Heimlich manoeuvre

Did you know that choking on a foreign body is not an unusual cause of death? The start of the windpipe is called the larynx. This connects to the food pipe (oesophagus) at the back of the throat. During swallowing, a flap of cartilage called the epiglottis moves down and closes off the larynx and trachea. When your muscles have relaxed at the end of the swallowing movement, the epiglottis moves back to its normal position, leaving the windpipe open. Usually, any food that passes into the trachea causes us to choke and cough, removing the food from the trachea. Sometimes the food, or in the case of a small child a small toy or a boiled sweet, gets into the back of the throat, or even into the trachea and can't be expelled by the normal reflexes. The Heimlich manoeuvre can force the foreign body up and out of the airway. If an adult (not a child, see below) is choking, but conscious and standing, ask them to bend forwards and cough. If this doesn't work, or they are unable to do it, stand behind them, encircling their abdomen with your arms, half way between the tummy button and the lower end of the breast bone. Make a fist, positioning your thumb to their tummy. Grab your fist with your other hand and with a sharp movement, press up and into the tummy. If they are unconscious, lie them on their back and use the heel of your hand to press in and upwards midway between the end of the breast bone and the tummy button. You may need several thrusts to succeed. Sweep the mouth with your finger to remove the object. You could also try a chest thrust, which is similar to a cardiac compression ie push down on the chest, at the lower end of the breast bone. Aim to depress the chest by one third of its diameter. For children Use back blows or chest thrusts. Do not attempt the Heimlich manoeuvre. Back blows entail using the heel of the hand to strike forcefully between the shoulder blades. You can put a child over your knees, head down, or if they are old enough ask them to lean forwards. If necessary, alternate 5 back blows with 5 abdominal/chest thrusts Doing something is better than nothing, but go more carefully with children in terms of the amount of force used. Call an ambulance if the obstruction does not immediately dislodge.

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This article published on
04 December 2005

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