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

Each year, approximately 3,000 adults die in the United States because they accidentally inhale rather than swallow food. The food gets stuck and blocks their trachea (windpipe), 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 "café 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 thrust, 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 out of the lungs under pressure. This air dislodges the obstruction in the trachea and brings the foreign material back up into the mouth.

The Heimlich maneuver is used mainly when solid materials such as 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, heart or internal organs of the person on whom it is performed. People may also vomit after being treated with the Heimlich maneuver. It is important to prevent aspiration of the vomitus.

Description

The Heimlich maneuver can be performed on all people. Modifications are necessary if the person choking is very obese, pregnant, a child, or an infant.

Indications that a person's airway is blocked include:

• inability to speak or cry out
• face turning blue from lack of oxygen
• desperate grabbing at the throat
• weak cough with labored breathing producing a high-pitched noise
• all of the above, followed by unconsciousness

Performing the Heimlich maneuver on adults

To perform the Heimlich maneuver on a conscious adult, the rescuer stands behind the affected person, who may be either sitting or standing. The rescuer makes a fist with one hand and places it, thumb toward the person choking, below the rib cage and above the waist. The rescuer encircles the other person's waist, placing the other hand on top of the fist.

In a series of six to 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 choking person is deprived of oxygen, the muscles of the trachea relax slightly. Because of this loosening, it is possible that a foreign object may be expelled on a second or third attempt.

If the individual choking is unconscious, the rescuer should place the person supine on the floor; bend the chin forward; make sure the tongue is not blocking the airway; and feel in the mouth for any foreign objects, being careful not to push them further into the airway. The rescuer kneels astride the choking person's thighs and places the fists between the bottom of the choking person's breast-bone and navel. The rescuer then executes a series of six to 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 any 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.

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 (sternum), and the motion of the chest thrust is in and downward, rather than upward. If the person choking 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 a child's ribs, breastbone, and internal organs.

INFANTS UNDER ONE YEAR OLD. The rescuer sits down and positions the infant along the rescuer's forearm with the infant's face pointed toward the floor and at a lower level than the infant's chest. The rescuer's hand supports the infant's head. The forearm rests on the rescuer's 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 both arms. The infant is turned over so that it lies face up, supported by the rescuer's 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, a choking person 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 choking person 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 person can be trained to perform the Heimlich maneuver. Knowing how to perform it may save someone's life. Before doing the maneuver, it is important to

determine if the airway is completely blocked. If the choking person can talk or cry, the Heimlich maneuver is not appropriate. If the airway is not completely blocked, the choking person should be allowed to try to cough up the foreign object without assistance.

Aftercare

Once the obstruction is removed, most persons who experience an episode of choking recover without any further care. Persons who have an obstruction that cannot be dislodged but are able to breathe should be taken to an emergency room for treatment.

KEY TERMS

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

Sternum —The breastbone. The sternum is located over the heart, is the point of attachment for ribs at the front of the body and provides protection to the heart beneath it.

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.

Complications

Many people vomit after being treated with the Heimlich maneuver. Depending on the length and severity of the choking episode, the person may need to be taken to a hospital emergency room. Occasionally, one or more ribs of the choking person may be broken during administration of the Heimlich maneuver. Applying the Heimlich maneuver too vigorously may result in an injury to the internal organs of the choking person. There may be some local pain and tenderness at the point where the rescuer's fist was placed. In infants, a 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. If the foreign material is not removed, the person choking will die from lack of oxygen.

Results

The Heimlich maneuver usually results in the expulsion and removal of an obstruction in the throat. The choking person suffers no permanent effects from the episode.

Health care team roles

Anyone can be trained to successfully apply the Heimlich maneuver. Most of the applications each year are provided by trained volunteers. Health professionals may become involved. Paramedics may apply the Heimlich maneuver to a choking person. Physicians, physician assistants and nurses may provide additional treatment in a hospital emergency room. Nurses may provide some follow-up care.

Resources

BOOKS

Colquhoun, Michael, and Philip Jevon. Resuscitation in Primary Care. London: Butterworth-Heinemann, 2001.

Leiken, Jerrold B., and Bernard J. Feldman. Handbook of First Aid and Emergency Care. New York: Random House, 2000.

Simon, Robert R., and Barry E. Brenner. Emergency Procedures and Techniques. Philadelphia: Lippincott Williams & Wilkins, 2001.

Spira, Alan. Common Sense First Aid for Travel and Home. Beverly Hills, CA; AMS Publications, 2000.

PERIODICALS

Dworkin, Gerald. "The Heimlich Maneuver Controversy in Near-Drowning Resuscitation." Parks and Recreation 32, no. 11 (November 1997): 16-17.

Fredman, Catherine. "How to perform the Heimlich maneuver on yourself." Ladies Home Journal (June 1, 2000): 77-79.

"Health tips: The Heimlich maneuver." Mayo Clinic Health Letter 17, no. 9 (1999): 3.

Rosen, P et al. "The use of the Heimlich maneuver in near drowning: Institute of Medicine report." Journal of Emergency Medicine 13, no. 3 (1995): 397-405.

ORGANIZATIONS

American College of Emergency Physicians. P.O. Box 619911, Dallas, TX 75261-9911. (800) 798-1822 or (972) 550-0911. Fax: (972) 580-2816. <http://www.acep.org/>. [email protected].

American College of Osteopathic Emergency Physicians. 142 E. Ontario Street, Suite 550, Chicago, IL 60611. (312) 587-3709 or (800) 521-3709. Fax: (312) 587-9951. <http://www.acoep.org>.

Heimlich Institute. PO Box 8858, Cincinnati, OH 45208. <http://www.heimlichinstitute.org/index.htm>. [email protected].

OTHER

Harvard Medical School web site. <http://www.health.harvard.edu/fhg/firstaid/heimlichChild.shtml>.

HealthAtoZ.com. <http://www.healthatoz.com/atoz/lifestyles/food/hfoodheimlich.asp>.

Learn 2.com. <http://www.learn2.com/07/0723/0723.asp>.

LearnFree.com. <http://www.learn-cpr.com/cpr11-adult-heimlich-maneuver.html>.

National Library of Medicine. <http://medlineplus.adam.com/ency/article/000047.htm>.

L. Fleming Fallon, Jr., MD, PhD, DrPH

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

Each year, approximately 3,000 adults die in the United States because they accidentally inhale rather than swallow food. The food gets stuck and blocks their trachea (windpipe), 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 "café 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 thrust, 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 out of the lungs under pressure. This air dislodges the obstruction in the trachea and brings the foreign material back up into the mouth.

The Heimlich maneuver is used mainly when solid materials such as 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, heart, or internal organs of the person on whom it is performed. People may also vomit after being treated with the Heimlich maneuver. It is important to prevent aspiration of the vomitus.

Description

The Heimlich maneuver can be performed on all people. Modifications are necessary if the person choking is very obese, pregnant, a child, or an infant.

Indications that a person's airway is blocked include:

• inability to speak or cry out
• face turning blue from lack of oxygen
• desperate grabbing at the throat
• weak cough with labored breathing producing a high-pitched noise
• all of the above, followed by unconsciousness

Performing the Heimlich maneuver on adults

To perform the Heimlich maneuver on a conscious adult, the rescuer stands behind the affected person, who may be either sitting or standing. The rescuer makes a fist with one hand and places it, thumb toward the person choking, below the rib cage and above the waist. The rescuer encircles the other person's waist, placing the other hand on top of the fist.

In a series of six to 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 choking person is deprived of oxygen, the muscles of the trachea relax slightly. Because of this loosening, it is possible that a foreign object may be expelled on a second or third attempt.

If the individual choking is unconscious, the rescuer should place the person supine on the floor; bend the chin forward; make sure the tongue is not blocking the airway; and feel in the mouth for any foreign objects, being careful not to push them further into the airway. The rescuer kneels astride the choking person's thighs and places the fists between the bottom of the choking person's breastbone and navel. The rescuer then executes a series of six to 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 any 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.

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 (sternum), and the motion of the chest thrust is in and downward, rather than upward. If the person choking 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 a child's ribs, breastbone, and internal organs.

INFANTS UNDER ONE YEAR OLD. The rescuer sits down and positions the infant along the rescuer's forearm with the infant's face pointed toward the floor and at a lower level than the infant's chest. The rescuer's hand supports the infant's head. The forearm rests on the rescuer's 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 both arms. The infant is turned over so that it lies face up, supported by the rescuer's 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, a choking person 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 choking person 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 person can be trained to perform the Heimlich maneuver. Knowing how to perform it may save someone's life. Before doing the maneuver, it is important to determine if the airway is completely blocked. If the choking person can talk or cry, the Heimlich maneuver is not appropriate. If the airway is not completely blocked, the choking person should be allowed to try to cough up the foreign object without assistance.

Aftercare

Once the obstruction is removed, most persons who experience an episode of choking recover without any further care. Persons who have an obstruction that cannot be dislodged but are able to breathe should be taken to an emergency room for treatment.

Complications

Many people vomit after being treated with the Heimlich maneuver. Depending on the length and severity of the choking episode, the person may need to be taken to a hospital emergency room. Occasionally, one or more ribs of the choking person may be broken during administration of the Heimlich maneuver. Applying the Heimlich maneuver too vigorously may result in an injury to the internal organs of the choking person. There may be some local pain and tenderness at the point where the rescuer's fist was placed. In infants, a 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. If the foreign material is not removed, the person choking will die from lack of oxygen.

Results

The Heimlich maneuver usually results in the expulsion and removal of an obstruction in the throat. The choking person suffers no permanent effects from the episode.

Health care team roles

Anyone can be trained to successfully apply the Heimlich maneuver. Most of the applications each year are provided by trained volunteers. Health professionals may become involved. Paramedics may apply the Heimlich maneuver to a choking person. Physicians, physician assistants and nurses may provide additional treatment in a hospital emergency room. Nurses may provide some follow-up care.

KEY TERMS

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

Sternum— The breastbone. The sternum is located over the heart, is the point of attachment for ribs at the front of the body and provides protection to the heart beneath it.

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.

Resources

BOOKS

Colquhoun, Michael, and Philip Jevon. Resuscitation in Primary Care. London: Butterworth-Heinemann, 2001.

Leiken, Jerrold B., and Bernard J. Feldman. Handbook of First Aid and Emergency Care. New York: Random House, 2000.

Simon, Robert R., and Barry E. Brenner. Emergency Procedures and Techniques. Philadelphia: Lippincott Williams & Wilkins, 2001.

Spira, Alan. Common Sense First Aid for Travel and Home. Beverly Hills, CA: AMS Publications, 2000.

PERIODICALS

Dworkin, Gerald. "The Heimlich maneuver controversy in near-drowning resuscitation." Parks and Recreation 32, no. 11 (November 1997): 16-17.

Fredman, Catherine. "How to perform the Heimlich maneuver on yourself." Ladies Home Journal (June 1, 2000): 77-79.

"Health tips: The Heimlich maneuver." Mayo Clinic Health Letter 17, no. 9 (1999): 3.

Rosen, P. et al. "The use of the Heimlich maneuver in near drowning: Institute of Medicine report." Journal of Emergency Medicine 13, no. 3 (1995): 397-405.

ORGANIZATIONS

American College of Emergency Physicians. P.O. Box 619911, Dallas, TX 75261-9911. (800) 798-1822 or (972) 550-0911. Fax: (972) 580-2816. 〈http://www.acep.org/〉. [email protected].

American College of Osteopathic Emergency Physicians. 142 E. Ontario Street, Suite 550, Chicago, IL 60611. (312) 587-3709 or (800) 521-3709. Fax: (312) 587-9951. 〈http://www.acoep.org〉.

Heimlich Institute. P.O. Box 8858, Cincinnati, OH 45208. 〈http://www.heimlichinstitute.org/index.htm〉. [email protected].

OTHER

Harvard Medical School web site. 〈http://www.health.harvard.edu/fhg/firstaid/heimlichChild.shtml〉.

HealthAtoZ.com. 〈http://www.healthatoz.com/atoz/lifestyles/food/hfoodheimlich.asp〉.

Learn 2.com. 〈http://www.learn2.com/07/0723/0723.asp〉.

LearnFree.com. 〈http://www.learn-cpr.com/cpr11-adult-heimlich-maneuver.html〉.

National Library of Medicine. 〈http://medlineplus.adam.com/ency/article/000047.htm〉.

Heimlich maneuver

Definition

The Heimlich maneuver is an emergency technique for removing a foreign object lodged in the airway that is preventing a child or an adult from breathing.

Purpose

The Heimlich maneuver is used when a person is choking on a foreign object to the extent that he/she cannot breathe. Oxygen deprivation from a foreign body airway obstruction can result in permanent brain damage or death in four minutes or less. Using the Heimlich maneuver can save a choking victim's life. The Heimlich maneuver is not performed on infants under one year of age (see below for technique for infants). Indications that a choking victim's airway is blocked include the following:

• inability to cough , cry, or speak
• blue or purple face color from lack of oxygen
• grabbing at throat
• weak cough and labored breathing that produces a high-pitched noise
• all of the above, followed by loss of consciousness

Each year, more than 17,000 infants and children are treated in hospital emergency departments for choking-related incidents, and more than 80 percent of these occur in children aged four years and younger. Airway obstruction death and injury are especially prevalent in children under age four due to their anatomy (small airway), natural curiosity and tendency to put objects in their mouths, and incomplete chewing. In infants, choking usually results from inhalation of small objects (e.g., coins, small toys , deflated balloons, buttons) that they place in their mouth.

Description

In 1974, Henry Heimlich first described an emergency technique for expelling foreign material blocking the trachea. This technique, now called the Heimlich maneuver, 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 and cardiopulmonary resuscitation (CPR) courses.

The theory behind the Heimlich maneuver is that by compressing the abdomen below the level of the diaphragm with quick abdominal thrusts, an "artificial cough" is created. Air is forced out of the lungs to dislodge the obstruction in the trachea and bring the foreign object back up into the mouth.

The Heimlich maneuver can be performed on all people; however, modifications are necessary infants, children, obese individuals, and pregnant women.

Performing the Heimlich maneuver on children

To perform the Heimlich maneuver on a conscious child, the rescuer stands or kneels behind the child, who may be seated or standing. The rescuer makes a fist with one hand, and places it, thumb toward the child, below the rib cage and above the waist. The rescuer encircles the child's waist, placing his other hand on top of the fist then gives a series of five quick and distinct inward and upward thrusts. If the foreign object is not dislodged, the cycle of five thrusts is repeated until the object is expelled or the child becomes unresponsive. As the child is deprived of oxygen, the muscles of the trachea relax slightly, and it is possible that the foreign object may be expelled on a second or third attempt.

If the victim is unconscious or becomes 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 the foreign object, being careful not to push any farther into the airway. The rescuer kneels astride the child's thighs and places his fists between the bottom of the victim's breast-bone and the navel. The rescuer then executes a series of five quick 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 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.

OBESE CHILDREN AND ADOLESCENTS The main difference in performing the Heimlich maneuver on an obese victim 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.

Foreign body obstruction in infants under age one year

The Heimlich maneuver as described above is not performed on infants under one year of age. Instead, a series of back blows and chest thrusts are used. The rescuer sits down and lays the infant along his or her fore-arm with the infant's face pointed toward the floor and tilted downward lower than the body. 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 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 just below the nipple line and makes gives five quick chest thrusts. This series of back blows and chest thrusts is alternated until the foreign object is expelled. If the infant becomes unconscious, CPR should be initiated.

Precautions

Any lay person can be trained to perform the Heimlich maneuver and to know how may save someone's life. Before doing the maneuver, it is important to determine if the airway is completely blocked. If the victim choking can talk or cry, the Heimlich maneuver should not be administered. 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

Vomiting may occur after being treated with the Heimlich maneuver. All infants and children who experience a choking episode severe enough to require the Heimlich maneuver should be taken to the hospital emergency room to be examined for airway injuries.

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. Following the Heimlich maneuver, dysphagia (swallowing difficulty) and obstructive pulmonary edema (fluid accumulation in the lungs) may occur.

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 choking victim may suffer permanent brain damage from lack of oxygen or may die.

Parental concerns

Because most choking incidents occur in the home, all parents and infant/child caregivers should be trained in the Heimlich maneuver. Training is available through the American Red Cross and American Heart Association at local schools, YMCAs, and community centers.

The likelihood of choking incidents can be reduced by closely supervising infants and children while eating and playing. Most choking incidents are associated with food items, especially hot dogs, candies, grapes, nuts, popcorn, and carrots. Common non-food items that are choking hazards include deflated balloons, buttons, coins, small balls, small toys, and toy parts. All toys should be examined to make sure they are age-appropriate and do not have loose parts.

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. This term is also used for a dome-shaped device used to cover the back of a woman's vagina during intercourse in order to prevent pregnancy.

Trachea —The windpipe. A tube composed of cartilage and membrane that extends from below the voice box into the chest where it splits into two branches, the bronchi, that lead to each lung.

Resources

BOOKS

Basic Life Support for Healthcare Providers. Dallas, TX: American Heart Association, 2001.

PERIODICALS

Ringold, Sarah, et al. "Postobstructive Pulmonary Edema in Children." Pediatric Emergency Care 20 (June 2004): 391–95.

Vilke, Gary M., et al. "Airway Obstruction in Children Aged Less Than 5 Years: The Prehospital Experience." Prehospital Emergency Care 8 (2004): 196–99.

ORGANIZATIONS

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. Web site: <www.americanheart.org>.

The Heimlich Institute. 311 Straight St., Cincinnati, OH 45219–9957. Web site: <www.heimlichinstitute.org>.

WEB SITES

"Heimlich Maneuver." American Heart Association, 2004. Available online at <www.americanheart.org/presenter.jhtml?identifier=4605> (accessed November 20, 2004).

"Infant First Aid for Choking and CPR: An Illustrated Guide." BabyCenter, 2004. Available online at <http://www.babycenter.com/general/9298.html> (accessed November 20, 2004).

Jennifer E. Sisk, MA

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.

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.

Heim·lich ma·neu·ver / ˈhīmlik; ˈhīmlikh/ • n. a first-aid procedure for dislodging an obstruction from a person's windpipe in which a sudden strong pressure is applied on the abdomen, between the navel and the rib cage.