Abdominal thrusts

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Heimlich maneuver
Abdominal thrusts against choking (cropped).jpg
Performing the Heimlich maneuver

Heimlich maneuver, also known as Abdominal thrusts or Heimlich manoeuvre, is a first-aid procedure used to treat upper-airway obstructions (or choking) by foreign objects. American doctor Henry Heimlich 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. This compresses the lungs and exerts pressure on the object lodged in the trachea in an effort to expel it.

Contents

Most modern protocols, including those of the American Heart Association, American Red Cross, and European Resuscitation Council, 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 as a final resort. Some guidelines also recommend alternating between abdominal thrusts and back slaps. [1] [2]

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. [3] 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. [4] According to Dr. Roger White of the Mayo Clinic 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." [5]

Henry Heimlich also promoted abdominal thrusts as a treatment for drowning [6] and asthma [7] 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. [8] [9] The 2005 drowning rescue guidelines of the American Heart Association [10] 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. [10]

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. [11] According to Heimlich's son, Peter M. Heimlich, "both 'rescues' were bogus." [12]

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. [13]

The man on the right is performing the universal sign of choking by placing both hands on his throat. haimrihibeob 20150724 rosdesinema jigweon siminanjeonpasuggun gyoyug DSC00696.jpg
The man on the right is performing the universal sign of choking by placing both hands on his throat.

Technique

Both the American Red Cross and UK National Health Service (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.

Point of application of abdominal thrusts (between chest and navel). The hands press inward and upward. Abdominal thrusts, point of applying.jpg
Point of application of abdominal thrusts (between chest and navel). The hands press inward and upward.

The American Red Cross, the NHS, the European Resuscitation Council and the Mayo Clinic recommend a repeating cycle of five back slaps and five abdominal thrusts. [14] [15] [1] [2] They are not recommended on children below the age of one. [16] [15] In contrast to the prevailing American and European advice, the Australian Resuscitation Council recommends chest thrusts instead of abdominal thrusts. [17]

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. As an example, WebMD recommends making a fist with one hand and grasping the fist with the other in order press with both just above the patient's navel. This compresses the lungs and exerts pressure on any object lodged in the trachea in an effort to expel it. The pressure amounts to an artificially induced cough. To assist a larger person, more force may be needed. [18] The Mayo Clinic recommends the same placement of fist and hand, with upward thrusts as if the rescuer is attempting to lift the victim. [2]

If the victim cannot receive pressure on the abdomen (for example, in case of pregnancy or excessive obesity), chest thrusts are advised. [19] These are applied on the lower half of the chest bone, but not in the very endpoint (the xiphoid process, which could be broken).

For victims who are not in an upright position, The American National Institutes of Health recommends positioning the victim on the back, then straddling the torso and employing chest thrusts. [16]

It is possible for conscious choking victims to perform the procedure on themselves, without assistance. [20]

Because of the forceful nature of the procedure, even when performed correctly, abdominal thrusts can injure the victim. Bruising to the abdomen is highly likely and more serious injuries can occur, including fracture of the xiphoid process or ribs. [21] The NHS recommends that victims subjected to abdominal thrusts should seek medical attention after the event. [15]

Researchers at Royal Brompton Hospital 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 administers of first aid. The highest pressures were produced by participants performing an abdominal thrust by pressing onto the back of a chair (115 cmH2O). [22] [23]

See also

Related Research Articles

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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 generally performed by someone with basic medical or first response training. Mental health first aid is an extension of the concept of first aid to cover mental health, while psychological first aid is used as early treatment of people who are at risk for developing PTSD. Conflict first aid, focused on preservation and recovery of an individual's social or relationship well-being, is being piloted in Canada.

<span class="mw-page-title-main">Cardiopulmonary resuscitation</span> Emergency procedure after sudden cardiac arrest

Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation, or mouth to mouth in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. It is recommended for those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations.

<span class="mw-page-title-main">Asphyxia</span> Severely deficient supply of oxygen

Asphyxia or asphyxiation is a condition of deficient supply of oxygen to the body which arises from abnormal breathing. Asphyxia causes generalized hypoxia, which affects all the tissues and organs, some more rapidly than others. There are many circumstances that can induce asphyxia, all of which are characterized by the inability of a person to acquire sufficient oxygen through breathing for an extended period of time. Asphyxia can cause coma or death.

<span class="mw-page-title-main">Mouth-to-mouth resuscitation</span> Artificial ventilation using exhaled air from the rescuer

Mouth-to-mouth resuscitation, a form of artificial ventilation, is the act of assisting or stimulating respiration in which a rescuer presses their mouth against that of the victim and blows air into the person's lungs. Artificial respiration takes many forms, but generally entails providing air for a person who is not breathing or is not making sufficient respiratory effort on their own. It is used on a patient with a beating heart or as part of cardiopulmonary resuscitation (CPR) to achieve the internal respiration.

<span class="mw-page-title-main">Choking</span> Mechanical obstruction of the flow of air from the environment into the lungs

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 deprivation. Although oxygen stored in the blood and lungs can keep a person alive for several minutes after breathing stops, choking often leads to death.

<span class="mw-page-title-main">Drowning</span> Respiratory impairment caused by submersion in liquid

Drowning is a type of suffocation induced by the submersion of the mouth and nose in a liquid. Submersion injury refers to both drowning and near-miss incident. 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 assistance. After successful resuscitation, drowning victims may experience breathing problems, confusion, or unconsciousness. Occasionally, victims may not begin experiencing these symptoms until several hours after they are rescued. An incident of drowning can also cause further complications for victims due to low body temperature, aspiration, or acute respiratory distress syndrome.

<span class="mw-page-title-main">Pulmonary aspiration</span> Entry of materials into the larynx (voice box) and lower respiratory tract

Pulmonary aspiration is the entry of solid or liquid material such as pharyngeal secretions, food, drink, or stomach contents from the oropharynx or gastrointestinal tract, into the trachea and lungs. When pulmonary aspiration occurs during eating and drinking, the aspirated material is often colloquially referred to as "going down the wrong pipe".

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. It can be provided by trained medical personnel, such as emergency medical technicians, qualified bystanders and anybody who is trained for providing BLS and/or ACLS.

<span class="mw-page-title-main">Airway management</span> Medical procedure ensuring an unobstructed airway

Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either clearing a previously obstructed airway; or by preventing airway obstruction in cases such as anaphylaxis, the obtunded patient, or medical sedation. Airway obstruction can be caused by the tongue, foreign objects, the tissues of the airway itself, and bodily fluids such as blood and gastric contents (aspiration).

<span class="mw-page-title-main">Respiratory arrest</span> Medical condition

Respiratory arrest is a serious medical condition caused by apnea or respiratory dysfunction severe enough that it will not sustain the body. Prolonged apnea refers to a patient who has stopped breathing for a long period of time. If the heart muscle contraction is intact, the condition is known as respiratory arrest. An abrupt stop of pulmonary gas exchange lasting for more than five minutes may permanently damage vital organs, especially the brain. Lack of oxygen to the brain causes loss of consciousness. Brain injury is likely if respiratory arrest goes untreated for more than three minutes, and death is almost certain if more than five minutes.

<span class="mw-page-title-main">Bag valve mask</span> Hand-held device to provide positive pressure ventilation

A bag valve mask (BVM), sometimes known by the proprietary name Ambu bag or generically as a manual resuscitator or "self-inflating bag", is a hand-held device commonly used to provide positive pressure ventilation to patients who are not breathing or not breathing adequately. The device is a required part of resuscitation kits for trained professionals in out-of-hospital settings (such as ambulance crews) and is also frequently used in hospitals as part of standard equipment found on a crash cart, in emergency rooms or other critical care settings. Underscoring the frequency and prominence of BVM use in the United States, the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care recommend that "all healthcare providers should be familiar with the use of the bag-mask device." Manual resuscitators are also used within the hospital for temporary ventilation of patients dependent on mechanical ventilators when the mechanical ventilator needs to be examined for possible malfunction or when ventilator-dependent patients are transported within the hospital. Two principal types of manual resuscitators exist; one version is self-filling with air, although additional oxygen (O2) can be added but is not necessary for the device to function. The other principal type of manual resuscitator (flow-inflation) is heavily used in non-emergency applications in the operating room to ventilate patients during anesthesia induction and recovery.

<span class="mw-page-title-main">ABC (medicine)</span> Mnemonic for airway, breathing, and circulation

ABC and its variations are initialism mnemonics for essential steps used by both medical professionals and lay persons when dealing with a patient. In its original form it stands for Airway, Breathing, and Circulation. The protocol was originally developed as a memory aid for rescuers performing cardiopulmonary resuscitation, and the most widely known use of the initialism is in the care of the unconscious or unresponsive patient, although it is also used as a reminder of the priorities for assessment and treatment of patients in many acute medical and trauma situations, from first-aid to hospital medical treatment. Airway, breathing, and circulation are all vital for life, and each is required, in that order, for the next to be effective: a viable Airway is necessary for Breathing to provide oxygenated blood for Circulation. Since its development, the mnemonic has been extended and modified to fit the different areas in which it is used, with different versions changing the meaning of letters or adding other letters.

The history of cardiopulmonary resuscitation (CPR) can be traced as far back as the literary works of ancient Egypt. However, it was not until the 18th century that credible reports of cardiopulmonary resuscitation began to appear in the medical literature.

Henry Judah Heimlich 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, first described in 1974. He also invented the Micro Trach portable oxygen system for ambulatory patients and the Heimlich Chest Drain Valve, or "flutter valve", which drains blood and air out of the chest cavity.

Pulmonary hygiene, also referred to as pulmonary toilet, is a set of methods used to clear mucus and secretions from the airways. The word pulmonary refers to the lungs. The word toilet, related to the French toilette, refers to body care and hygiene; this root is used in words such as toiletry that also relate to cleansing.

<span class="mw-page-title-main">Foreign body aspiration</span> Medical condition

Foreign body aspiration occurs when a foreign body enters the airway which can cause difficulty breathing or choking. Objects may reach the respiratory tract and the digestive tract from the mouth and nose, but when an object enters the respiratory tract it is termed aspiration. The foreign body can then become lodged in the trachea or further down the respiratory tract such as in a bronchus. Regardless of the type of object, any aspiration can be a life-threatening situation and requires timely recognition and action to minimize risk of complications. While advances have been made in management of this condition leading to significantly improved clinical outcomes, there were still 2,700 deaths resulting from foreign body aspiration in 2018. Approximately one child dies every five days due to choking on food in the United States, highlighting the need for improvements in education and prevention.

Pediatric Basic Life Support (PBLS) is a rescue procedure which has purpose of preventing the anoxic brain damage by promoting the return of spontaneous circulation and breathing in cases of cardiac arrest.

<span class="mw-page-title-main">Basic airway management</span> Medical intervention

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. Airway obstructions can occur in both conscious and unconscious individuals. They can also be partial or complete. Airway obstruction is commonly caused by the tongue, the airways itself, foreign bodies or materials from the body itself, such as blood or vomit. Contrary to advanced airway management, basic airway management technique do not rely on the use of invasive medical equipment and can be performed with less training. Medical equipment commonly used includes oropharyngeal airway, nasopharyngeal airway, bag valve mask, and pocket mask. Airway management is a primary consideration in cardiopulmonary resuscitation, anaesthesia, emergency medicine, intensive care medicine and first aid.

<span class="mw-page-title-main">Act+Fast Anti Choking Trainer</span> Anti Choking simulation training equipment.

The Act+Fast Anti Choking Trainer, also known as the “Choking Rescue Training Vest”, is a simulation device manufactured by Act+Fast LLC, a company based in California. It helps practice choking rescue techniques and is mainly used in basic airway management to teach choking rescue protocols, abdominal thrusts and the back slap method. The Anti Choking Trainer was exhibited at the 2008 EMS Expo in Las Vegas, Nevada.

Choking rescue training devices are choking simulation equipment used by first aid learners to prepare for dealing with real world choking scenarios. They have been approved and used by the European Resuscitation Council, St John Ambulance, and International Red Cross and Red Crescent Movement. The simulation devices are used to demonstrate choking rescue techniques such as abdominal thrusts and backslap method and practice choking rescue protocols by American Heart Association and Red Cross.

References

  1. 1 2 Nolan, JP; Soar, J; Zideman, DA; Biarent, D; Bossaert, LL; Deakin, C; Koster, RW; Wyllie, J; Böttiger, B; ERC Guidelines Writing Group (2010). "European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary". Resuscitation. 81 (10): 1219–76. doi:10.1016/j.resuscitation.2010.08.021. hdl: 10067/1302980151162165141 . PMID   20956052.
  2. 1 2 3 Foreign object inhaled: First aid, Mayo Clinic staff, November 1, 2011.
  3. ↑ "Heimlich, on the maneuver". The New York Times. February 6, 2009. Retrieved February 7, 2009.
  4. ↑ "Lifejackets on Ice (August 2005)" (PDF). University of Pittsburgh Medical School. Retrieved May 24, 2009.
  5. ↑ Pamela Mills-Senn (April 2007). "A New Maneuver (August 2005)". Cincinnati Magazine. Retrieved December 22, 2013.
  6. ↑ "Heimlich Institute on rescuing drowning victims". Archived from the original on January 24, 2008. Retrieved June 5, 2007.
  7. ↑ "Heimlich Institute on rescuing asthma victims". Archived from the original on March 14, 2011. Retrieved June 5, 2007.
  8. ↑ Heimlich, Peter M. "Outmaneuvered – How We Busted the Heimlich Medical Frauds" . Retrieved June 22, 2007.
  9. ↑ Heimlich's son cites Dallas case in dispute. Wilkes-Barre News, August 22, 2007
  10. 1 2 "Part 10.3: Drowning". Circulation. 112 (24): 133–135. November 25, 2005. doi: 10.1161/CIRCULATIONAHA.105.166565 .
  11. ↑ Walters, Joanna (May 27, 2016). "Dr Henry Heimlich uses Heimlich maneuver to save a life at 96". TheGuardian.com .
  12. ↑ Samways, Ana (October 28, 2021). "Sideswipe: Too good to be true?". New Zealand Herald. Retrieved December 12, 2021.
  13. ↑ "Choking first aid – adult or child over 1 year – series". MedlinePlus. National Institutes of Health. Retrieved March 11, 2016.
  14. ↑ "STEP 3: Be Informed – Conscious Choking | Be Red Cross Ready". www.redcross.org. Retrieved December 4, 2017.
  15. 1 2 3 "What should I do if someone is choking? NHS.UK". October 30, 2015. Retrieved July 26, 2018.
  16. 1 2 "Abdominal thrusts". MedlinePlus. National Institutes of Health. Retrieved March 11, 2016.
  17. ↑ "Australian (and New Zealand) Resuscitation Council Guideline 4 AIRWAY". Australian Resuscitation Council (2010). Archived from the original on February 14, 2014. Retrieved February 9, 2014.
  18. ↑ Heimlich Maneuver for Adults and Children Older Than 1 Year – Topic Overview, WebMD, April 28, 2010.
  19. ↑ "Choking Safety Talk". Oklahoma State University. Archived from the original on January 30, 2020.
  20. ↑ "Heimlich maneuver on self". MedlinePlus. National Institutes of Health. Retrieved March 11, 2016.
  21. ↑ Broomfield, James (January 1, 2007). "Heimlich maneuver on self". Discovery Channel. Retrieved June 15, 2007.
  22. ↑ Pavitt, Matthew J.; Swanton, Laura L.; Hind, Matthew; Apps, Michael; Polkey, Michael I.; Green, Malcolm; Hopkinson, Nicholas S. (April 5, 2017). "Choking on a foreign body: a physiological study of the effectiveness of abdominal thrust manoeuvres to increase thoracic pressure". Thorax. 72 (6): 576–578. doi:10.1136/thoraxjnl-2016-209540. ISSN   0040-6376. PMC   5520267 . PMID   28404809.
  23. ↑ "How to perform the Heimlich manoeuvre on yourself (and yes, it's just as effective)". The Telegraph. Retrieved April 13, 2017.
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