Abdominal thrusts, also known as the Heimlich maneuver or Heimlich manoeuvre, is a

first aid First aid is the first and immediate assistance given to any person with either a minor or serious illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery. It includes initial i ...

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 dep ...

) by foreign objects. American doctor Henry Heimlich is often credited for its creation. Performing abdominal thrusts involves a rescuer standing behind a patient and using their hands to exert 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 ...

. This compresses the lungs and exerts pressure on any object lodged in the

trachea The trachea, 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 air- breathing animals with lungs. The trachea extends from t ...

, hopefully expelling 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 cardiac care in an effort to reduce disability and deat ...

American Red Cross The American Red Cross (ARC), also known as the American National Red Cross, is a non-profit humanitarian organization that provides emergency assistance, disaster relief, and disaster preparedness education in the United States. It is the des ...

and the

European Resuscitation Council The European Resuscitation Council (ERC) is the European Interdisciplinary Council for Resuscitation Medicine and Emergency Medical Care Emergency medicine is the medical speciality concerned with the care of illness A disease is a ...

, 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.Foreign object inhaled: First aid
Mayo Clinic staff, November 1, 2011.

History

Thoracic surgeon and medical researcher Henry Heimlich, noted for promulgating abdominal thrusts, claimed that back slaps were proven to cause death by lodging foreign objects into the windpipe. The 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 Roger White MD of the

Mayo Clinic The Mayo Clinic () is a nonprofit American academic medical center focused on integrated health care, education, and research. It employs over 4,500 physicians and scientists, along with another 58,400 administrative and allied health staf ...

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." 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 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 Drowning is a type of suffocation induced by the submersion of the mouth and nose in a liquid. Most instances of fatal drowning occur alone or in situations where others present are either unaware of the victim's situation or unable to offer as ...

and

asthma Asthma is a 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 wheezing, co ...

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. 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. 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 and throwing up) is the involuntary, 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, gastroenter ...

leading to aspiration. In May 2016 Henry Heimlich, age 96, personally used the maneuver to save the life of a fellow resident at his retirement home in Cincinnati. According to the article, it was either the first or second time Heimlich himself used his namesake maneuver to save the life of someone in a non-simulated choking situation.

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.

Technique

Both the American Red Cross and UK

National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...

(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 five slaps on the back, after bending the patient forward. Abdominal thrusts are recommended only if these methods fail. Abdominal thrusts, point of applying

As with the

and the Mayo Clinic, they recommend a repeating cycle of 5 back slaps and 5 abdominal thrusts. They are not recommended on babies below the age of 1. In contrast to the prevailing American and European advice, the Australian Resuscitation Council recommends chest thrusts instead of abdominal thrusts. Performing abdominal thrusts involves a rescuer standing behind an upright patient, and using their hands to exert forceful pressures on the bottom of the

. As an example, WebMD recommends making a fist with one hand grasping it with the other, to press with both just above the person's bellybutton. This compresses the lungs and exerts pressure on any object lodged in the

, hopefully expelling it. The pressure amounts to an artificially induced

cough A cough is a sudden expulsion of air through the large breathing passages that can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three ph ...

. To assist a larger person, more force may be needed. The Mayo Clinic recommends the same placement of fist and hand and upward thrusts as if you are trying to lift the person. If the victim can not receive pressures on the abdomen (for example, in case of pregnancy or excessive obesity), chest thrusts are advised instead. These are applied on the lower half of the chest bone, but not in the very endpoint (which is the xiphoid process and could be broken). If the victim is not upright, the US

National Institutes of Health The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the lat ...

(NIH) recommends positioning the person on their back, then straddling the torso and using chest thrusts. It is possible for still-conscious choking victims to perform the procedure on themselves, without assistance. However, this can be difficult, so, in this cases and some others (disabled people, etc.), the use of an anti-choking device is recommended. 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 The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the to ...

is highly likely and more serious injuries can occur, including fracture of the xiphoid process or

rib In vertebrate anatomy, ribs ( la, costae) are the long curved bones which form the rib cage, part of the axial skeleton. In most tetrapods, ribs surround the chest, enabling the lungs to expand and thus facilitate breathing by expanding the ches ...

s. The NHS recommend that anyone who has been subjected to abdominal thrusts should seek a medical examination afterwards. 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''. 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).

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, December 17, 2016 {{authority control Survival skills First aid

History

Universal sign of choking

Technique

See also

References

External links