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Heimlich Maneuver: Best Practices

One of the first skills taught in CPR is the Heimlich maneuver, but it doesn’t get nearly as much attention as the other skills in the program. Actually, most civilians are more likely to use the Heimlich maneuver in the field than compressions or rescue breaths. For this reason, it is important to know how to perform this common rescue move and to help a patient who can’t clear their airway. Whether you are using it in a restaurant or a hospital, you want to make sure you are performing the technique correctly.

You may benefit strongly from reading about the Heimlich maneuver, but practicing on a person will give you a better feel for the process. You shouldn’t completely perform the maneuver on your volunteer as it can be painful and cause injury. However, you should still find the landmarks for the practice and visualize doing the procedure correctly. As with other techniques taught in CPR, the proper placement of the hands and the correct use of the maneuver are the most important aspects to grasp. Practice and study can help you understand the Heimlich maneuver and perform it correctly in a crisis.

Indications for Maneuver

Sometimes the hardest part of the Heimlich maneuver is determining when to use it. It is indicated for choking, but how do you know that it is bad enough to warrant intervention? Even worse, you don’t want to wait too long as the patient could pass out. This is where the universal sign of choking comes into play. Usually, those who cannot breathe will grab their neck with both hands in an attempt to clear their airway. It is important to listen for the exchange of breath when someone is coughing. If you can hear air move, you probably would not get much clearance with the Heimlich maneuver.

Another way to determine if the victim can’t breathe is if they are able to talk. If they can get words out, then you may not need to perform the maneuver on them. You also want to look for color changes in the face. At first, their face may turn red, but as they become more hypoxic, you will see a bluish hue. It is frightening when someone is choking and you aren’t sure if you should perform the maneuver. Simply, if you are in doubt, you should position the victim and administer the maneuver. They will not suffer tremendous damage from the Heimlich maneuver, and it just may save their life.

Positioning and Technique

Once you determine the Heimlich maneuver is necessary, you need to know exactly how to perform the technique. First, get behind the victim. If they are sitting, try to get them to stand as this will help with the thrusts. Wrap your arms around the victim’s midsection and search for their bellybutton. You don’t have to be precise in finding the bellybutton, but the general area is good enough. Also, outline the lower margin of the ribcage. You want to focus the maneuver in the soft area above the bellybutton but below the apex of the ribcage.

Make a fist with one hand and grasp it with the other hand. You want to thrust both of your hands into this soft spot in an inward and upward fashion. Try to imagine pushing the blockage out of the patient’s airway with your combined hands. If possible, have the victim lean over slightly while you drive your fist up and into their abdomen. Usually, this will cause the victim to involuntarily heave, and that is the mechanism by which the foreign object is expelled. Continue your thrusts until the blockage comes out or until the patient loses consciousness.

Recovery and Further Intervention

If you are successful in removing the obstruction, you still need to activate EMS. You should have the person sit down, loosen any tight clothing, and wait for the paramedics to arrive. They may not need to go to the hospital, but it is a good idea to have them evaluated for any unnoticed sequelae to the choking and the Heimlich maneuver.

If the obstruction is not removed and the patient passes out, you need to gently lower them to the floor. Open the mouth with the head tilt/ chin lift and look inside. If you can see the blockage, use your forefinger to hook the object and drag it out of the mouth. At this point, you should also check for breathing and a pulse. If there is no pulse, commence with hands only CPR. If there is a pulse but no breathing, you may want to give further thrusts to the abdomen. Straddle the victim and, using both hands, deliver thrusts in and up toward the head. Your hands should be in about the same place as with the standing Heimlich maneuver, and you should hold them in roughly the same configuration as when performing compressions. After five thrusts, check the mouth for the object and remove it if necessary. Also, check for breathing and pulse until the paramedics arrive.