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How To Do the Heimlich Maneuver in the Conscious Adult

(Abdominal Thrusts; Subdiaphragmatic Abdominal Thrusts)

By Charles D. Bortle, EdD, Director of Clinical Simulation, Office of Academic Affairs, Einstein Medical Center

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Patient Education

The Heimlich maneuver is a rapid first aid procedure to treat choking due to upper airway obstruction by foreign objects such as food, a toy, or other object.

Indications

  • Choking due to severe upper airway obstruction due to a foreign object. Choking is signaled by inability to speak, cough, or breathe adequately.

The Heimlich maneuver should only be used when the airway obstruction is severe and life is endangered. Do not interfere if the choking person can speak, cough forcefully, or breathe adequately.

Contraindications

Absolute contraindications:

  • Age < 1 yr

Relative contraindications:

  • Children < 20 kg (typically < 5 yr) should receive only moderate pressure thrusts.

  • Obese patients and women in late pregnancy should receive chest thrusts instead of abdominal thrusts.

Complications

  • Rib injury or fracture

  • Internal organ injury

Equipment

  • None

Additional considerations

  • This rapid first aid procedure is done immediately wherever the person is choking.

Positioning

  • In general, the rescuer is standing behind the choking person.

  • For children < 20 kg (typically < 5 yr), the rescuer should kneel at the child’s feet rather than stand astride them.

Abdominal thrusts with victim standing or sitting (conscious).

Relevant anatomy

  • The vocal cords in the larynx protect the airway. Food and foreign objects that are aspirated and cause severe airway obstruction are usually stopped at this level.

Step-by-step description of procedures and key teaching points

  • Determine if there is severe airway obstruction, which may endanger the person’s life. Look for signs of severe airway obstruction 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 choking person nods yes and cannot speak, cough, or breathe adequately, that suggests severe airway obstruction and the need for assistance.

  • To perform the Heimlich maneuver, stand directly behind the choking person with arms encircling the patient’s midsection. One fist is clenched and placed midway between the umbilicus and xiphoid. The other hand grabs the fist.

  • Deliver a firm inward and upward thrust by pulling with both arms sharply backward and upward.

  • Repeat the thrust 6 to 10 times as needed.

  • Continue until obstruction is removed or advanced airway management is available.

  • If the person loses consciousness, start CPR.

Aftercare

  • Transport the patient to an emergency department as soon as possible, even after successful removal of the airway obstruction and resumption of normal breathing.

Warnings and common errors

  • Do not do the Heimlich maneuver if the choking person can speak, cough forcefully, or breathe adequately.

  • In obese patients and women in late pregnancy, use chest thrusts instead of abdominal thrusts.

Tips and tricks

  • The Heimlich maneuver may induce vomiting. Although vomiting may assist in dislodging a tracheal foreign body, it does not necessarily mean that the airway has been cleared.

References

American Heart Association: Basic Life Support (BLS) Provider Manual. Dallas, American Heart Association, 2016.

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