Abdominal thrusts
The method of
abdominal thrusts, previously known as the
Heimlich Maneuver, is a controversial
first aid procedure for clearing an obstructed airway.
Dr. Henry Heimlich also has promoted it as a treatment for
drowning and
asthma attacks, but the practice of using the manoeuvre for these afflictions has not gained wide acceptance.
The Heimlich manoeuvre is named after
Henry Heimlich, who first described it in
1974. However,
Edward A. Patrick, MD, PhD, has claimed to be the uncredited co-developer of the maneuver.
From 1985-2005, the Heimlich maneuver was the only recommended treatment for choking in the published guidelines of the American Heart Association and the American Red Cross. In 2006, both organizations drastically changed course and
"downgraded" the use of the Heimlich maneuver. For conscious victims, the new guidelines recommend first applying backslaps; if this method failed to remove the airway obstruction, rescuers were to then apply abdominal thrusts. For unconscious victims, the new guidelines recommend chest thrusts, a method first recommended in a 1976 study by
Charles Guildner MD whose results were duplicated in a year 2000 study by
Audun Langhelle MD. The
2006 guidelines also eliminated the phrase "Heimlich maneuver" and replaced it with the more descriptive "abdominal thust."
Briefly, a person performing the Heimlich maneuver uses their hands to exert pressure on the bottom of the
diaphragm. This compresses the lungs and exerts pressure on any object lodged in the
trachea, hopefully expelling it. This amounts to an artificial
cough. (The victim of an obstructed airway, having lost the ability to draw air into the lungs, has lost the ability to cough on their own.)
Even when performed correctly, the Heimlich Maneuver can injure the person it is performed on. The Heimlich Maneuver should never be performed on someone who can still cough, breathe, or speak - bend them at the waist, head down, encourage them to cough, and deliver a series of thumps between their shoulderblades using a flat palm.
Indications that someone is choking
* The person cannot speak or cry out.
* The person's 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 any or all of the above, then becomes unconscious.
On an unconscious victim
If the victim is unconscious or loses consciousness, yell for help before proceeding. If no help is available, you may want to attempt to dislodge the object prior to leaving the victim to call for help. You may be able to dislodge the foreign object, open the victim's airway, and allow them to breath normally on their own. Every minute that a victim is without oxygen, heart and brain tissue dies. Neither rescue breathing nor CPR will be effective if the victim's airway is occluded.
If the victim is pregnant or too large for the first aid provider to wrap their arms around, the person giving the Heimlich manoeuvre positions himself behind the victim as usual, but moves his arms up into the victims armpits, and makes a fist in the centre of the chest, over the sternum. The rescuer makes swift inward movements until the victim becomes unconscious or the object is dislodged.
If the victim becomes unconscious, medical help should be summoned immediately, and the rescuer should kneel down astride the victim. The rescuer then places his hands over the centre of the sternum, just as he would as if giving CPR. The rescuer will then perform compressions the same ratio as for CPR, but will check the airway after each cycle of compressions, to see if the object has been dislodged. If it has been dislodged, the rescuer shall remove it and attempt to give rescue breathing.
On oneself
A person may perform the Heimlich Maneuver on themselves using the same procedure described above. One hand is balled into a fist and placed against their upper abdomen, while the other hand grabs the first and directs it in a series of upward thrusts until the airway is clear.
A person may also perform the Heimlich Maneuver on themselves by leaning their upper abdomen against a fixed object (such as the back of a chair) and repeatedly thrusting their body downward against the object until they expel the obstruction. Usually, a person must jump in the air and fall onto the object to provide sufficient force. It is likely that one may break a rib or become severely bruised.
On an infant
To perform the Heimlich manoeuvre on a child less than one year old, the child is positioned on their back. The first aid provider kneels at the child's feet and places the index and middle fingers of one hand together against the upper abdomen of the child, below the rib cage and above the navel. These fingers are covered with the index and middle fingers of the other hand. The top hand then repeatedly presses the fingers of the lower hand upward and into the child's abdomen, until the airway is clear. This must be done gently. The same force as would be used on an adult victim should not be used because it could result in injury to the child.
After the airway is clear
After the obstructing object or liquid has been expelled from the airway, it is possible, especially if the victim was unconscious to begin with, that the victim may not resume breathing on their own. Continuing the Heimlich Maneuver will not restore breathing.
Artificial respiration (if the patient has a pulse but is not breathing) or
CPR must be used for this purpose (if there is no pulse).
Medical advice is necessary after a Heimlich Maneuver:
* when the person breathes again: it may be necessary to have a medical evaluation due to possible secondary
trauma;
* when the person does not breathe: to get a
paramedic or a medical team for medicalised resuscitation (the phone call should be made before beginning the CPR);see
Call for help.
*
The Heimlich Institute*
Articles and information about Dr. Henry Heimlich's use of fraudulent case reports to promote the Heimlich maneuver for drowning rescue and asthma.
