Heimlich maneuver

The Heimlich maneuver is an emergency procedure for removing a foreign objectlodged in the airway that is preventing a person from breathing.

Every year about 3,000 adults die because they accidentally inhale rather than swallow food. The food blocks their windpipe (trachea), making breathing impossible. Death follows rapidly unless the food or other foreign material canbe displaced from the airway.

The Heimlich maneuver, or abdominal thrusts, is simple enough that it can beperformed immediately by anyone trained in the maneuver. By compressing the abdomen, air is forced out of the lungs, dislodging the obstruction and bringing the foreign material up into the mouth.

The maneuver is used mainly when solid material like food, coins, vomit, or small toys are blocking the airway. There has been some controversy about whether it is appropriate to use routinely on near-drowning victims. The AmericanRed Cross and American Heart Association both recommend that the Heimlich maneuver be used only as a last resort, after traditional airway clearance techniques and cardiopulmonary resuscitation (CPR) have been tried repeatedly and failed, or if it is clear that a solid foreign object is blocking theairway.

The Heimlich maneuver can be performed on all people, but modifications are necessary if the choking victim is very obese, pregnant, a child, or an infant.

Indications that a person's airway is blocked include:

  • The person cannot speak or cry out.
  • The face turns blue from lack of oxygen.
  • The person desperately grabs at his or her throat.
  • The person has a weak cough, and labored breathing produces a high-pitched noise.
  • The person does all of the above, then becomes unconscious.

To perform the Heimlich maneuver on a conscious adult, the rescuer stands behind the victim, who may either be sitting or standing. The rescuer makes a fist with one hand, and places it, thumb toward the victim, below the rib cageand above the waist. The rescuer encircles the victim's waist, placing his other hand on top of the fist.

In a series of 6-10 sharp and distinct thrusts upward and inward, the rescuerattempts to develop enough pressure to force the foreign object back up thetrachea. If the maneuver fails, it is repeated. It is important not to give up if the first attempt fails. As the victim is deprived of oxygen, the muscles of the trachea relax slightly. Because of this loosening, it is possible that the foreign object may be expelled on a second or third attempt.

Unconscious victims should be laid on the floor. Bend the chin forward, makesure the tongue is not blocking the airway, and feel in the mouth for foreignobjects, being careful not to push any farther into the airway. The rescuerkneels astride the victim's thighs and places his or her fists between the bottom of the victim's breastbone and the navel. The rescuer then executes a series of 6-10 sharp compressions by pushing inward and upward.

After the abdominal thrusts, the rescuer repeats the process of lifting the chin, moving the tongue, feeling for and possibly removing the foreign material. If the airway is not clear, the rescuer repeats the abdominal thrusts as often as necessary. If the foreign object has been removed, but the victim isnot breathing, the rescuer starts CPR.

In pregnant or very obese people, the main difference in performing the Heimlich maneuver is in the placement of the fists. Instead of abdominal thrusts,chest thrusts are used. The fists are placed against the middle of the breastbone, and the motion of the thrust is in and downward, rather than upward. Ifthe victim is unconscious, the thrusts are similar to those used in CPR.

The technique in children over one year of age is the same as in adults, except that the force used is less than used with adults, to avoid damaging the child's ribs, breastbone, and internal organs.

With infants less than one year old, the rescuer sits down and lays the infant along his or her forearm with the face pointed toward the floor. The rescuer's hand supports the infant's head, and with the rescuer's forearm resting on his or her own thigh for additional support. Using the heel of the other hand, the rescuer administers four or five rapid blows to the infant's back between the shoulder blades.

After the back blows, the rescuer sandwiches the infant between his or her arms, and turns the infant over so that the child is lying face up supported bythe opposite arm. Using the free hand, the rescuer places the index and middle finger on the center of the breastbone and makes four sharp chest thrusts.This series of back blows and chest thrusts is alternated until the foreignobject is expelled.

To apply the Heimlich maneuver to yourself, make a fist with one hand and place it in the middle of the body at a spot above the navel but below the breastbone, then grasp the fist with the other hand and push sharply inward and upward. If this fails, press the upper abdomen over the back of a chair, edge of a table, porch railing or something similar, and thrust up and inward untilthe object is dislodged.

Before doing the maneuver on anyone, it is important to determine if the airway is completely blocked. If the person choking can talk or cry, Heimlich maneuver is not appropriate. If the airway is not completely blocked, the choking victim should be allowed to try to cough up the foreign object on his or her own.

Many people vomit after being treated with the Heimlich maneuver. Depending on the length and severity of the choking episode, the choking victim may needto be taken to a hospital emergency room.

Incorrectly applied, the Heimlich maneuver can break bones or damage internalorgans. In infants, the rescuer should never attempt to sweep the baby's mouth without looking to remove foreign material. This is likely to push the material farther down the trachea.

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