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How to Do the Heimlich Maneuver

photo: adapted from Jason Eppink via Flickr

Imagine you’re having a meal in a nice restaurant or you’re having dinner with your family. Suddenly, your partner or a nearby person chokes his or her own food. What do you do?

A person can only survive a few minutes without oxygen. After that, the brain dies. This is a common scenario even among small children who put various things inside their mouth, such as tiny toys, or whatever they can find on the ground.

Calling 911 means you have to wait more than 6 minutes for the ambulance to arrive. The main objective of this article is to prep you on a simple but lifesaving procedure which you can perform in a short period of time when someone is choking. It’s called the Heimlich maneuver.

THE SEVERITY OF CHOKING…..

Choking is the fourth leading cause of unintentional death in USA. More than 1 million people around the world die of choking per year. In USA, a child dies every 5 minutes from choking.

Most adults are choking while eating. Meat and fish are the main source, however, other foods like vegetables and fruits and various other materials like glass balls, round objects, soft toys can be the culprit too, but this mainly happens in younger children and people with mental challenges.

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For years, people have tried various methods to help choking victims. Back blows, chest thrusts and attempting to use one’s finger to extract the object from the throat, to name just a few. But the American Red Cross society and American Heart association concluded in 1985 that the Heimlich maneuver is the best way to give first aid in a choking situation.

Back blows, abdominal thrusts and finger sweeping can be dangerous to the victim, even lethal. They should only done by the experts. A back slap can dislodge and move the foreign object further down the trachea (Windpipe) and can cause complete obstruction to the windpipe (trachea), resulting in a quick death by suffocation.

THE HEIMLICH MANEUVER – A GIFT FROM GOD

Late Dr. Henry Heimlich was a reputable US surgeon who introduced this unique technique in late 1970s, and until now this procedure has saved millions of lives worldwide.

ANATOMICAL BASIS OF THE HEIMLICH MANEUVER

Humans has two lungs which can accommodate large volumes of air. After full inspiration about 5 to 6 liters of air remain inside the lungs. If someone can press the lungs in a sudden and powerful pressure the air inside lungs will squeeze out through the windpipe thus expelling the foreign object.

The lungs are protected by the rib cage, therefore we can’t just use our hands to press them. But when pressing the abdomen, the pressure inside it rises and it’s transmitted to the thorax or chest cavity through the diaphragm. So the lungs can be squeezed via the abdomen.

This procedure should be done with a lot of force and should be repeated until the foreign body is expelled.

HOW TO IDENTIFY A CHOKING VICTIM? …

It is essential to recognize the victim who is choking early on. The first thing you will see is them in an uncomfortable position. Most experience pain, but it may be some other condition like heart attack, stroke, fainting attack or a seizure.

You may see the victim is gasping for breath often holding the neck with both hands and, the neck bending forward. The victim may soon become pink or unconscious. There might be vigorous coughs. Occasionally, you may hear a whistling sound which, in medical terms, is called as “STRIDOR”.

It may be a complete obstruction in the windpipe or a partial obstruction.

In a partial obstruction, the victim can talk or breathe and a stridor may be present.

In a complete obstruction, the victim can’t talk nor cough and most importantly can’t breathe. You have to act quickly in a complete obstruction, if not the victim may die.

If you carefully examine the environment you will most likely see the choking objects such as food or other foreign materials such as glass balls, soft toys, coins, insects etc.

Awareness exercise: make it a habit to pay attention to adults or children who act weird suddenly. He or she may be choking!

Be your own doctor post collapse. Click here

See the following YouTube to identify choking behavior:

THE PROCEDURE

This Heimlich maneuver can be done even the victim is in standing position or seated position or even the victim is lying down on the floor. And the other thing is it can be done on oneself too in a situation of self-choking.

But the important thing is the victim must be conscious.

First, approach the person. Always talk to him or her and ask what the problem is:

Can you talk?  Can you cough?

You can even ask them directly:

Are you choking?

The victim may nod to confirm.

If he can cough or talk do not try to do the Heimlich maneuver. Do not interrupt the cough and if he can speak encourage coughing. With vigorous coughing, most foreign objects come out easily.

If there are people around you, ask one of them to call 911 while you are preparing to do the Heimlich maneuver.

If the victim cannot talk or cough but he is conscious then you can perform the Heimlich maneuver. It mainly consists of vigorous and repetitive abdominal thrusts done with the sole purpose of dislodging the foreign object and expelling it.

Whether the person is standing or sitting, you have to go behind him and come to his back. Clothes need not to be removed. But if the victim is wearing a tie or any other tight accessory around the neck, you should loosen it or remove it before the procedure. If you have to, just cut the tie or other garments with a knife or a scissor. Be careful not to tighten them and do not waste time more than 15 seconds in doing this.

Then, lean the person forward and give five blows to their back with the heel of your hand.

After going from the behind, wrap your arms around his or her waist. Make sure to keep them tight, with interlocking fingers of each hand. Keep them in between the umbilicus (belly button) and the xiphisternum which is the lowest part of the chest (the ending point of the rib cage in front of the body). Then grasp both hands together and make a fist. Using the fist, squeeze the tummy inside and upwards.

If the victim is lying on the floor do not try to make him or her stand. If he is lying on the back, straddle the victim facing the head, and keep your hands as mentioned above. Push the fist inward and upward and squeeze the lungs. Then most likely the foreign body should come out.

Repeat the procedure until the victim can talk or cough on his own. Once he can cough then foreign body will come out. Encourage the victim to cough well.

Here’s how it should be done:

THE HEIMLICH MANEUVER IN SPECIAL SITUATIONS…..

ON A PREGNANT WOMAN NEAR TERM OR ON AN OBESE PERSON…

Pregnant and obese people have a big tummy and it’s difficult to squeeze the abdomen using the Heimlich maneuver, so you should adjust to this situation

Place your hands a little bit higher on their chest around the base of the chest bone (sternum) and do the procedure:

ON AN INFANT…

If the victim is an infant younger than 1 year, it is dangerous to perform the Heimlich maneuver the usual way. You can easily squeeze the abdomen and damage the internal organs. So the position and the force of performing the Heimlich maneuver is little bit less than in adults.

You can sit down in a chair and hold the infant on your forearms and the child should be facing down. Your hands should be resting on your thighs or lap.

Keep the child face up and resting on your forearms and still keeping the head lower than the torso. Then keep your index and middle fingers of your dominant hand at the center of the chest bone, and press down hard and with force.

Repeat this procedure at least 5 times or until the infant starts breathing, crying or coughing.

PERFORMING THE HEIMLICH MANEUVER ON YOURSELF…

There are many instances when you’re alone and choking. The good news is you can perform Heimlich maneuver on yourself.

Use your both hands and make a good fist. Keep it on your tummy just above the belly button. Then squeeze your tummy inside and upwards. This can be painful, but keep doing it until the object is expelled and you can breathe or cough.

When you are able to breathe, start coughing to expel the choking object.

IF THE VICTIM IS UNCONSCIOUS OR UNRESPONSIVE…

With severe or complete obstruction the victim may become unresponsive and not breathing. It is mainly because lack of oxygen supply to the brain. In this scenario, you must supply oxygen to the brain, else the victim might die.

In our body, oxygen is supplied via the blood. Therefore you should activate the circulation system by doing CPR (Cardiopulmonary resuscitation or chest compressions).

911 must be called in this situation ideally by someone else rather than you (while you’re doing CPR). Do not attempt to do Heimlich when victim is unconscious.

The victim should be lying flat on the floor with his face up. No need to remove clothes but it is better to remove thicker ones like sweaters, jerseys etc. Unbuttoning should be enough to expose the chest.

Make a strong fist using both hands and keep it over the chest of the victim, preferably in the middle of the breast bone. Your elbows should be straight, as this will allow you to put much of your weight. Then push down as hard as you can. It should be done at a rate of 100 pushes per minute (which is faster than one per second).

After 30 chest compressions, open the victim’s mouth and perform rescue breathing. While opening the mouth look for foreign objects, and if you can reach them with your finger, then try to remove them. Just make sure that you don’t push them further and into the throat.  Continue CPR until help arrives.

SUMMARY… 

Choking is a very common scenario. It can happen to anyone, regardless of age. This article will prep you for unexpected, sudden choking scenario which you have only 6 minutes to save someone from certain death… and that someone may be you!

Be a rescuer – make a change – save a life – save the world.

Disclaimer

The information in this article is provided “as is” and should not be mistaken  for or be a substitute for medical advice. Always consult your physician before trying any of the advice presented on this page. Always seek the help of a professional when delivering a baby. Neither the author nor www.SurvivalSullivan.com or the company behind the website shall be held liable for any negative effects of you putting into practice the information in this article.

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About Dr. Akila Rathnayake

Dr. Akila Rathnayake
Dr. Akila Rathnayake is a medical doctor currently working in a Government hospital in Sri Lanka. He is a Bachelor of Medicine and Bachelor of Surgery, and has taken numerous other courses, such as the Cardiopulmonary Resuscitation Course and the Advanced Life Support Course. Working in tough medical conditions, he as a wealth of knowledge to dispose of medicine in survival and emergency situations.

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