Choking: The Heimlich Maneuver Revisited

Some of what we know about treatment of choking has changed, mainly, we no longer give back blows before trying the Heimlick Maneuver and have special procedures for obese or pregnant individuals and infants. For the videos, Ctrl-Click on the underlined links.

Confirm they are choking. If they are coughing, breathing or speaking, they are not choking. 

Sign of Choking:

•      Universal sign of clutching one’s throat

•       Inability to cough or speak

•       Labored or noisy breathing

•       Bluish lips, skin or nails

•       Loss of consciousness

Heimlick Maneuver:

• 1. If the person CONSCIOUS but is still choking, do abdominal thrust, also known as the Heimlich maneuver.

     1. Stand or knell behind the person and wrap your arms around the victim.

     2. Make a fist with one hand.

     3. Place the thumb side of your fist against the victim's abdomen, in the mid-line, slightly above the navel and well below the breastbone.

     4. Grasp the fist with your other hand and press the fist into the victims abdomen with a quick, forceful upward thrust.

     5. Repeat thrusts until the object is expelled from the air way or become unresponsive.

        1. Give each new thrust with a separate, distinct movement to relieve the obstruction.

           1. For Adults: Heimlich maneuver. (A different location for the maneuver is used in pregnant women is shown in the video above).

           2. For Children: Heimlich maneuver in a Child.

           3. For Infants: Conscious Choking Infant.

  2. If the person is UNCONSCIOUS: Immediately begin CPR.   Non-trained:CPR for non-trained     Trained Individual: Adult   Child   Infant.

• • 1. Lower the person on their back onto the floor and start CPR.

    2. For trained CPR individuals: Every time you open the airway to give breaths, open the patients mouth wide and look for objects. If you can see an object that can easily be removed, remove it with your fingers (don't dig deeply for it may push any object further down).

    3. After 5 cycles or about 2 minutes, call 911 if someone has not already done so. Then continue CPR.

    4. Even if the obstruction comes out but the person is not breathing continue CPR until EMS arrive.

• 3. Follow-up

• • 1. In the non-breathing or unconscious person, the EMS will take over CPR as the case requires.

    2. If the object comes out and the patient can breath and talk normally but there is persistent cough of feeling that something still stuck in their throat, seek medical attention through an Ambulatory Center or the person’s medical professional.

Prevention:

• Don’t drink too much alcohol before eating. It dulls one’s senses and you may not chew your food well or swallow too large a piece.

• Cut your food in small pieces and chew well.

References:

1. BLS for Health Care Providers, American Heart Association, 2011 (As presented at BLS re-certification in 2015)

2. Choking in adults   From WebMD

3. Choking First Aid   Mayo Clinic

4. CPR   University of Arizona

5. How to give the Heimlich maneuver   Howcast

6. How to perform the Heimlich maneuver   Howcast

7. Emergency Health Tips   From Expert Village

Addendum:

Heimlich, self-performed: