Heimlich maneuver

Heimlich Maneuver 

Definition

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

Purpose

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.

Precautions

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.

Description

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.

Performing the heimlich maneuver on adults

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.

To perform the Heimlich maneuver on a conscious adult (as illustrated above), the rescuer stands behind the victim and encircles his waist. The rescuer makes a fist with one hand and places the other hand on top, positioned below the rib cage and above the waist. The rescuer then applies pressure by a series of upward and inward thrusts to force the foreign object back up the victim's trachea.

(Illustration by Electronic Illustrators Group.)

Performing the heimlich maneuver under special circumstances

OBVIOUSLY PREGNANT AND VERY OBESE PEOPLE. 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.

CHILDREN. 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.

INFANTS UNDER ONE YEAR OLD. 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.

After administering the back blows, the rescuer sandwiches the infant between his or her arms, and turns the infant over so that the infant is lying face up supported by the 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 foreign object is expelled.

SELF-ADMINISTRATION OF THE HEIMLICH MANEUVER. To apply the Heimlich maneuver to oneself, one should make a fist with one hand and place it in the middle of the body at a spot above the navel and below the breastbone, then grasp the fist with the other hand and push sharply inward and upward. If this fails, the victim should press the upper abdomen over the back of a chair, edge of a table, porch railing or something similar, and thrust up and inward until the object is dislodged.

Preparation

Any lay person can be trained to perform the Heimlich maneuver. Knowing how may save someone's life. Before doing the maneuver, 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.

Aftercare

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

Risks

Incorrectly applied, the Heimlich maneuver can break bones or damage internal organs. 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.

Normal results

In many cases the foreign material is dislodged from the throat, and the choking victim suffers no permanent effects of the episode. If the foreign material is not removed, the person dies from lack of oxygen.

Resources

Organizations

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. http://www.americanheart.org.

Key terms

Diaphragm — The thin layer of muscle that separates the chest cavity containing the lungs and heart from the abdominal cavity containing the intestines and digestive organs.

Trachea — The windpipe. A tube extending from below the voice box into the chest where it splits into two branches, the bronchi, that lead to each lung.

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maneuver /ma·neu·ver/ (mah-noo´ver) a skillful or dextrous method or procedure.

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Bracht's maneuver  a method of extraction of the aftercoming head in breech presentation.

Brandt-Andrews maneuver  a method of expressing the placenta from the uterus.

forward-bending maneuver  a method of detecting retraction signs in neoplastic changes in the mammae; the patient bends forward from the waist with chin held up and arms extended toward the examiner. If retraction is present, an asymmetry in the breast is seen.

Heimlich maneuver  a method of dislodging food or other material from the throat of a choking victim: wrap one's arms around the victim, allowing their upper torso to hang forward; with both hands against the victim's abdomen (slightly above the navel and below the rib cage), make a fist with one hand, grasp it with the other, and forcefully press into the abdomen with a quick upward thrust. Repeat several times if necessary.

Heimlich maneuver.

Pajot's maneuver  a method of forceps delivery with traction along the axis of the superior pelvic aperture.

Pinard's maneuver  a method of bringing down the foot in breech extraction.

Prague maneuver  a method of extracting the aftercoming head in breech presentation.

Scanzoni maneuver  double application of forceps blades for delivery of a fetus in the occiput posterior position.

Toynbee maneuver  pinching the nostrils and swallowing; if the auditory tube is patent, the tympanic membrane will retract medially.

Valsalva maneuver 

1. increase in intrathoracic pressure by forcible exhalation effort against the closed glottis.

2. increase in the pressure in the eustachian tube and middle ear by forcible exhalation effort against occluded nostrils and closed mouth.

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Heimlich maneuver

n.

An emergency technique used to eject an object, such as food, from the trachea of a choking person. The technique employs a firm upward thrust just below the rib cage to force air from the lungs up through the trachea, thus dislodging the obstruction.

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Heimlich maneuver

[hīm′lik, -lish]

Etymology: H. J. Heimlich, American physician, b. 1920; Fr, manjuvre, work done by hand

an emergency procedure for dislodging a bolus of food or another obstruction from the trachea to prevent asphyxiation. The choking person is grasped from behind by the rescuer, whose fist, thumb side in, is placed just below the victim's xiphoid with the other hand placed firmly over the fist. The rescuer then pulls the fist firmly and abruptly upward into the epigastrium, forcing the obstruction up the trachea. If repeated attempts do not clear the airway, an emergency cricothyrotomy may be necessary. Also spelled Heimlich manoeuvre. Also called abdominal thrust.

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Heimlich maneuver,

n.pr technique designed to assist a person suffering from a windpipe obstruction; the person helping wraps his arms around the person choking, and then with both hands grasped together, employs a quick, upward thrust just under the breastbone.

Heimlich maneuver.

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Heimlich maneuver (hīm´lik),

n.pr an emergency procedure for dislodging food or other obstruction from the trachea to prevent asphyxiation. The choking person is grasped from behind by the rescuer, whose fist, thumb side in, is placed just below the victim's sternum and whose other hand is placed firmly over the fist. The rescuer then pulls the fist firmly and abruptly into the epigastrium, forcing the obstruction up the trachea.

Heimlich maneuver.

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Heimlich maneuver

Public health A technique for removing a bolus of food stuck in the oropharynx potentially causing acute asphyxia. See Cafe coronary, Flake maneuver.