The airway may be obstructed externally or internally, for example, by an object that is stuck at the back of the throat. How Can you Recognize Choking? Features of hypoxia, such as grey-blue tinge to the lips,
earlobes, and nailbeds (cyanosis). Difficulty speaking and breathing. Noisy breathing. Red, puffy face. Signs of distress from the victim, who may point to the throat or grasp
the neck. Flaring of the nostrils.