Introduction
The Heimlich maneuver is an emergency procedure for clearing the airways.
More precisely, this particular maneuver is considered a first aid technique that must be put into practice in case of risk of suffocation caused by an obstruction of the respiratory tract.
The Heimlich maneuver - characterized by the execution of those that are defined as abdominal thrusts or compressions - takes its name from the doctor who first described it in 1974. Since then, the maneuver has been used successfully against the suffocation caused by the presence of bodies strangers in the airways, although there are some limitations to its use especially concerning infants and newborns.
What is that
What is the Heimlich maneuver?
The Heimlich maneuver is an emergency procedure put into practice in the event of suffocation caused by the presence of foreign bodies in the airways. It was put just after a brilliant intuition by the American doctor Henry Heimlich who described it first in June of 1974. The procedure in question can be considered relatively simple to perform, so much so that it does not require degrees in medicine or of a medical preparation to be implemented. To learn it, in fact, it may be sufficient to follow special courses that are sometimes organized free of charge by hospitals, schools or other institutions.
The Heimlich maneuver can be applied to individuals of any sex and age, so it can be successfully practiced on the elderly, young adults, adolescents and children, provided they are one year old.
Please note
The Heimlich maneuver should not be performed in infants and children under one year of age .
For more information on the rescue to be given to infants and children in the event of suffocation, see the article dedicated to: Pediatric Disruption Maneuvers.
When to Practice It
When should the Heimlich maneuver be performed?
The Heimlich maneuver should be practiced only and exclusively if there is absolute certainty that the individual is suffocating due to an airway obstruction. Furthermore, abdominal thrusts should only be performed if the subject is conscious .
To understand if it is necessary to intervene with the Heimlich maneuver, it is very important to identify the signs of the imminent suffocation, recognizable because the individual:
- He puts his hands to his throat and is unable to speak;
- It has great difficulty in breathing and emits squeaky sounds whenever it tries to inhale;
- He coughs weakly, unable to fill his lungs with air to cough more vigorously;
- It takes on a color from red to purple to bluish (cyanosis) due to lack of oxygen.
If the person manifests one or more of the above behaviors and is conscious, the Heimlich maneuver can be practiced.
If, on the other hand, the person is able to cough sufficiently vigorously and is able to breathe, it may be sufficient to encourage her to continue this action so as to allow the foreign body to be expelled directly with coughing. However, if the cough becomes weak and insufficient, as well as if it ceases completely, it is appropriate to proceed with the Heimlich maneuver.
Curiosity
The act of bringing the hands to the throat when one is unable to breathe is considered as a universal sign of suffocation .
Rescuers Without Medical Preparation
Since this is a life-saving procedure, the Heimlich maneuver should also be carried out by rescuers who do not have any kind of medical preparation, as long as they are aware of the way in which the abdominal thrusts that characterize it are performed.
Did you know that ...
The Heimlich maneuver can also be done in the veterinary field on domestic animals such as dogs and cats. Of course, the procedure should be practiced only if you have the absolute certainty that our four-legged friend is suffocating due to an obstruction of the airways and only if you know how to perform the maneuver.
How you do it
How to do the Heimlich maneuver
The Heimlich maneuver involves performing abdominal compressions in order to expel the obstruction that is causing the suffocation to the individual.
The procedure to correctly execute the Heimlich maneuver can be summarized as follows:
- The rescuer must stand upright behind the suffocation victim who may be sitting or even standing;
- Afterwards, the rescuer must bend the individual forward and embrace his waist with both arms: a hand must be closed in a fist and the flattened part of the thumb (the one corresponding to the proximal phalanx, for instance) must be placed in contact with the abdomen of the victim, between the lower end of the sternum and the navel ; the other hand must grasp the fist so positioned so as to ensure a firm grip and so as to allow the execution of abdominal compressions.
- Once correctly positioned, the rescuer, using the hand that grasps the fist, must exert a series of thrusts on the abdomen . The latter must be rapid, deep and performed in antero-posterior and caudo-cranial sense ; in simple words, the compressions must be carried out inward, attracting the victim to him, and must be directed from the bottom upwards, as if one wanted to lift the person.
- The Heimlich maneuver thus performed must be continued until the individual expels the obstruction that prevents breathing; or until the victim loses consciousness . In the latter case, the Heimlich maneuver can no longer be performed and it is necessary to intervene in another way (more detailed information is given in the dedicated chapter "Guidelines").
Remember that:
- When performing the Heimlich maneuver, the rescuer must keep his head next to the victim's; in this way collisions between the victim and the rescuer should be avoided.
- Abdominal compressions should NEVER be performed on the rib cage, but only on the part of the abdomen between the lower end of the sternum and the navel.
Heimlich maneuver in pregnant women
The Heimlich maneuver can also be practiced on pregnant women. In such cases, however, the hands should be positioned slightly higher, just below the sternum, but still on the abdomen and NEVER on the rib cage.
Heimlich maneuver on oneself
Strange as it may seem, the Heimlich maneuver can also be practiced on oneself. In such a situation, it is necessary to have quick reflexes and the ability to remain lucid enough to be able to put the debulking into practice.
There are two ways to practice the Heimlich maneuver on oneself:
- It is possible to carry out the same technique described above, therefore, it is possible to proceed by placing one's own hands closed in a fist between the sternum and the navel and exerting abdominal pressures from the bottom upwards until the foreign body is expelled;
or
- It is possible to make use of the help of a fixed object - such as, for example, a chair with a sufficiently high backrest or the back of a sofa or an armchair - resting the upper part of the abdomen and exerting pressure from the bottom to the 'high until the foreign body is expelled.
Purpose of the Heimlich maneuver
The purpose of the abdominal thrusts that characterize the Heimlich maneuver is to exert pressure that compresses the diaphragm and the lungs, causing the residual air in them to escape. This air, exiting, will then exert a pneumatic pressure on the foreign body that causes the obstruction, thus allowing its expulsion.
Guidelines
Guidelines for the Treatment of Foreign Body Airborne Obstruction
The guidelines dictated by the European Resuscitation Council for the treatment of strangulation suffocation do not provide for the sole execution of the Heimlich maneuver to perform airway clearance.
In fact, when the victim is unable to cough and shows signs of suffocation, they advise:
- Perform, first, five percussion on the back ( backstroke or interscapular strokes). These percussions must be performed as follows:
- The rescuer must be placed next to the victim, bending the trunk forward, supporting the chest with the arm and the neck with the hand;
- Once correctly positioned, the rescuer will have to give five vigorous shots between the shoulder blades of the victim with a side escape route, ie taking care not to hit the victim's head.
- If the percussion on the back does not cause the expulsion of the foreign body, then the rescuer can proceed with the Heimlich maneuver by performing five abdominal compressions .
- The alternate percussion cycle on the back / Heimlich maneuver must be repeated until the obstruction is expelled.
- If the victim loses consciousness before expelling the foreign body, the above procedures must be stopped.
What to do if the victim loses consciousness?
Despite the execution of the Heimlich maneuver, it can happen that the individual loses his senses without expelling the foreign body. In such a situation, therefore, it is necessary:
- Place the individual in a supine position (ie, lie on his back) on a rigid surface (for example, on the floor or on a table);
- Hyper-extend the head and check the oral cavity in an attempt to identify the foreign body that obstructs the respiratory tract. If the foreign body is surfacing, then one can think of proceeding with its removal.
- If the foreign body is not visible and cannot be removed, it may be useful to perform cardiopulmonary resuscitation (CPR) except to help the foreign body escape as much as to try to maintain basic vital functions. The latter procedure provides for the alternation of mouth-to-mouth and chest compressions according to a precise pattern that varies according to the victim's condition. However, the resuscitation procedure will not be considered in this article.
Of course, the importance of requesting medical assistance in the shortest possible time is reiterated.
What to do next
What to do after successfully completing the Heimlich maneuver?
If the individual is conscious and the Heimlich maneuver has led to the expulsion of the object responsible for airway obstruction, it is very likely that breathing resumes spontaneously. Should this not occur, it is necessary to intervene promptly by artificial respiration and cardiopulmonary resuscitation . Clearly, these are emergency procedures not really available to everyone, which is why it is always necessary to alert health workers.
Please note
Medical assistance should also be contacted if the Heimlich maneuver has been successfully performed and the patient has resumed breathing spontaneously. This is because it would be good for the unfortunate victim to undergo medical checks in order to exclude the presence of any damage caused by the newly escaped risk of suffocation and / or the presence of the foreign body in the airways.
Undesirable Risks and Effects
Undesirable Effects and Possible Risks Related to the Execution of the Heimlich Maneuver
Even if performed correctly, the Heimlich maneuver is still a "forced" procedure that can lead to the appearance of undesirable effects. Among these, the most common is represented by the localized hematoma at the point where the compressions were performed. Furthermore, if the maneuver is not carried out correctly and is carried out too vigorously, there is also a real risk of suffering serious injuries, such as the fracture of the xiphoid process or even of the ribs.
For this reason, in the event of suffocation, the importance of immediately alerting health assistance is reiterated. It should also be remembered that - even if the Heimlich maneuver is performed correctly and successfully (by rescuers without preparation as well as by health workers) - it is very important that the victim undergoes a medical examination to ensure not reported damage.
