An unresponsive 2-year-old child who is choking and not breathing: what is the first action you should take?

• A. begin chest compressions
• B. perform a series of abdominal thrusts
• C. lift her by the feet and perform back slaps
• D. inspect the airway, possibly a finger sweep

Answer: (A)

When a child is unresponsive and choking with no breathing, the priority is to restore circulation and provide ventilation. Starting chest compressions right away is the best first action because it sustains blood flow to the brain and vital organs while you address the airway. Abdominal thrusts or back slaps are for a conscious choking victim; once the child is unresponsive, those maneuvers aren’t the initial step. A finger sweep should only be considered if you can clearly see and safely remove an object, and blindly sweeping the airway in an unresponsive patient can push the obstruction deeper or cause injury. After starting compressions, you’ll open the airway and provide rescue breaths, then continue CPR in cycles and activate emergency help.