Abdominal thrusts

Abdominal thrusts
US medic teaches the abdominal thrusts to Afghans
Specialty	{{#statements:P1995}}

Abdominal thrusts, also called the Heimlich manoeuvre or Heimlich maneuver, is a first aid procedure used to treat upper airway obstructions (or choking) by foreign objects. The term Heimlich maneuver is named after Dr. Henry Heimlich, who first described it in 1974.

Performing abdominal thrusts involves a rescuer standing behind a patient and using his or her hands to exert pressure on the bottom of the diaphragm. This compresses the lungs and exerts pressure on any object lodged in the trachea, hopefully expelling it.

Most modern protocols, including those of the American Heart Association, American Red Cross and the European Resuscitation Council, recommend several stages for airway obstructions, designed to apply increasingly more pressure. Most protocols recommend encouraging the victim to cough, followed by hard back slaps, and finally abdominal thrusts or chest thrusts as a last resort. Some guidelines also recommend alternating between abdominal thrusts and back slaps.

History

A demonstration of abdominal thrusts on a person showing signs of choking

Henry Heimlich, noted for promulgating abdominal thrusts, claimed that back slaps were proven to cause death by lodging foreign objects into the windpipe. The 1982 Yale study by Day, DuBois, and Crelin that persuaded the American Heart Association to stop recommending back blows for dealing with choking was partially funded by Heimlich's own foundation. According to Roger White MD of the Mayo Clinic and American Heart Association (AHA), "There was never any science here. Heimlich overpowered science all along the way with his slick tactics and intimidation, and everyone, including us at the AHA, caved in."

From 1985-2005, abdominal thrusts were the only recommended treatment for choking in the published guidelines of the American Heart Association and the American Red Cross. In 2006, both organizations drastically changed course and "downgraded" the use of the technique. For conscious victims, the new guidelines recommend first applying back slaps; if this method failed to remove the airway obstruction, rescuers were to then apply abdominal thrusts. For unconscious victims, the new guidelines recommend chest thrusts.

The European Resuscitation Council and the Mayo Clinic recommend alternating between 5 back slaps and 5 abdominal thrusts in severe airway obstructions.

In some areas, such as Australia, authorities believe that there is not enough scientific evidence to support the use of abdominal thrusts and their use is not recommended in first aid. Instead, chest thrusts are recommended.

Henry Heimlich also promoted it as a treatment for drowning and asthma attacks. The Red Cross contests his claims that the maneuver could help drowning victims and someone suffering an asthma attack. The Heimlich Institute has stopped advocating on their website for the Heimlich maneuver to be used as a first aid measure for drowning victims. His son, Peter M. Heimlich, alleges that in August 1974 his father published the first of a series of fraudulent case reports in order to promote the use of abdominal thrusts for near-drowning rescue. The 2005 drowning rescue guidelines of the American Heart Association did not include citations of Heimlich's work and warn against the use of the Heimlich maneuver for drowning rescue as unproven and dangerous, due to its risk of vomiting leading to aspiration.

Technique

Performing abdominal thrusts involves a rescuer standing behind a patient and using his or her hands to exert pressure on the bottom of the diaphragm. This compresses the lungs and exerts pressure on any object lodged in the trachea, hopefully expelling it. This amounts to an artificial cough. For example, WebMD recommends the rescuer placing his or her fist just above the person's bellybutton and grasping with other hand. To assist a larger person, more force may be needed. The Mayo Clinic recommends the same placement of fist and hand and upward thrusts as if you are trying to lift the person.

Due to the forceful nature of the procedure, even when done correctly, it can injure the person on whom it is performed. Bruising to the abdomen is highly likely and more serious injuries can occur, including fracture of the xiphoid process or ribs.

See also

• Basic airway management
• Basic life support

External links

• Media related to at Wikimedia Commons
• The Heimlich Institute
• Articles and information about Dr. Henry Heimlich's use of fraudulent case reports to promote the Heimlich maneuver for drowning rescue and asthma.