The Heimlich maneuver is an emergency first-aid procedure used when a person’s airway is fully blocked by a foreign object. It works by creating an artificial cough, forcefully increasing air pressure in the lungs to dislodge the obstruction from the windpipe (trachea). The maneuver must only be performed on conscious individuals who are unable to breathe, speak, or cough effectively due to the blockage. A completely blocked airway can lead to brain damage from oxygen deprivation in minutes.
Recognizing a Choking Emergency
Recognizing a choking emergency begins with determining the severity of the obstruction. The universal sign is a person instinctively clutching their throat. A complete obstruction means the person is unable to speak, breathe, or cough effectively, often producing only weak, silent coughs. Signs of oxygen deprivation, such as the skin, lips, or nail beds turning blue (cyanosis), may also appear.
If the person can still cough forcefully or speak, they have a partial obstruction, and you should not perform the maneuver. Encourage them to continue coughing to expel the object naturally. Intervention is mandatory only if the cough is ineffective, they cannot make any sound, or they become completely silent. Once a complete blockage is confirmed, direct a bystander to call emergency services immediately while you begin the procedure.
Performing Abdominal Thrusts on Adults and Older Children
To perform abdominal thrusts on an adult or child over one year old, stand directly behind the victim. Place one of your legs slightly between the person’s legs to provide a stable base, supporting them if they lose consciousness. Wrap both of your arms around the person’s waist, positioning them just above the navel and below the ribcage.
Make a tight fist with one hand and place the thumb side against the person’s abdomen, slightly above the navel. Cover that fist with your other hand. Deliver a quick, forceful thrust into the abdomen, pulling both inward and upward in a “J-shape” motion. This action pushes the diaphragm up, compressing the lungs and generating the pressure needed to expel the foreign body.
Repeat the thrusts up to five times. Check after each thrust to see if the object has been dislodged and the person can breathe. If the blockage remains, continue the cycle of five abdominal thrusts until the object is cleared or the person becomes unresponsive. If the victim loses consciousness, lower them gently to the ground and immediately begin cardiopulmonary resuscitation (CPR).
Maneuver for Infants Under One Year Old
Infants (under one year old) require a different approach that avoids abdominal thrusts entirely due to anatomical differences. The procedure involves alternating five back blows and five chest thrusts to clear the airway. Begin by positioning the infant face-down along your forearm, resting your arm on your thigh for support.
The infant’s head must be kept lower than their chest. Deliver five firm, controlled back blows with the heel of your hand directly between the infant’s shoulder blades. If the object is not expelled, turn the infant over, supporting the head and neck. They should now be face-up along your forearm, with their head still lower than the body.
Use two fingers to deliver five rapid chest thrusts to the center of the breastbone, just below the nipple line. These thrusts should be quick and about one to one-and-a-half inches deep. Continue alternating the five back blows and five chest thrusts until the object is dislodged, the infant begins to cough or cry, or they lose consciousness, requiring CPR to be started.
Modifications for Specific Situations
Certain physical conditions require modifications to the abdominal thrust technique. For pregnant individuals or those who are very obese, the location of the thrusts is moved from the abdomen to the middle of the chest. Stand behind the person and deliver chest thrusts directly onto the breastbone, similar to a chest compression. This avoids injury to the pregnant uterus or bypasses excess abdominal tissue.
If you are alone and choking, you can attempt to administer the thrusts to yourself. Make a fist, place it above your navel, grasp it with your other hand, and thrust inward and upward quickly. Alternatively, you can lean over a firm, horizontal edge, such as the back of a chair or a counter, and thrust your upper abdomen against the object. If the victim becomes unresponsive at any point, stop the maneuver and begin CPR starting with chest compressions.
Necessary Follow-Up Care
Even after the foreign object has been expelled, immediate medical attention is necessary. The forceful nature of abdominal and chest thrusts carries a risk of complications that may not be immediately obvious. These complications can include soft tissue bruising, cracked ribs, or internal injuries to abdominal organs.
A medical professional must assess the person for signs of internal trauma or residual fragments in the airway. Airway swelling may also occur, which a doctor can monitor and treat. Calling 911 or visiting an emergency room ensures a thorough examination to rule out any delayed or unseen damage that could become serious.