Choking kills an estimated 8000 to 10,000 people per year in the United States. Many victims have long suffered from some degree of paralysis or other malfunction of the muscles involved in swallowing, often without consciously realizing it. Swallowing is a very complex process in which the mouth, pharynx, esophagus, and vocal cords must be coordinated with great precision. Functional muscular disorders of this mechanism can originate in a variety of ways – as birth defects, for example, or from brain tumors or vascular accidents involving the swallowing center of the brain stem.

Choking is more likely to occur in restaurants, where social interactions and unfamiliar surroundings are likely to distract a person’s attention from swallowing, and where alcohol is more likely to be taken with the meal. A large number of choking victims have a substantial blood alcohol content upon autopsy, which suggests the possibility that in them a marginally effective swallowing reflex was further and fatally compromised by the effects of alcohol on the brain.

Anyone who begins to choke and gasp during a meal should be asked if he or she can speak. If not, as indicated by shaking the head or other gestures, the person is probably suffering a laryngeal obstruction rather than a coronary heart attack. If you are present during such an episode, be aware that you can take certain steps that can save the person’s life. Stand behind the victim, bring your arms around the person’s waist, and clasp your hands just above the beltline. Your thumbs should be facing inward against the victim’s body. Then squeeze abruptly and strongly in an upward direction. Repeat the upward thrusts five times. In most instances the residual air in the lungs will pop the obstruction out like a cork from a bottle. If the obstruction is no relieved, reassess the victim’s status and reattempt multiple thrusts. This procedure is called the abdominal thrust, or Heimlich maneuver.

If the Heimlich maneuver must be preformed with the victim lying down, place the person face up. Kneel astride the victim’s, hip and, with one of your hands on top of the other, place the heel of your bottom hand on the abdomen slightly above the navel but below the rib cage. Press into the victim’s abdomen with a quick upward thrust. This may be repeated if necessary.