Heimlich maneuver

Encyclopedia of Medicine, Apr 06, 2001 by Tish Davidson

The Heimlich maneuver is an emergency procedure for removing a foreign object lodged 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 gets stuck and blocks their trachea, making breathing impossible. Death follows rapidly unless the food or other foreign material can be displaced from the airway. This condition is so common it has been nicknamed the "cafe coronary."

In 1974 Dr. Henry Heimlich first described an emergency technique for expelling foreign material blocking the trachea. This technique, now called the Heimlich maneuver or abdominal thrusts, is simple enough that it can be performed immediately by anyone trained in the maneuver. The Heimlich maneuver is a standard part of all first aid courses.

The theory behind the Heimlich maneuver is that by compressing the abdomen below the level of the diaphragm, air is forced under pressure out of the lungs dislodging the obstruction in the trachea and bringing the foreign material back up into the mouth.

The Heimlich 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 the Heimlich maneuver is appropriate to use routinely on near-drowning victims. After several studies of the effectiveness of the Heimlich maneuver on reestablishing breathing in near-drowning victims, the American Red Cross and the 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 the airway.

Incorrect application of the Heimlich maneuver can damage the chest, ribs, and internal organs of the person on whom it is performed. People may also vomit after being treated with the Heimlich maneuver.

The Heimlich maneuver can be performed on all people. 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 can not 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 all of the above, then becomes unconscious.

To perform the Heimlich maneuver on a conscious adult, the rescuer stands behind the victim. The victim may either be sitting or standing. The rescuer makes a fist with one hand, and places it, thumb toward the victim, below the rib cage and 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 rescuer attempts to develop enough pressure to force the foreign object back up the trachea. 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.

If the victim is unconscious, the rescuer should lay him or her on the floor, bend the chin forward, make sure the tongue is not blocking the airway, and feel in the mouth for foreign objects, being careful not to push any farther into the airway. The rescuer kneels astride the victim's thighs and places his 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 is not breathing, the rescuer starts CPR.

The main difference in performing the Heimlich maneuver on this group of people is in the placement of the fists. Instead of using abdominal thrusts, chest thrusts are used. The fists are placed against the middle of the breastbone, and the motion of the chest thrust is in and downward, rather than upward. If the victim is unconscious, the chest 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 amount of force used is less than that used with adults in order to avoid damaging the child's ribs, breastbone, and internal organs.

The rescuer sits down and lays the infant along his or her forearm with the infant's face pointed toward the floor. The rescuer's hand supports the infant's head, and his or her forearm rests 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.