Staying healthy in Japan

Features Health - August 26th, 1988
CHOKING AND THE HEIMLICH MANEUVER

by Elyse M. Rogers

Picture this scene: You’re at dinner at a nice restaurant, enjoying the good food and fine wine being served, when all of a sudden one of your companions pushes himself away from the table, staggers forward and clutches at his throat. Your first thought is “What’s happened?” and your second one is “What can I do?”

The answer to the first ques­tion is that he’s probably chok­ing, from either trying to swallow too large a piece of food, or from having a piece of food go “down the wrong way.” The “wrong way” problem comes from the fact that two of our body’s important passageways are in very close proximity to one another.

The esophagus is the passage­way through which food goes from the mouth to the stomach, and the trachea is the tube through which air passes from the nose and/or mouth into the lungs. The problem of choking occurs when food (or another object — sometimes children swal­low marbles or tiny toys) gets caught in the airway and blocks or par­tially blocks off the air supply.

WHAT TO DO IF YOU SUSPECT SOMEONE IS CHOKING

  1. Assess the situation. Quickly figure out exactly what the situation seems to be and what might be involved.
  2. Talk to the victim. Ask him, “Are you choking?” This helps you further assess the situation. If he answers you know he’s getting air and he can tell you if it’s a pain in his chest, choking, head pain (pos­sible stroke), etc.
  3. Call for help. If no one is close by, yell your little heart out; if friends or people are close by, ask someone to call an ambulance, paramedics or a doctor.
  4. Decide whether or not action is needed and respond to the best of your ability.

KNOWING WHEN NOT TO INTERFERE

It’s important to know when to help and when not to help a “choking person.” If the air­way is only partially blocked and the person is conscious, coughing and inhaling enough air to have his color stay pink, do not interfere. Encourage him to cough, which will usual­ly dislodge the object safely.

The universal sign for chok­ing, that most everyone uses instinctively is clutching the throat. It’s a good sign to teach family members too, since if they ever are choking, by using this signal they will be readily understood.

You’ll also want to dis­tinguish between the choking person and one who has an­other problem, such as a heart attack. Usually you can tell by behavior. Also, a person with a heart attack can speak if he/she is not unconscious.

THE HEIMLICH MANEUVER

If you’ve determined the per­son is choking and he is cough­ing only weakly, and having difficulty breathing, first aid is needed. In this case, the Heim­lich Maneuver is recommended and is as follows:

  • With the victim in a standing position, place yourself behind him/her.
  • Place your fist (thumb in­side) against the victim’s waist, (just above the navel), and put your other hand over that fist. Pull towards you in and up above the belt line (try not to get too close to the ribs), with a quick thrust. This movement causes air pressure to rise sud­denly within the lungs and ex­pel the foreign body from the trachea (wind pipe).
  • If the obstruction is not dislodged, repeat the thrust six to ten times. Make sure each thrust is a separate and dis­tinct motion.
  • If the obstruction has been dislodged but the patient is not breathing, start mouth-to-mouth resuscitation.

Fortunately, the last two steps are rarely needed.

IF THE PATIENT IS UNCONSCIOUS

If the patient is unconscious, follow the following steps:

  • Lay him down on the floor and roll him on his back.
  • Position yourself facing the patient, straddling his thighs.
  • Place the heel of one hand on the abdomen, right above the navel. Cover that hand with the other. Apply a firm, sudden “in and up” thrusting motion. This move creates the necessary sudden increase of air pressure in the lungs to dislodge the object.
  • Repeat six to ten times; until the object is dislodged.

WHEN A CHILD CHOKES

A young child or baby is much more easily handled because of his size. Depending on the age and size, do one of the following:

  • Baby—turn him over on your forearm and thump him on the back, between the shoulder blades with the other hand.
  • Child—sit yourself down on a chair and place the child face downward across your knees. Support him/her firmly with one hand while thumping on the back, between the shoulder blades, with the other.
  • With a larger child, (over 8 years of age or so), the Heimlich maneuver can be used.

Caution: be somewhat gentle when “thumping” young children, or when administering the Heimlich Maneuver on older ones.

After using the Heimlich Maneuver or other rigorous first aid treatment, it’s best to have even a fully recovered patient checked by a physician. There is some slight risk of rib damage from the maneuver. However, that should in no way deter you from using this important, life-saving techniques.


Heimlich Maneuver

THE HEIMLICH MANEUVER

Perform Abdominal Thrusts

▪ Stand behind victim.
▪ Wrap arms around victim’s waist.
▪ Make a fist with one hand and place thumb side of fist against middle of victim’s abdomen just above navel and well below lower tip of breastbone.
▪ Grasp your fist with your other hand.
▪ Keeping elbows out, press fist into victim’s abdomen with a quick upward thrust.
▪ Each thrust should be a separate and distinct at­tempt to dislodge the object.
▪ Repeat thrusts until ob­struction is cleared or victim becomes unconscious.

If the victim is unconscious perform 6 to 10 abdominal thrusts

▪ Straddle victim’s thighs.
▪ Place heel of one hand against middle of victim’s abdomen just above navel and well below lower tip of breastbone.
▪ Place other hand directly on top of first hand (fingers of both hands should be pointing toward victim’s head).
▪ Press into victim’s abdo­men 6 to 10 times with quick upward thrusts.
▪ Each thrust should be a separate and distinct at­tempt to dislodge the object.