Abdominal thrusts
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The method of abdominal thrusts, also 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 maneuver for these afflictions has not gained wide acceptance.
The Heimlich maneuver 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 thrust."
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[edit] Performing the Heimlich Maneuver
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 shoulder blades using a flat palm.
[edit] 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.
[edit] On a large person
If the victim is pregnant or too large for the first aid provider to wrap their arms around, the person giving the Heimlich maneuver 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.
[edit] On an unconscious victim
If the victim becomes unconscious, call for someone to contact help, then safely lower the victim to the ground, making sure the head does not hit anything. Once the victim is on the ground, open the airway and look in the mouth to see if anything is there. If an obstruction is seen, try to remove it by doing a finger sweep. If an obstruction is not seen, do not do a finger sweep as this may lodge the object further in. After checking for visible obstructions, try to give one rescue breath. If the chest rises and falls, continue with another one. If it does not, reset the airway, look in the mouth again, and try again. If it still doesn't work, immediately start chest compressions, not abdominal thrusts as used to be recommended. After those, check in the mouth again and look for any obstruction. Hopefully it can now be seen or has already been removed, if not, resume chest compressions until further help arrives.
[edit] 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.
[edit] On a child
The Resuscitation Council (UK) advise use of abdominal thrusts on children over a year old where five back slaps have failed to clear the airway; their recommended pediatric procedure [1] is similar to their recommended procedure for an adult [2]. They advise against performing abdominal thrusts on an infant under one year old, and instead recommend chest thrusts.
[edit] On an infant
To perform the Heimlich maneuver 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.
[edit] 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.
[edit] External links
- 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.
