7/28/2019 "The Heimlich Manuever [sic]," a two-part Public Health Statement by Surgeon General C. Everett Koop, Decemb

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December 11,1985

I U S ocoa~lrnentei Hcann and nman >avres ~ l j t i r l cHrZ'lh Scrvae IThe Heimlich Manuever(Part one of two parts)

More than 3,000 people die fromchoking in the United States each year.lMost choking in adults occurs whikthey are eating. Meat is the usual cul-prit. Other foods and objects causechoking, too. especially in young chil-dren who, as all parents know, seem todelight in putting all sorts of things intotheir mouths.For years medical opinion differed onthe best way, o r ways, of dislodging anobject from the throat of a choking vic-tim. Sharp blows to the back, fingersweeps of the throa t and manual thruststo the chest were methods often recom-mended. Today, there is universal agree-ment that these methods can be danger-ous and should not be performed. Aback slap or a probing finger, for in-stance,can drive the foreign object wendeeper into the throat. The best rescuetechnique in any choking situation, doc-tors now agree, is the Heimlich Manue-ver, which I shall describe briefly in to-day's article and in more detail nextmonth.The Heimlich Manuever is safe, ef-fective an d easilymastered by the avw-

age person. Basically, it require therescuer t o press sharply and repeatedlyon th e victim's abdomen, just abovethe naveI, thereby forcing air from thelungs up the airway with such forcethat it dislodges the obstruction. TheManuever can be performed on stand-ing or seated victims and on personswho have fallen t o the floor. It can beperformed on children. Before resort-ing to the Manuever, however, the firstthing the would-be rescuer must do , to

the best of his or her ability, is to m ak esure th at the victim actually is chokingand not suffering from another condi-tion, such as a heart attack.Look far the sign of choking thatmany victims give instinctively by u.bringing their hands to their throatswith thumbs and fingers spread wide.Ask the victim, "Are you chokiEven if he cannot answer, he maable to nod affirmatively. m ESometimes, th e airway will be o n lypartially blocked, allowing the YcmSHIEto cough and to breathe to some ex-tent. In most cases, the victim wilI beable to expel the foreign bo dy withoutthe assistance of another person. Ifspontaneous expulsion does not soonoccur, however-if breathing becomesmo re difficult and the victim's distressincreases-the He imlich M an ueve rshould be started, before the comp lica-tions of prolong ed, inadequate ventila-tion or complete blockage of the air-way can occur.If the victim does not give the chokingsign, look for three more signs that willindicate completeobstruction o f the air-way: first, an inability to breathe, coughor speak; second, pale skin color tha t isbeginning to turn bluish, and; third, lossof consciousness. The Heimlich Manue-ver should be started at the first sight ofany of these signs.A more difficult situation is pre-sented when someone is found uncon-scious and not breathing and no one

saw a choking attack take place. If thevictim is young (under 30) or a child,and if he is in the vicinity of a restau-rant-for instance, in the restroom orhallway leading to it-the rescuershould assume that choking has takenplace and should begin the HeimlichManu ever imm ediately. If the situationdoes not suggest choking, the victimmust be treated as aheart atta ck victimand CPR should be initiated. If the re isan obstruction in the airway after all,the rescuer will realize it at once whenhe is unable to breathe for the victim.Th e rescuer should immediately initiatethe Heimlich Manuever to clear theblacked air passage.Next month: How To Per form theHeimlich Manuever.

7/28/2019 "The Heimlich Manuever [sic]," a two-part Public Health Statement by Surgeon General C. Everett Koop, Decemb

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December 2'7,1985

I U S Deparrment 01 Hcalrn and Human Services t '~l?l* HrA'.% 5ervlce IHeimlich Manuever

c nd of cr two-part series)1FB"Heimlich Manuever" for res-J B m g choking victims was devised in

t h e early 1970's by Henry J. Heimlich,M.D., Professor of Advanced ClinicalSciences at Xavier University. Dr.Heimlich's manuever depends for itssuccess on the fact that a choking vic-tim has a large volume of air in hislungs, w e n if he was exhaling when thechoking began. If a rescuer pressessharply and repeatedly on th e victim'sabdomen at a point between th e ribcage and th e navel, tha t reservoir of airis expelled up the airway with a greatdeal of force, thus dislodging the ob-struction fro m th e victim's throat.As we noted in last month's column,the Heimlich Manuever can be per-

formed on standing or seated victimsand o n persons who have fallen to thefloor. It can be performed o n childrenan d even o n one's self. When the vie-tim is standing, the rescuer stands be-hind him and wraps his arms aroundhis waist. He thenmakes a fist with onehand and places the thum b side of thefist just above the victim's navel andbelow the tip of the breastbone. Hegrasps the fist with his other hand an dpresses it into the victim's abdomenwith a quick upward thrust. Severalthrusts m ay be necessary to clear theairway.The technique for the seated victimdiffers only in that the rescuer kneelsbehind the chair and wraps his armsa round both chair and victim (unless

the chair back is too large, in whichcase he turns the victim and performsthe Manuever from the side).The victim who has collapsed t o thefloor is rolled onto his back, face up .The rescuer straddles the victim andplaces his hands, one on top of theother, o n the victim's abdomen, withthe heel of the bottom hand slightlyabove th e navel. He then presses intothe abdomen with a quick upwardthrust, repeating thrusts as necessary.A choking infant is either held in th erescuer's lap or placed o n a firm sur-face, such as a table. Instead of fistsand hands, the rescuer uses two orthree fingers for the quick upwardthrusts into the baby's abdomen. Re-peat as necessary, taking care not to in-jure the child with too much force.Many people have saved themselvesfrom choking by positioning their ow nhands sIightly above their navels andthrusting upward quickly and sepeat-edly. Alternatively, the victim can posi-tion his abdom en against the edge of achair back, a table o r similar soIid ob-ject and press himself quickly andforcefully against it. As with th e otherforms of t h e Manuever, several thrustsm ay be necessary.Whenever the Heimlich Manueverhas been performed , th e victim shouldbe seen by a physician as soon as possi-ble, even if no complications are ap-parent. Injury from the Manuever israre, but it can occur if the M anueverwas not perform ed properly.The best way to deal with obstructionof t h e airway, of course, is t o prevent it.The American Red Cross, w hose experi-ence with this problem is great, offersthe following advice: cut food intosmall pieces and chew slowly and thor-oughIy, especially if you wear dentures;don't laugh and talk while chewing andswallowing, and avoid excessive intakeof alcohol before and during meaIs; fin-ally, keep children from walking, run-ning or playing while they have food intheir mouths, and keep small objects,such as marbles, beads and thum btacks,out of the reach of infants and smallchildren.