1. History

2. Universal sign of choking

3. Technique

4. See also

5. References

6. External links

Abdominal thrusts (also called the Heimlich maneuver or Heimlich manoeuvre, {{IPA-de|ˈhaɪmlɪç -}}) is a first aid procedure used to treat upper airway obstructions (or choking) by foreign objects. The term Heimlich maneuver is named after Dr. Henry Heimlich, who first described it in 1974.

Performing abdominal thrusts involves a rescuer standing behind a patient and using his or her hands to exert pressure on the bottom of the diaphragm. This compresses the lungs and exerts pressure on any object lodged in the trachea, hopefully expelling it.

Most modern protocols, including those of the American Heart Association, American Red Cross and the European Resuscitation Council, recommend several stages for airway obstructions, designed to apply increasingly more pressure. Most protocols recommend encouraging the victim to cough, followed by hard back slaps, and finally abdominal thrusts or chest thrusts as a last resort. Some guidelines also recommend alternating between abdominal thrusts and back slaps.^[1][1]

History

From 1985 to 2005, abdominal thrusts were the only recommended treatment for choking in the published guidelines of the American Heart Association and the American Red Cross. In 2006, both organizations{{cn|date=September 2017}} drastically changed course and "downgraded" the use of the technique. For conscious victims, the new guidelines recommend first applying back slaps; if this method failed to remove the airway obstruction, rescuers were to then apply abdominal thrusts. For unconscious victims, the new guidelines recommend chest thrusts.

Henry Heimlich also promoted abdominal thrusts as a treatment for drowning^[5] and asthma^[6] attacks. The Red Cross now contests his claims that the maneuver could help drowning victims or someone suffering an asthma attack. The Heimlich Institute has stopped advocating on their website for the Heimlich maneuver to be used as a first aid measure for drowning victims. His 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.^[7][8] The 2005 drowning rescue guidelines of the American Heart Association^[9] 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 leading to aspiration.^[9]

In May 2016 Henry Heimlich used the maneuver for the second time (the first was around 2000), saving the life of a fellow resident at his retirement home in Cincinnati.^[10]

Universal sign of choking

A choking victim is usually unable to speak, and may not be able to make much sound at all. 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 assist.^[11]

Technique

Both the American Red Cross and UK National Health Service (NHS) advise that as a first resort, a rescuer should encourage the patient to cough out the obstruction. As a second resort, the rescuer should give them five slaps on the back. Abdominal thrusts are recommended only if these methods fail. As with the European Resuscitation Council and the Mayo Clinic, they recommend a repeating cycle of 5 back slaps and 5 abdominal thrusts.^[12][13].^[14][1] They are not recommended on babies below the age of 1.^[18][13] In contrast to the prevailing American and European advice, the Australian Resuscitation Council recommends chest thrusts instead of abdominal thrusts.^[15]

Performing abdominal thrusts involves a rescuer standing behind an upright patient and using his or her hands to exert pressure on the bottom of the diaphragm. This compresses the lungs and exerts pressure on any object lodged in the trachea, hopefully expelling it. This amounts to an artificially induced cough. For example, WebMD recommends the rescuer placing his or her fist just above the person's bellybutton and grasping it with the other hand. To assist a larger person, more force may be needed.^[16] The Mayo Clinic recommends the same placement of fist and hand and upward thrusts as if you are trying to lift the person.^[1]

If the victim is not upright, the US National Institutes of Health (NIH) recommends positioning the person on his or her back, then straddling the torso and using chest thrusts.^[17]

It is possible for a still-conscious choking victim to perform the procedure on themself, without assistance.^[18]

Due to the forceful nature of the procedure, even when done correctly, abdominal thrusts can injure the person on whom it is performed. Bruising to the abdomen is highly likely and more serious injuries can occur, including fracture of the xiphoid process or ribs.^[19] The NHS recommend that anyone who has been subjected to abdominal thrusts should seek a medical examination afterwards.^[13]

Researchers at Royal Brompton Hospital have demonstrated that similar intrathoracic pressures (50-60 cmH₂O) are produced by a first aider performing abdominal thrusts inwards as are produced when the force is directed inwards and upwards.^[20][21] They argue that this may be easier to perform with less concern about injury to ribcage or upper abdominal organs. Self-administered abdominal thrusts by study participants produced similar pressures to those generated by first aiders. The highest pressures were produced by participants performing an abdominal thrust onto the back of a chair (115 cmH₂O).

See also

• Basic airway management
• Basic life support

References

External links

• {{Commons category inline|Abdominal thrusts}}
• The Heimlich Institute promotes various methods of dealing with obstructed breathing
• Articles and information about Dr. Henry Heimlich's use of fraudulent case reports to promote the Heimlich maneuver for drowning rescue and asthma

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