The Heimlich Maneuver: A Lifesaving Technique for Choking Emergencies

INTRODUCTION 

The Heimlich maneuver was initially introduced in 1974 by Dr. Henry Heimlich after proving his theory that the reserve of air in the lung could serve to dislodge objects from the esophagus by quick upwards thrust under the ribcage. 

Abdominal thrusts or the Heimlich maneuver is a first-aid procedure used to treat upper airway obstruction caused by a foreign body. This skill is commonly taught during basic life support (BLS) and advanced cardiac life support (ACLS) classes. The abdominal thrust maneuver can be performed in both children and adults via different techniques

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ANATOMICAL AND PHYSIOLOGICAL CHANGES 

Anatomicaly ,Foreign objects associated with choking are usually stuck above the cricoid cartilage in the supra-laryngeal area. As for the maneuver itself, the thrusts must be executed over the epigastric region just below the ribcage and directed upwards towards the head of the patient.

Physiologically, the abdominal thrust maneuver is effective due to increasing intrathoracic pressure affecting the lung/airway, stomach, and esophagus produced by diaphragmatic thrusts.

INDICATION 

 - Conscious choking victims 

 - Subjects with universal choking signs mainly consists of inability to speak, breathe, or cough   while holding both hands up to one's own throat. 

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CONTRAINDICATIONS 

 - No absolute contraindication

 - But ,the Maneuver is not recommended by AHA for infants and unconscious patients 

TECHNIQUE 

1) PREPARATION :Cases  of choking happen in mere seconds and unexpectedly, making preparation nearly impossible. As mentioned above, the Heimlich maneuver is taught during BLS for the conscious choking adult.

2) HOW TO PERFORM:

  - It is performed by a bystander on a person who appears to be choking. 

  - The bystander stands behind the subject and wraps his/her arms around the upper abdominal region, about two inches above the belly button. 

  - Making a fist with one hand and wrapping the other hand tightly over the fist and delivering five sharp midline thrusts inward and upward.

  - Recently, other techniques such as the circumferential (horizontal) abdominal thrust, chair thrust, and auto up-thrust have been studied comparing the gastric and esophageal pressures generated with each, finding that chair thrusts might be more effective in these parameters.

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COMPLICATIONS 

   - Displacement of diaphragm 

   - sudden intrathoracic pressure increases 

   - Rib fracture 

   - Gastric or esophageal perforation

CONCLUSION

The Heimlich maneuver, introduced by Dr. Henry Heimlich in 1974, remains an essential life-saving technique for managing upper airway obstructions caused by foreign bodies. Its simplicity, effectiveness, and widespread teaching in BLS and ACLS courses have made it a cornerstone of first-aid practices. By understanding its anatomical and physiological basis, proper indications, and technique, responders can effectively perform the maneuver to prevent fatalities from choking incidents. However, awareness of potential complications and contraindications is vital for ensuring patient safety. Continuous education and adaptation of newer techniques, like chair thrusts, further enhance the efficacy of this life-saving intervention.