• Difficulty in speaking and breathing
• Congested face initially
• A bluish colouration of the skin, lips or nails (Cyanosis) later
• Distressing signs from the casualty, who may point to the throat or grasp the neck

1. If the casualty is breathing, encourage him to cough, as this will help to dislodge the obstruction. Check the mouth and remove obvious obstructions if possible.
2. If the casualty seems to be weakening, or stops coughing or breathing, stand to the side and slightly behind him, remove obvious obstructions from the mouth and give five sharp slaps to his back, between the shoulder blades. Check the mouth again.
3. If the back slap fails, you need to give five abdominal thrusts (The Heimlich Manoeuvre). Stand behind the casualty and place your arms around his abdomen, bend him slightly forwards and put your clenched fist just below the base of the breastbone. Put your other hand on top and pull sharply inwards and upwards five times. Listen for the obstruction being dislodged. Check the mouth again.
4. If the blockage does not clear repeat steps 2 & 3 three times.
5. If the above fails call 999.

This video illustrates the above sequence very well. It will take approximately 2 minutes to download via a dial-up connection. Also, you'll need to have Windows Media Player installed.