Editing Abdominal thrusts

{{short description|First aid procedure}}
{{redirect|Heimlich||Heimlich (disambiguation)}}
{{Unfocused|date=December 2023}}
{{Use mdy dates|date=May 2019}}
{{Infobox medical intervention
|Name        = Heimlich maneuver
|Image       = Abdominal thrusts against choking (cropped).jpg
|image_size  = 
|Caption     = Performing the Heimlich maneuver
|ICD10       = 
|ICD9        = 
|MeshID      = 
|OPS301      = 
|OtherCodes  = 
|HCPCSlevel2 = 
}}

'''Heimlich maneuver,''' also known as '''abdominal thrusts''' or '''Heimlich manoeuvre''', is a [[first aid|first-aid]] procedure used to treat [[upper airway obstruction|upper-airway obstruction]]s (or [[choking]]) by [[foreign body|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 (anatomy)|diaphragm]]. This compresses the lungs and exerts pressure on the object lodged in the [[trachea]] in an effort to expel it.

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.<ref name="ERC2010" /><ref name="MayoClinic-Nov-2011">{{Cite web |title=Foreign object inhaled: First aid |url=https://www.mayoclinic.org/first-aid/first-aid/basics/art-20056612 |access-date=2025-03-18 |website=Mayo Clinic |language=en}}</ref>

== 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.<ref>{{cite news|url=https://www.nytimes.com/2009/02/06/opinion/l06heimlich.html|newspaper=The New York Times|title=Heimlich, on the maneuver|access-date=February 7, 2009 | date=February 6, 2009}}</ref> 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.<ref>{{Cite news|url=http://pittmed.health.pitt.edu/AUG_2005/life_jackets.pdf|publisher=University of Pittsburgh Medical School|title=Lifejackets on Ice (August 2005)|access-date=May 24, 2009}}</ref> According to Dr. Roger White of the [[Mayo Clinic]] and [[American Heart Association|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.”<ref>{{Cite news|url=https://books.google.com/books?id=rcMqOFGzb_oC&q=a+new+maneuver+mills-senn&pg=PA88|publisher=Cincinnati Magazine|title=A New Maneuver (August 2005)|author=Pamela Mills-Senn|date=April 2007|access-date=December 22, 2013}}</ref>

Henry Heimlich also promoted abdominal thrusts as a treatment for [[drowning]]<ref>{{Cite web |url=http://www.heimlichinstitute.org/drowning.php |title=Heimlich Institute on rescuing drowning victims |access-date=June 5, 2007 |archive-date=January 24, 2008 |archive-url=https://web.archive.org/web/20080124163011/http://www.heimlichinstitute.org/drowning.php |url-status=dead }}</ref> and [[asthma]]<ref>{{Cite web |url=http://www.heimlichinstitute.org/asthma.php |title=Heimlich Institute on rescuing asthma victims |access-date=June 5, 2007 |archive-date=March 14, 2011 |archive-url=https://web.archive.org/web/20110314151117/http://www.heimlichinstitute.org/asthma.php |url-status=dead }}</ref> 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.<ref name="pheimlich">{{Cite web|url=http://www.medfraud.info|title=Outmaneuvered – How We Busted the Heimlich Medical Frauds |first=Peter M |last=Heimlich |access-date=June 22, 2007}}</ref><ref>[http://medfraud.info/TimesLeader_8-22-07.html Heimlich's son cites Dallas case in dispute.] ''Wilkes-Barre News'', August 22, 2007</ref> The 2005 drowning rescue guidelines of the American Heart Association<ref name = Drowning>{{cite journal|date=November 25, 2005|title=Part 10.3: Drowning|journal=Circulation|volume=112|issue=24|pages=133–135|doi=10.1161/CIRCULATIONAHA.105.166565|doi-access=free}}</ref> 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 [[Pulmonary aspiration|aspiration]].<ref name = Drowning/>

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.<ref>{{cite web|url=https://www.theguardian.com/us-news/2016/may/27/dr-heimlich-performs-heimlich-manoeuvre-for-first-time-aged-96|title=Dr Henry Heimlich uses Heimlich maneuver to save a life at 96|first=Joanna|last=Walters|website=[[TheGuardian.com]]|date=May 27, 2016}}</ref> According to Heimlich's son, Peter M. Heimlich, "both 'rescues' were bogus."<ref>{{Cite news|last=Samways|first=Ana|date=October 28, 2021|title=Sideswipe: Too good to be true?|work=New Zealand Herald|url=https://www.nzherald.co.nz/entertainment/sideswipe-october-29-alfresco-dining-in-ponsonby-2021/6SCDQNZUUI2ORSHIYVVSQ5J2SU/|access-date=December 12, 2021}}</ref>

==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.<ref>{{Cite web |last=Rivera |first=Anna |date=2025-02-06 |title=Dysphagia: Understanding Choking and Swallowing Problems in Elderly Adults |url=https://willnice.net/choking-prevention/what-causes-choking-in-older-adults/ |access-date=2025-03-18 |website=Willnice |language=en-US}}</ref><ref name="MedlineUSC">{{cite web|title=Choking first aid – adult or child over 1 year – series |url=https://medlineplus.gov/ency/presentations/100222_1.htm |website=MedlinePlus |publisher=National Institutes of Health |access-date=March 11, 2016 }}</ref>
[[File:하임리히법 20150724 롯데시네마 직원 시민안전파수꾼 교육 DSC00696.jpg|thumb|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.

[[File:Abdominal thrusts, point of applying.jpg|thumb|Point of application of abdominal thrusts (between chest and navel). The hands press inward and upward.|alt=]]
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.<ref name="redcross.org">{{cite web|title=STEP 3: Be Informed – Conscious Choking {{!}} Be Red Cross Ready|url=http://www.redcross.org/flash/brr/English-html/conscious-choking.asp|website=www.redcross.org|access-date=December 4, 2017}}</ref><ref name="nhs">{{cite web|url=https://www.nhs.uk/common-health-questions/accidents-first-aid-and-treatments/what-should-i-do-if-someone-is-choking|title=What should I do if someone is choking? NHS.UK|date=October 30, 2015|access-date=July 26, 2018}}</ref><ref name=ERC2010>{{cite journal |last1=Nolan |first1=JP |last2=Soar |first2=J |last3=Zideman |first3=DA |last4=Biarent |first4=D |last5=Bossaert |first5=LL |last6=Deakin |first6=C |last7=Koster |first7=RW |last8=Wyllie |first8=J |last9=Böttiger |first9=B |last10=ERC Guidelines Writing Group |title=European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary |journal=Resuscitation |volume=81 |issue=10 |pages=1219–76 |doi=10.1016/j.resuscitation.2010.08.021| pmid=20956052 |year=2010|hdl=10067/1302980151162165141 |hdl-access=free }}</ref><ref name=MayoClinic-Nov-2011/> They are not recommended on children below the age of one.<ref name="Medline" /><ref name="nhs"/> In contrast to the prevailing American and European advice, the Australian Resuscitation Council recommends chest thrusts instead of abdominal thrusts.<ref>
{{Cite web|url=http://www.resus.org.au/policy/guidelines/section_4/airway.htm |title=Australian (and New Zealand) Resuscitation Council Guideline 4 AIRWAY |publisher=Australian Resuscitation Council (2010) |access-date=February 9, 2014 |url-status=dead |archive-url=https://web.archive.org/web/20140214093540/http://www.resus.org.au/policy/guidelines/section_4/airway.htm |archive-date=February 14, 2014 }}</ref>

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 (anatomy)|diaphragm]].<ref>{{Cite web |title=How To Do the Heimlich Maneuver |url=https://my.clevelandclinic.org/health/treatments/21675-heimlich-maneuver |archive-url=http://web.archive.org/web/20250303235904/https://my.clevelandclinic.org/health/treatments/21675-heimlich-maneuver |archive-date=2025-03-03 |access-date=2025-03-18 |website=Cleveland Clinic |language=en}}</ref> As an example, [[WebMD]] recommends making a fist with one hand and grasping the fist with the other in order to press with both just above the patient's [[navel]]. This compresses the lungs and exerts pressure on any object lodged in the [[vertebrate trachea|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.<ref>{{Cite web |title=Heimlich Maneuver for Adults and Children Older Than 1 Year - Topic Overview |url=http://firstaid.webmd.com/tc/heimlich-maneuver-for-adults-and-children-older-than-1-year-topic-overview |archive-url=https://web.archive.org/web/20160306091727/http://www.webmd.com/first-aid/tc/heimlich-maneuver-for-adults-and-children-older-than-1-year-topic-overview |archive-date=March 6, 2016 |website=WebMD}}</ref> The Mayo Clinic recommends the same placement of fist and hand, with upward thrusts as if the rescuer is attempting to lift the victim.<ref name="MayoClinic-Nov-2011" />

If the victim cannot receive pressure on the abdomen (for example, in case of pregnancy or excessive obesity), chest thrusts are advised.<ref>{{Cite web|url=https://ehs.okstate.edu/site-files/docs/cpr-and-choking-5-min-safety-talk.pdf/|title=Choking Safety Talk|website=Oklahoma State University|url-status=live|archive-url=https://web.archive.org/web/20200130145512/https://ehs.okstate.edu/site-files/docs/cpr-and-choking-5-min-safety-talk.pdf/|archive-date=2020-01-30}}</ref> 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.<ref name="Medline">{{cite web|title=Abdominal thrusts|url=https://www.nlm.nih.gov/medlineplus/ency/article/000047.htm|website=MedlinePlus|publisher=National Institutes of Health|access-date=March 11, 2016}}</ref>

It is possible for conscious choking victims to perform the procedure on themselves, without assistance.<ref name="MedlineSelf">{{cite web|title=Heimlich maneuver on self |url=https://www.nlm.nih.gov/medlineplus/ency/article/001983.htm|website=MedlinePlus |publisher=National Institutes of Health|access-date=March 11, 2016}}</ref>

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 [[rib]]s.<ref>{{Cite web|url=http://www.health.discovery.com/encyclopedias/illnesses.html?article=671 |title=Heimlich maneuver on self |publisher=Discovery Channel |last=Broomfield |first=James |date=January 1, 2007 |access-date=June 15, 2007}}</ref> The NHS recommends that victims subjected to abdominal thrusts should seek medical attention after the event.<ref name="nhs" />

Researchers at [[Royal Brompton Hospital]] have demonstrated that levels of intrathoracic pressures (50–60 cmH<sub>2</sub>O) 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 administering first aid. The highest pressures were produced by participants performing an abdominal thrust by pressing onto the back of a chair (115 cmH<sub>2</sub>O).<ref>{{Cite journal |date=April 5, 2017 |title=Choking on a foreign body: a physiological study of the effectiveness of abdominal thrust manoeuvres to increase thoracic pressure |url= |journal=Thorax |language=en |volume=72 |issue=6 |pages=576–578 |doi=10.1136/thoraxjnl-2016-209540 |issn=0040-6376 |pmc=5520267 |pmid=28404809 |last1=Pavitt |first1=Matthew J. |last2=Swanton |first2=Laura L. |last3=Hind |first3=Matthew |last4=Apps |first4=Michael |last5=Polkey |first5=Michael I. |last6=Green |first6=Malcolm |last7=Hopkinson |first7=Nicholas S. }}</ref><ref>{{Cite news|url=https://www.telegraph.co.uk/science/2017/04/12/perform-heimlich-manoeuvre-yes-just-effective/|title=How to perform the Heimlich manoeuvre on yourself (and yes, it's just as effective)|work=The Telegraph|access-date=April 13, 2017|language=en-GB}}</ref>

==See also==
*[[Choking#Basic treatment (first aid)|First-aid treatment of choking]]
*[[Basic airway management]]
* [[Basic life support]]

==References==
{{Reflist|30em}}

== External links ==
{{Wikibooks|First Aid|Obstructed Airway}}
{{Commons category}}
* [http://www.heimlichinstitute.org/ The Heimlich Institute] promotes various methods of dealing with obstructed breathing
* [http://medfraud.info/ Articles and information] about Dr. Heimlich's use of fraudulent case reports to promote the Heimlich maneuver for drowning rescue and asthma. Dr. Heimlich died in Cincinnati, Ohio, USA, on December 17, 2016

{{First aid topics}}
{{Authority control}}

[[Category:First aid]]
[[Category:Survival skills]]
[[Category:Eponyms]]
[[Category:Emergency medicine]]