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1. Confirm that the airway is obstructed. Only initiate the following steps if the victim is unable to speak or cough, or can do so only weakly. Ask the victim, "Are you choking? Can you speak?"
2. Stand behind the victim and wrap your arms around his or her waist (or around the chest if the person is pregnant or very obese).
3. Make a fist. Place the thumb side of your fist in the middle of the victim's abdomen, just above the navel and well below the tip of their breastbone (or on the middle of the victim's breastbone if the victim is pregnant or very obese).
4. Grasp the fist with your other hand.
5. Keep your elbows out and press your fist abruptly into the victim's abdomen using an upward and inward thrust (or straight backward if positioned over the breastbone of a pregnant or very obese victim).
6. Continue these thrusts until the object is dislodged or the victim loses consciousness.
7. If the victim loses consciousness, give first aid for an unconscious victim.
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