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Merck Manual

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


Dorothy Habrat

, DO, Department of Emergency Medicine, University of New Mexico School of Medicine

Last full review/revision Aug 2019
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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.


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

The Heimlich maneuver 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 interference is required.


Absolute contraindications:

Relative contraindications:

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

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


  • Rib injury or fracture

  • Internal organ injury


  • None

Additional Considerations

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


  • In general, the rescuer stands behind the choking person.

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

Abdominal thrusts with victim standing or sitting (conscious)

Abdominal thrusts with victim standing or sitting (conscious)

Relevant Anatomy

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

  • Objects that are aspirated beyond the epiglottis may be stopped by the vocal cords in the larynx and, at this level, cause a life-threatening complete airway obstruction.

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 choking person nods yes and cannot speak, cough, or breathe adequately, that suggests severe airway obstruction and the need for assistance.

Do the Heimlich maneuver:

  • Stand directly behind the choking person with arms encircling the patient’s midsection. 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.

  • 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 cardiopulmonary resuscitation (CPR).


  • 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

  • The Heimlich maneuver should not be attempted 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

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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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