Heimlich Maneuver

CHAPTER 227 Heimlich Maneuver



Raymond F. Jarris, Jr.


Each year in the United States, 3000 people die from swallowing or aspirating objects. When a patient displays the distress signal for choking (i.e., clutching the neck) or becomes cyanotic, unconscious, or unable to cough or breathe effectively (suggesting complete obstruction), efforts to clear the obstruction are warranted. The Heimlich maneuver (abdominal thrusts) causes a sudden increase in intrathoracic pressure, forcing an obstructing object from the glottis (Fig. 227-1).


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Figure 227-1 The Heimlich maneuver causes a sudden increase in intrathoracic pressure, forcing an obstructing object from the glottis. If the patient is sitting or standing, the clinician should stand behind the patient and wrap his or her arms around the patient’s waist. The clinician’s fist should be placed with the thumb side against the patient’s abdomen, above the umbilicus but below the rib cage.


note: In the event of partial foreign body aspiration, if the patient is able to move air or speak, the Heimlich maneuver and probing of the oropharynx should be avoided and the patient should be transported to a source of emergency medical care.



Indication


Asphyxiation from a foreign body obstruction of the upper airway indicates treatment. If forceful coughing is occurring, do not interfere with the coughing. However, the Heimlich maneuver is indicated if the cough becomes silent, respiratory difficulty increases and is accompanied by stridor, or the victim becomes unresponsive. In the unresponsive patient, a “finger sweep” of the posterior oropharynx should only be used when the provider can see solid material obstructing the airway.



Contraindications


The Heimlich maneuver is contraindicated in infants, small children, and pregnant women (abdominal thrusts inappropriate). It may also be difficult to accomplish in obese patients if the clinician is unable to encircle the victim’s abdomen. In obese patients and in pregnant women, chest thrusts may be appropriate.



Technique



Adults and Children Older Than 1 Year of Age



Sitting or Standing


Apply three to five abdominal or chest thrusts (Fig. 227-2A). These thrusts lift the diaphragm and force enough air from the lungs to create an artificial cough to move and expel an obstructing foreign body in an airway.



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Figure 227-2 Abdominal thrusts. A, If the patient is sitting or standing, the clinician should stand behind the patient, wrap his or her arms around the patient’s waist, grasp the fist or wrist of one hand with the other, place the hands against the patient’s abdomen between the navel and rib cage, and press the fist into the patient’s abdomen with a quick thrust upward. This should be repeated up to three to five times. B, If the patient has collapsed or is unable to be lifted, he or she should be placed in the supine position and the clinician should kneel beside the patient’s abdomen or straddle it. The clinician should place one hand on top of the other, with the heel of the bottom hand in the midline between the patient’s navel and rib cage. He or she should lean forward so that the shoulders are over the patient’s abdomen and press toward the diaphragm with a quick thrust, inward and upward. The clinician should not press to the right or left of the midline. This should be repeated up to three to five times if necessary.

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May 14, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Heimlich Maneuver

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