MANAGEMENT FOR CHOKING IN ALDULTS Step 1 Victim will usuall lean forward. Give up to 5 sharp blows with the heel of your hand in the middle of victim’s back between the shoulder blades. Stop when the victim can cough. Step 2 Give up to 5 sharp chest thrusts with your palm in the center of the victim’s chest. Alternate between 5 back blows and 5 chest thrusts until the victim can cough. If the victim still cannot cough and they become unconscious, commence CPR (click to watch the instruction)