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Heimlich maneuver, also known as abdominal thrusts or Heimlich manoeuvre, is a
first-aid First aid is the first and immediate assistance given to any person with a medical emergency, with care provided to preserve life, prevent the condition from worsening, or to promote recovery until medical services arrive. First aid is gener ...
procedure used to treat upper-airway obstructions (or
choking Choking, also known as foreign body airway obstruction (FBAO), is a phenomenon that occurs when breathing is impeded by a blockage inside of the respiratory tract. An obstruction that prevents oxygen from entering the lungs results in oxygen de ...
) by foreign objects. American doctor
Henry Heimlich Henry Judah Heimlich (February 3, 1920 – December 17, 2016) was an American thoracic surgeon and medical researcher. He is widely credited for the discovery of the Heimlich maneuver, a technique of abdominal thrusts for stopping choking, f ...
is often credited for its discovery. To perform a Heimlich maneuver, a rescuer stands behind a choking victim and uses their hands to apply pressure to the bottom of the victim's
diaphragm Diaphragm may refer to: Anatomy * Thoracic diaphragm, a thin sheet of muscle between the thorax and the abdomen * Pelvic diaphragm or pelvic floor, a pelvic structure * Urogenital diaphragm or triangular ligament, a pelvic structure Other * Diap ...
. This compresses the lungs and exerts pressure on the object lodged in the
trachea The trachea (: tracheae or tracheas), also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all animals' lungs. The trachea extends from ...
in an effort to expel it. Most modern protocols, including those of the
American Heart Association The American Heart Association (AHA) is a nonprofit organization in the United States that funds cardiovascular medical research, educates consumers on healthy living and fosters appropriate Heart, cardiac care in an effort to reduce disability ...
,
American Red Cross The American National Red Cross is a Nonprofit organization, nonprofit Humanitarianism, humanitarian organization that provides emergency assistance, disaster relief, and disaster preparedness education in the United States. Clara Barton founded ...
, and
European Resuscitation Council The European Resuscitation Council (ERC) is the European Interdisciplinary Council for Resuscitation Resuscitation is the process of correcting physiological disorders (such as lack of breathing or heartbeat) in an Acute (medicine), acutely ill ...
, recommend that treatment of airway obstructions be performed in several stages designed to apply increasing levels of pressure. Most protocols recommend encouraging the victim to cough, followed by hard back slaps, and finally abdominal thrusts or
chest thrusts Choking, also known as foreign body airway obstruction (FBAO), is a phenomenon that occurs when breathing is impeded by a blockage inside of the respiratory tract. An obstruction that prevents oxygen from entering the lungs results in oxygen de ...
as a final resort. Some guidelines also recommend alternating between abdominal thrusts and back slaps.


History

Thoracic surgeon and medical researcher
Henry Heimlich Henry Judah Heimlich (February 3, 1920 – December 17, 2016) was an American thoracic surgeon and medical researcher. He is widely credited for the discovery of the Heimlich maneuver, a technique of abdominal thrusts for stopping choking, f ...
, noted for promulgating abdominal thrusts, claimed that back slaps were proven to cause death by lodging foreign objects into the windpipe. A 1982 Yale study by Day, DuBois, and Crelin that persuaded the American Heart Association to stop recommending back blows for dealing with choking was partially funded by Heimlich's own foundation. According to Dr. Roger White of the
Mayo Clinic Mayo Clinic () is a Nonprofit organization, private American Academic health science centre, academic Medical centers in the United States, medical center focused on integrated health care, healthcare, Mayo Clinic College of Medicine and Science ...
and American Heart Association (AHA), “There was never any science here. Heimlich overpowered science all along the way with his slick tactics and intimidation, and everyone, including us at the AHA, caved in.” Henry Heimlich also promoted abdominal thrusts as a treatment for
drowning Drowning is a type of Asphyxia, suffocation induced by the submersion of the mouth and nose in a liquid. Submersion injury refers to both drowning and near-miss incidents. Most instances of fatal drowning occur alone or in situations where othe ...
and
asthma Asthma is a common long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wh ...
attacks. The Red Cross now contests those claims. The Heimlich Institute has stopped advocating on their website for the Heimlich maneuver to be used as a first aid measure for drowning victims. Heimlich's son, Peter M. Heimlich, alleges that in August 1974 his father published the first of a series of fraudulent case reports in order to promote the use of abdominal thrusts for near-drowning rescue. The 2005 drowning rescue guidelines of the American Heart Association did not include citations of Heimlich's work, and warned against the use of the Heimlich maneuver for drowning rescue as unproven and dangerous, due to its risk of
vomiting Vomiting (also known as emesis, puking and throwing up) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteritis, pre ...
leading to aspiration. In May 2016, Henry Heimlich, then age 96, claimed to have personally used the maneuver to save the life of a fellow resident at his retirement home in Cincinnati. It was alleged to be either the first or second time Heimlich himself used his namesake maneuver to save the life of someone in a non-simulated choking situation. According to Heimlich's son, Peter M. Heimlich, "both 'rescues' were bogus."


Universal sign of choking

A choking victim is usually unable to speak, and may not be able to make much sound. A universal sign of choking has been designated as a silent indication from a person who is unable to breathe, and consists of placing both hands on one's own throat while trying to attract the attention of others who might help.


Technique

Both the
American Red Cross The American National Red Cross is a Nonprofit organization, nonprofit Humanitarianism, humanitarian organization that provides emergency assistance, disaster relief, and disaster preparedness education in the United States. Clara Barton founded ...
and UK
National Health Service The National Health Service (NHS) is the term for the publicly funded health care, publicly funded healthcare systems of the United Kingdom: the National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care (Northern ...
(NHS) advise that for a first attempt, a rescuer should encourage the patient to expel the obstruction by coughing. As a second measure, the rescuer should deliver five slaps to the back after bending the patient forward. Abdominal thrusts are recommended only if these methods fail. The American Red Cross, the NHS, the
European Resuscitation Council The European Resuscitation Council (ERC) is the European Interdisciplinary Council for Resuscitation Resuscitation is the process of correcting physiological disorders (such as lack of breathing or heartbeat) in an Acute (medicine), acutely ill ...
and the Mayo Clinic recommend a repeating cycle of five back slaps and five abdominal thrusts. They are not recommended on children below the age of one. In contrast to the prevailing American and European advice, the Australian Resuscitation Council recommends chest thrusts instead of abdominal thrusts. To perform a Heimlich maneuver, a rescuer stands behind an upright patient, using the hands to exert forceful pressure on the bottom of the
diaphragm Diaphragm may refer to: Anatomy * Thoracic diaphragm, a thin sheet of muscle between the thorax and the abdomen * Pelvic diaphragm or pelvic floor, a pelvic structure * Urogenital diaphragm or triangular ligament, a pelvic structure Other * Diap ...
. As an example,
WebMD WebMD is an American corporation which publishes online news and information about human health and well-being. The WebMD website also includes information about drugs and is an important healthcare information website and the most popular cons ...
recommends making a fist with one hand and grasping the fist with the other in order to press with both just above the patient's
navel The navel (clinically known as the umbilicus; : umbilici or umbilicuses; also known as the belly button or tummy button) is a protruding, flat, or hollowed area on the abdomen at the attachment site of the umbilical cord. Structure The u ...
. This compresses the lungs and exerts pressure on any object lodged in the
trachea The trachea (: tracheae or tracheas), also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all animals' lungs. The trachea extends from ...
in an effort to expel it. The pressure amounts to an artificially induced
cough A cough is a sudden expulsion of air through the large breathing passages which can help clear them of fluids, irritants, foreign particles and Microorganism, microbes. As a protective reflex, coughing can be repetitive with the cough reflex fol ...
. To assist a larger person, more force may be needed. The Mayo Clinic recommends the same placement of fist and hand, with upward thrusts as if the rescuer is attempting to lift the victim. If the victim cannot receive pressure on the abdomen (for example, in case of pregnancy or excessive obesity), chest thrusts are advised. These are applied on the lower half of the chest bone, but not in the very endpoint (the
xiphoid process The xiphoid process (), also referred to as the ensiform process, xiphisternum, or metasternum, constitutes a small cartilaginous process (extension) located in the inferior segment of the sternum, typically ossified in adult humans. Both the Gr ...
, which could be broken). For victims who are not in an upright position, The American
National Institutes of Health The National Institutes of Health (NIH) is the primary agency of the United States government responsible for biomedical and public health research. It was founded in 1887 and is part of the United States Department of Health and Human Service ...
recommends positioning the victim on the back, then straddling the torso and employing chest thrusts. It is possible for conscious choking victims to perform the procedure on themselves, without assistance. Because of the forceful nature of the procedure, even when performed correctly, abdominal thrusts can injure the victim. Bruising to the
abdomen The abdomen (colloquially called the gut, belly, tummy, midriff, tucky, or stomach) is the front part of the torso between the thorax (chest) and pelvis in humans and in other vertebrates. The area occupied by the abdomen is called the abdominal ...
is highly likely and more serious injuries can occur, including fracture of the
xiphoid process The xiphoid process (), also referred to as the ensiform process, xiphisternum, or metasternum, constitutes a small cartilaginous process (extension) located in the inferior segment of the sternum, typically ossified in adult humans. Both the Gr ...
or
rib In vertebrate anatomy, ribs () are the long curved bones which form the rib cage, part of the axial skeleton. In most tetrapods, ribs surround the thoracic cavity, enabling the lungs to expand and thus facilitate breathing by expanding the ...
s. The NHS recommends that victims subjected to abdominal thrusts should seek medical attention after the event. Researchers at
Royal Brompton Hospital Royal Brompton Hospital is the largest specialist heart and lung medical centre in the United Kingdom. It is managed by Guy's and St Thomas' NHS Foundation Trust. History Consumption in the 19th century In the 19th century, consumption was a co ...
have demonstrated that levels of intrathoracic pressures (50–60 cmH2O) exerted by inward abdominal thrusts are similar to those produced when the force is directed both inward and upward. The researchers argue that this may be easier to perform with less concern for injury to the rib cage or upper abdominal organs. Self-administered abdominal thrusts by study participants produced similar pressures to those generated by administering first aid. The highest pressures were produced by participants performing an abdominal thrust by pressing onto the back of a chair (115 cmH2O).


See also

* First-aid treatment of choking *
Basic airway management Basic airway management is a concept and set of medical procedures performed to prevent and treat airway obstruction and allow for adequate ventilation to a patient's lungs. This is accomplished by clearing or preventing obstructions of airways. Ai ...
*
Basic life support Basic life support (BLS) is a level of medical care which is used for patients with life-threatening condition of cardiac arrest until they can be given full medical care by advanced life support providers (paramedics, nurses, physicians or any ...


References


External links


The Heimlich Institute
promotes various methods of dealing with obstructed breathing
Articles and information
about Dr. Heimlich's use of fraudulent case reports to promote the Heimlich maneuver for drowning rescue and asthma. Dr. Heimlich died in Cincinnati, Ohio, USA, on December 17, 2016 {{Authority control First aid Survival skills Eponyms Emergency medicine