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How To Do the Heimlich Maneuver in the Conscious Adult or Child

By

Dorothy Habrat

, DO, University of New Mexico School of Medicine

Last full review/revision Aug 2019| Content last modified Mar 2021
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Topic Resources

The Heimlich maneuver (abdominal thrusts) is a rapid first-aid procedure to treat choking due to upper airway obstruction by a foreign object, typically food or a toy. Chest thrusts and back blows can also be used if needed.

Indications

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

The Heimlich and other maneuvers should be used only when the airway obstruction is severe and life is endangered. If the choking person can speak, cough forcefully, or breathe adequately, no intervention is required.

Contraindications

Absolute contraindications

Relative contraindications

  • Children < 20 kg (45 lb; typically < 5 years) should receive only moderate pressure thrusts and back blows.

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

Complications

  • Rib injury or fracture

  • Internal organ injury

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

  • In general, the rescuer stands behind the choking person or kneels behind a child.

Relevant Anatomy

  • The epiglottis usually protects the airway from aspiration of foreign objects (eg, food).

  • Aspirated objects may be above or below the vocal cords.

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

Abdominal thrusts (Heimlich maneuver):

Abdominal thrusts with victim standing or sitting (conscious)

Abdominal thrusts with victim standing or sitting (conscious)

Chest thrusts:

  • Encircle the patient’s midsection with your arms.

  • Clench one fist and place it on the lower half of the sternum.

  • Grab the fist with the other hand.

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

  • Rapidly repeat the thrust 6 to 10 times as needed.

Back blows:

  • Wrap one arm around the waist to support the patient's upper body; small children can be laid across your legs.

  • Lean the person forward at the waist, about 90 degrees if possible.

  • Using the heel of your other hand, rapidly deliver 5 firm blows between the person's shoulder blades.

Aftercare

  • Patients with any symptoms remaining after foreign body removal should have a medical evaluation.

Warnings and Common Errors

  • These maneuvers should not be done if the choking person can speak, cough forcefully, or breathe adequately.

  • In obese patients and women in late pregnancy, chest thrusts are used 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.

More Information

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

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