(See also Overview of Respiratory Arrest and Airway Establishment and Control.)
Indications
Contraindications
Absolute contraindications
-
Age < 1 year is a contraindication to the Heimlich maneuver (see How to Treat the Choking Conscious Infant).
Relative contraindications
Complications
Additional Considerations
-
These rapid first aid procedures are done immediately wherever the person is choking.
-
Use of significant, abrupt force is appropriate for these maneuvers. However, clinical judgment is needed to avoid excessive forces that can cause injury.
-
The Heimlich maneuver is well known and widely used. However, chest thrusts and back blows may produce higher airway pressures. More than one maneuver may be used in succession if the initial maneuver fails to remove the obstructing object.
Positioning
Relevant Anatomy
Step-by-Step Description of Procedure
Determine if there is severe airway obstruction
-
Look for signs such as inability to speak, cough, or breathe adequately.
-
Look for hands clutching the throat, which is the Universal Distress Signal of severe airway obstruction.
-
Ask: “Are you choking?”
-
If the person can speak and breathe, encourage them to cough but do not initiate airway clearance maneuvers; instead arrange medical evaluation.
-
If the choking person nods yes or cannot speak, cough, or breathe adequately, that suggests severe airway obstruction and the need for airway clearance maneuvers.
Treat the choking conscious adult or child
-
Stand directly behind the choking adult or kneel behind a child.
-
Begin with abdominal thrusts for people who are not pregnant or obese; do chest thrusts for obese patients and women in late pregnancy.
-
Alternate between sets of abdominal thrusts (Heimlich maneuver), chest thrusts, and back blows as needed to relieve the obstruction.
-
Continue until obstruction is removed or advanced airway management is available.
If the person loses consciousness, start cardiopulmonary resuscitation (CPR). After each set of chest compressions, look inside the patient's mouth before giving rescue breaths and remove any visible obstruction that can be reached. Do not do blind finger sweeps.
Abdominal thrusts (Heimlich maneuver):
-
Encircle the patient’s midsection with your arms.
-
Clench one fist and place it midway between the umbilicus and xiphoid.
-
Grab the fist with the other hand (see figure Abdominal thrusts with victim standing or sitting).
-
Deliver a firm inward and upward thrust by pulling with both arms sharply backward and upward.
-
Rapidly repeat the thrust 6 to 10 times as needed.
Chest thrusts:
Back blows:
