Heimlich maneuver


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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.
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.

Heimlich maneuver

 [hīm´lik]
a technique for removing foreign matter from the airway of a choking victim; the technique may be carried out with the victim in a standing position or lying down.
Standing Position. The rescuer stands behind the victim and wraps his arms around the victim's waist, allowing the victim's head, arms, and upper torso to hang forward. A fist is made with one hand and held with the other. The thumb side of the fist is then placed against the victim's abdomen at a point slightly above the umbilicus and below the rib cage. The rescuer's fist is then pressed into the victim's abdomen with a forceful upward thrust. The maneuver may be repeated if necessary to clear the air passages.
Supine Position. The victim is placed on the back with the head turned to one side. The rescuer kneels astride the victim's hips and places both hands on the abdomen, one hand upon the other. The heel of the lower hand is placed slightly above the umbilicus and below the rib cage. Pressure is applied to the victim's abdomen with a forceful upward thrust. The maneuver may be repeated if necessary to clear the air passages.
Heimlich maneuver.

Heim·lich ma·neu·ver

(hīm'lik),
an action designed to expel an obstructing bolus of food from the throat by placing a fist on the abdomen between the navel and the costal margin, grasping the fist from behind with the other hand, and forcefully thrusting it inward and upward to force the diaphragm upward, forcing air up the trachea to dislodge the obstruction.

Heimlich maneuver

(hīm′lĭk′, -lĭKH′)
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, thereby dislodging the obstruction.

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
A technique for removing a bolus of food stuck in the oropharynx potentially causing acute asphyxia
Technique The practictioner stands behind the victim and clasps his/her hands around the victim, slightly above the umbilicus, and abruptly pulls backwards, forcing residual air in the lungs out the trachea
Complication Fatal aortic regurgitation

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.

Heim·lich ma·neu·ver

(hīm'lik mă-nū'vĕr)
A procedure to expel an obstructing bolus of food from the throat by placing a fist on the abdomen between the navel and the costal margin, grasping the fist with the other hand, and thrusting it inward and upward so as to drive the diaphragm upward, forcing air up the trachea to dislodge the obstruction.
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HEIMLICH MANEUVER: (for removal of a foreign body blocking the airway)

Heimlich maneuver

A technique for removing a foreign body, such as a food bolus, from the throat, trachea, or pharynx of a choking victim, where it is preventing air flow to and from the lungs. Synonym: abdominal thrust maneuver.

For a conscious victim, the maneuver consists of the rescuer applying subdiaphragmatic pressure by wrapping his or her arms around the victim's waist from behind, making a fist with one hand, placing it against the patient's abdomen between the navel and the rib cage, and then clasping the fist with the free hand and pressing in with a quick, forceful upward thrust. This procedure should be repeated several times if necessary. If one is alone and experiences airway obstruction caused by a foreign body, this technique may be self-applied.

For the unconscious victim, starting CPR is now the recommended procedure because chest compressions are often effective for removing a foreign body. It is a simple method that can be taught to the general public.

When the patient is a child and can speak, breathe, or cough, the maneuver is unnecessary. If the maneuver is done, it should be applied as gently as possible but still forcibly enough to dislodge the obstruction (the abdominal viscera of children are more easily damaged than those of adults).

This treatment is quite effective in dislodging the obstruction by forcing air against the mass, much as pressure from a carbonated beverage forcibly removes a cork or cap from a bottle. The average air flow produced is 225 L/min.

CAUTION!

The Heimlich maneuver should not be performed unless complete airway obstruction is present. If the patient can cough, this maneuver should not be performed. In infants, extremely obese patients, and obviously pregnant patients, chest thrusts are used instead of abdominal thrusts to facilitate removal of the obstruction. See: illustration; choking

Heimlich,

Harry J., U.S. thoracic surgeon, 1920–.
Heimlich maneuver - a method used to expel an obstructing bolus of food from the throat.
Heimlich operation
Heimlich tube
Heimlich valve

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.
Enlarge picture
Heimlich maneuver.

Heim·lich ma·neu·ver

(hīm'lik mă-nū'vĕr)
Action designed to expel an obstructing bolus of food from the throat by placing a fist on the abdomen between navel and costal margin, grasping fist from behind with other hand, and forcefully thrusting it inward and upward to force the diaphragm upward, thus forcing air up the trachea to dislodge obstruction.

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.
Enlarge picture
Heimlich maneuver.
References in periodicals archive ?
Asthmatics using the Heimlich maneuver every other night before retiring experience significant relief of their symptoms.
Before Friday, Weil had never performed the Heimlich maneuver and said he had no formal training in the technique.
The long-used Heimlich maneuver includes the abdominal thrusts but rejects the use of back blows, saying that they can lodge the obstruction more tightly into the windpipe.
The next time you dine out, ask the waiter or manager to show you the Heimlich maneuver chart.
for Life, a new organization formed to promote infant and child CPR and The Heimlich Maneuver education for first-time parents.
Lentz saved Mays life by performing the Heimlich maneuver after the nursing home resident choked on turkey on Thanksgiving.
One of my friends, Margaret Benoit, stepped in without hesitation to perform the Heimlich maneuver and courageously saved this woman's life.
He kept his arms tightly around Matt, and continued to administer the Heimlich maneuver until Matt spit out the cherry pit that had lodged in his throat.
The young man is also a member of the ROTC, where he learned to perform the Heimlich maneuver.
Corey had just saved Kevin's life using the Heimlich maneuver (HIME-lick man-OO-ver), which uses air from the choking person's own lungs to knock loose whatever they are choking on.
Lieutenant Mance moved immediately to the booth, lifted the victim from her seat, and began to administer the Heimlich maneuver.
One of the things they had learned was the Heimlich maneuver.