The method of abdominal thrusts, also known as the
Heimlich Manoeuvre or Heimlich Maneuver, is a 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 un-credited
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."
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.
 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.
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 center of the chest, over the sternum. The rescuer makes swift
inward movements until the object is dislodged or the victim becomes
unconscious.
On An Unconscious Victim
 If the victim becomes unconscious, call for someone to contact help, then safely
put the victim on 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.
On Oneself
A person may perform the Heimlich maneuver on himself or herself 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 himself or herself 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.
On A Child
The Resuscitation Council (UK) advises use of abdominal thrusts on children over
a year old where five back slaps have failed to clear the airway; their
recommended pediatric procedure is similar to their recommended procedure for an
adult. They advise against performing abdominal thrusts on an infant under one
year old, and instead recommend chest thrusts.
On An Infant
To perform the Heimlich maneuver on a child less than one year old, the child is
positioned on his or her 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.
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).
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Maneuver
