Heimlich maneuver - for adults, children, infants, pregnant women, yourself & your pets

2 months ago, a young doctor died in Trissur when she choked on a piece of food while at the mall food court. What was really tragic was that she was not alone -  there were hundreds of people in the mall at that time. And yet,  none could help dislodge the piece of food that went down her airway. Residing in India, you all would have read this news article,  I assume. You would have lamented the tragic loss and shook your head, I am sure.

Here's my question to you - did you go online and read what should have been done under such circumstances to save a life? 

I am guessing the answer to that is no. 

I had written in detail about this years ago but now is as good a time as any to review this topic on the blog so that everyone can learn/recall what they know about it. 

The Heimlich maneuver requires no specific medical expertise. Dr Henry Heimlich devised this precisely for that reason - because doctors cannot be everywhere and a person can choke to death in minutes. 

Choking is defined as the inability to breathe due to obstruction of the trachea. It is a medical emergency as the obstruction prevents air from entering the lungs. If this obstruction cannot be relieved, the lack of oxygen will eventually lead to death.

Every year, nearly 1,00,000 people die due to accidental suffocation of food or a foreign body.

Signs and Symptoms of a blocked airway :

Choking is usually a sudden event.

• The person may desperately grab at his throat. 
• He maybe unable to cough or have a weak cough.
• He won't be able to speak or cry out.
• As oxygen-lack sets in, his face will turn blue and he may lose consciousness.

For the sake of clarity, we'll discuss the Heimlich maneuver under six separate categories :

1. Adults
2. Children more than 1 year of age.
3. Infants ( less than 1 year of age. )
4. Pregnant women / Obese people.
5. If you start to choke when you are alone.
6. Pets

In all cases, if the person is able to speak or cough forcefully, do not forcefully attempt the HM on the person. But do keep a strict eye on him as unsuccessful attempts could lead to rapid deterioration and require your active assistance.

1. Adults :

This wonderful illustration does all my work for me : giving a visual idea as well as directions.

Please note:

• Principle: The HM raises the diaphragm and thus compresses the lungs, forcing air out of it at a pressure high enough to expel the object.

2. Children greater than 1 year 

The same steps apply as in the case of adults with the single change that you may need to kneel to get your hands at the same level of the child's abdomen.

3. Infants ( less than 1 year )

This is slightly more tricky. It involves a bit of tricky maneuvering of the infant and two separate actions.

a) Back slaps.

Kneel or sit and place the infant in your lap.Look at the picture clearly.

Note how we've turned the infant's face downwards while also giving support to the head. Be careful not to inadvertently apply pressure on the neck while doing this.

Also note how you can support both your hand and the infant with your lap by sitting down.

Give up to 5 back slaps between the infant's shoulder blades with enough force to dislodge the foreign body. 

If it hasn't dislodged, you move to Step B.

• Turning the child over is gonna be tricky. Remember that hand you gave the back slaps with ? Place that hand over the child's back, supporting even the head. The child is now sandwiched between both your hands and with one palm supporting the face and the other supporting the back of the head, turn him over. 

• Again, support the child with your arm and thigh and place the head lower than the trunk. Give 5 quick downward thrusts ( 1 per second ) over the lower part of the breastbone. Repeat until the infant spits out the object or becomes unresponsive.

4. Pregnant women /Obese people

Instead of abdominal thrusts as seen in HM, deliver chest thrusts.

5. What if you are alone?

Find a surface you can lean forward on ( eg : a chair ) and after positioning your hands as mentioned earlier, give rhythmic forceful thrusts. 

6. Pets

What happens if your attempts have been unsuccessful and the person becomes unconscious ?

Read up on the C-A-B of saving a life.  

Call for help and start compressions. 

When you open the airway to deliver breaths, check if you can visualise the foreign body. If yes, remove it. Otherwise continue till help arrives or the child regains consciousness.

Speaking as a doctor, a big mistake you all make is in assuming that only a doctor can save you at all times. The whole point of the Heimlich maneuver was to help the everyday Joe,  Janet and Jamila save a life in case of an emergency. 

Somebody choking with an obstructed airway does not have a lot of time. Every second counts. You cannot wait for an auto rickshaw or ambulance and wade through traffic to reach a hospital. 

You have minutes before the person or child loses consciousness. 

A few more before brain damage begins. 

A few more before they are lost forever. 

These are fragile lives we have. The unforeseen lurks around every corner. 

I pray you never have a reason to give the Heimlich to anyone in your life. But if the situation arises, I hope you will step up and save a life. 

P. S.  An interesting footnote - 

Dr Henry Heimlich who devised this maneuver in 1974 and taught it thousands of times over the years used it for the first time in his life a few months ago in May 2016 to save the life of an 87 year old man dining next to him at an assisted living facility. 

Dr Henry Heimlich was 96 years old when he performed it. 

Which means I was 61 years younger than he was when I performed it for the first time in my life last week.

Authors note:

This is my take on the theme "Fragile Lives" for the blogger challenge Blog-A-Thon by Blog-A-Rhythm. You can read other entries for this theme by fellow bloggers here.

During this 7 day challenge, I have written on:

Day 1 - The Curious Case of the Dog that Barked (Religion)

Day 2 - You Never Know where your Journey in Life Will Take you (Inspiration/Movies)

Day 3 - Heimlich Maneuver - for all scenarios (Medical) 

Day 4 - Caught Red Handed - Doggone it! (Dog years)

Day 5 - Robert the Doll (Horror/ Real life)

Day 6 - The Saviour (Short Fiction) 

Day 7 - Recipe - Easy Eggless Chocolate Cake (Food)