equipment, never thrusts, fully tightened tourniquets, or compressions on healthy partners or real infants. This course does not award practical certification.

Bilingual terms

有效咳嗽 · Effective cough

A forceful cough with continuing ability to breathe.

严重气道梗阻 · Severe airway obstruction

Severely restricted airflow with ineffective coughing or inability to vocalize.

直接压迫 · Direct pressure

Sustained firm pressure at a bleeding wound.

止血带 · Tourniquet

A device controlling life-threatening limb bleeding.

休克 · Shock

A critical state of inadequate effective tissue perfusion and oxygen delivery.

Sources and further reading

• AHA 2025 Adult Foreign-Body Airway Obstruction
• AHA/AAP 2025 Pediatric Basic Life Support
• AHA/AAP 2025 Child Foreign-Body Airway Obstruction
• RCUK 2025 First Aid
• Red Cross: Life-Threatening External Bleeding
• Red Cross: How to Apply a Tourniquet
• NHS: Burns and Scalds
• NHS: Head Injury and Concussion
• AHA 2025 Adult Choking Demo Video
• AHA 2025 Child Choking Demo Video
• AHA 2025 Infant Choking Demo Video

Original course source-check record: 9 September 2026. Full Chinese and English sentence-by-sentence language review: 14 September 2026. AI editing and language review are not human clinical review. Linked institutions have not participated in or endorsed this course.