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Choking Emergency

The Heimlich Manoeuvre: What to Do in a Choking Emergency

Choking is a terrifying experience for anyone, whether you are the victim or a bystander. The moment the flow of air to our lungs is blocked we immediately feel panic-stricken, while the people who are with us may feel helpless.

Choking always occurs very suddenly, and we are usually completely unprepared for the crisis. It happens when an object gets stuck in the throat or windpipe, making it impossible to breathe. Adults may choke on a piece of food, while young children often choke on small objects they put in their mouths. In either case, as soon as oxygen flow is cut off, you have to act quickly.

The most effective means of removing the cause of the choking is to use an abdominal thrust called the Heimlich Manoeuvre. Most of us will first try other ways to get the object out. We may try to dig it out of the back of a child’s throat or give the victim a few hard thumps on the back. This is not wrong, but if it does not work immediately then the next step is to apply strong compressions on the abdomen or back to force air upwards out of the windpipe, to expel the object.

As a bystander, you may not realise that someone is choking until they are in severe distress. When you see someone clutching their hands to the throat, do you know that this is usually the first sign that the person may be choking?

Other actions will also give an indication:

  • Inability to talk
  • Difficulty breathing or noisy breathing
  • Squeaky sounds when trying to breathe
  • Cough, which may either be weak or forceful
  • Skin, lips and nails turning blue or dusky
  • Skin that is flushed then turns pale or bluish in colour
  • Loss of consciousness

As soon as you realise that this is a life or death situation, you will need to perform the Heimlich Manoeuvre.

The Heimlich Manoeuvre Step-by-step

  1. If possible, first ask “Are you choking?” If the victim nods, proceed with the Heimlich Manoeuvre.
  2. Stand behind the victim.
  3. Place one foot in front of the other to brace yourself.
  4. Reach around the person’s waist.
  5. Clench one hand into a fist and position it against the person’s abdomen, above the navel and below the rib cage.
  6. Grasp your fist with your other hand.
  7. Now pull sharply backwards, using the force of both your arms, so that your fist literally punches the victim in the abdomen. Try for a small upward movement as you pull, to expel air up the windpipe. The thrusting movement should be inward and upward.
  8. Repeat this action over and over again until the object is dislodged and coughed up.

What if it’s a child?

  1. Kneel down behind the child.
  2. Follow the same process as for an adult but use less force.

What if it’s an infant?

  1. Sit down and hold the baby face down on your lap. Rest your forearm on your thigh and support its head and neck with your hand.
  2. Ensure that the baby’s head is lower than its torso.
  3. Now use the heel of your other hand (the bottom of your palm) to thump the baby gently but firmly on its back. Keep your fingers pointing up so that you don’t hit the back of the baby’s head.
  4. If the baby is still not breathing, turn it onto its back, in the same position, on your lap with your hand supporting the head but holding it lower than the torso.
  5. Place two fingers at the centre of the baby’s breastbone. Thrust firmly down against the baby’s chest to compress it downwards. Wait for the chest to rise again, then repeat. Do this five times.
  6. If the baby is still not breathing, call emergency services. Then continue to alternate between back and chest compressions until help arrives.
  7. If you are able to clear the airway, but the baby has stopped breathing, start CPR immediately.
  8. If the child is older than age 1 and conscious, give abdominal thrusts only. Be careful not to use too much force to avoid damaging ribs or internal organs.

What if the person is pregnant or obese?

  1. Instead of using abdominal thrusts, use chest thrusts, placing your fist against the lower part of the chest, where the lower ribs join to the breastbone.
  2. If the person becomes unconscious, perform cardiopulmonary resuscitation (CPR) with chest compressions and rescue breaths.

What if I am choking and I’m alone?

It’s a good idea to practice this procedure so that you can act swiftly if it ever happens to you. You can perform abdominal thrusts on yourself.

  1. Lean forward over the back of a chair and position your abdomen against the top of the chair’s backrest.
  2. Thrust hard against the back of the chair to compress your abdomen.
  3. Repeat 6-10 times quickly.
  4. If there is no chair to use, place a clenched fist above your navel, and place your other hand over the fist. Using the force of both arms, perform the abdominal thrust on yourself.
  5. Repeat 6-10 times quickly.

In all cases where you are the bystander, you will also need to perform CPR if the victim falls unconscious. Both the Heimlich Manoeuvre and CPR are essential first aid skills that any individual can learn to do

This article is courtesy of IPSS Medical Rescue. To learn more about IPSS Medical Rescue, visit www.ipssrescue.co.za.

For more information or in the case of a medical emergency in the KZN region, please contact:
IPSS Medical Rescue on emergency Telephone: +27 (0)823 911 911

Disclaimer: Any information contained here is merely a guideline. Always visit your healthcare practitioner for any health-related advice or diagnosis.