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Abdominal thrusts

August 29, 2023

Abdominal thrusts, also known as the Heimlich maneuver or Heimlich manoeuvre, is a first aid procedure used to treat upper airway obstructions (or choking) by foreign objects. American doctor Henry Heimlich is often credited for its creation. Performing abdominal thrusts involves a rescuer standing behind a patient and using their 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.

Abdominal thrusts
Performing the Heimlich maneuver
[edit on Wikidata]

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.[1][2]

History Edit

Thoracic surgeon and medical researcher Henry Heimlich, noted for promulgating abdominal thrusts, claimed that back slaps were proven to cause death by lodging foreign objects into the windpipe.[3] A 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.[4] According to Dr. Roger White 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."[5]

From 1985 to 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[citation needed] drastically changed course and "downgraded" the use of the technique. For conscious victims, the new guidelines recommend first applying back slaps. If this method fails to remove the airway obstruction, rescuers are to then apply abdominal thrusts. For unconscious victims, the new guidelines recommend chest thrusts.

Henry Heimlich also promoted abdominal thrusts as a treatment for drowning[6] and asthma[7] attacks. The Red Cross now contests those claims. The Heimlich Institute has stopped advocating on their website for the Heimlich maneuver to be used as a first aid measure for drowning victims. Heimlich's 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.[8][9] The 2005 drowning rescue guidelines of the American Heart Association[10] did not include citations of Heimlich's work, and warned against the use of the Heimlich maneuver for drowning rescue as unproven and dangerous, due to its risk of vomiting leading to aspiration.[10]

In May 2016, Henry Heimlich, then age 96, claimed to have personally used the maneuver to save the life of a fellow resident at his retirement home in Cincinnati. It was alleged to be either the first or second time Heimlich himself used his namesake maneuver to save the life of someone in a non-simulated choking situation.[11] According to Heimlich's son, Peter M. Heimlich, "both 'rescues' were bogus."[12]

Universal sign of choking Edit

A choking victim is usually unable to speak, and may not be able to make much sound. A universal sign of choking has been designated as a silent indication from a person who is unable to breathe, and consists of placing both hands on one's own throat while trying to attract the attention of others who might help.[13]

Technique Edit

Both the American Red Cross and UK National Health Service (NHS) advise that, as a first resort, a rescuer should encourage the patient to cough out the obstruction. As a second resort, the rescuer should give five slaps on the back, after bending the patient forward. Abdominal thrusts are recommended only if these methods fail.

 
Point of applying of the abdominal thrusts (between chest and belly button). The hands press in the in-and-up direction.

As with the European Resuscitation Council and the Mayo Clinic, they recommend a repeating cycle of 5 back slaps and 5 abdominal thrusts.[14][15][1][2] They are not recommended on babies below the age of 1.[16][15] In contrast to the prevailing American and European advice, the Australian Resuscitation Council recommends chest thrusts instead of abdominal thrusts.[17]

Performing abdominal thrusts involves a rescuer standing behind an upright patient, and using their hands to exert forceful pressures on the bottom of the diaphragm. As an example, WebMD recommends making a fist with one hand grasping it with the other, to press with both just above the person's bellybutton. This compresses the lungs and exerts pressure on any object lodged in the trachea, hopefully expelling it. The pressure amounts to an artificially induced cough. To assist a larger person, more force may be needed.[18] The Mayo Clinic recommends the same placement of fist and hand and upward thrusts as if you are trying to lift the person.[2]

If the victim can not receive pressures on the abdomen (for example, in case of pregnancy or excessive obesity), chest thrusts are advised instead.[19] These are applied on the lower half of the chest bone, but not in the very endpoint (which is the xiphoid process and could be broken).

If the victim is not upright, the US National Institutes of Health (NIH) recommends positioning the person on their back, then straddling the torso and using chest thrusts.[16]

It is possible for still-conscious choking victims to perform the procedure on themselves, without assistance.[20] However, this can be difficult, so, in this cases and some others (disabled people, etc.), the use of an anti-choking device is recommended[citation needed].

Due to the forceful nature of the procedure, even when done correctly, abdominal thrusts 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.[21] The NHS recommend that anyone who has been subjected to abdominal thrusts should seek a medical examination afterwards.[15]

Researchers at Royal Brompton Hospital have demonstrated that similar intrathoracic pressures (50–60 cmH2O) are produced by a first aider performing abdominal thrusts inwards as are produced when the force is directed inwards and upwards.[22][23] They argue that this may be easier to perform with less concern about injury to ribcage or upper abdominal organs. Self-administered abdominal thrusts by study participants produced similar pressures to those generated by first aiders. The highest pressures were produced by participants performing an abdominal thrust onto the back of a chair (115 cmH2O).

See also Edit

References Edit

  1. ^ a b Nolan, JP; Soar, J; Zideman, DA; Biarent, D; Bossaert, LL; Deakin, C; Koster, RW; Wyllie, J; Böttiger, B; ERC Guidelines Writing Group (2010). "European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary". Resuscitation. 81 (10): 1219–76. doi:10.1016/j.resuscitation.2010.08.021. hdl:10067/1302980151162165141. PMID 20956052.
  2. ^ a b c Foreign object inhaled: First aid, Mayo Clinic staff, November 1, 2011.
  3. ^ "Heimlich, on the maneuver". The New York Times. February 6, 2009. Retrieved February 7, 2009.
  4. ^ "Lifejackets on Ice (August 2005)" (PDF). University of Pittsburgh Medical School. Retrieved May 24, 2009.
  5. ^ Pamela Mills-Senn (April 2007). "A New Maneuver (August 2005)". Cincinnati Magazine. Retrieved December 22, 2013.
  6. ^ . Archived from the original on January 24, 2008. Retrieved June 5, 2007.
  7. ^ . Archived from the original on March 14, 2011. Retrieved June 5, 2007.
  8. ^ Heimlich, Peter M. "Outmaneuvered – How We Busted the Heimlich Medical Frauds". Retrieved June 22, 2007.
  9. ^ Heimlich's son cites Dallas case in dispute. Wilkes-Barre News, August 22, 2007
  10. ^ a b . Circulation. 112 (24): 133–135. November 25, 2005. doi:10.1161/CIRCULATIONAHA.105.166565. Archived from the original on April 4, 2008. Retrieved April 4, 2008.
  11. ^ Walters, Joanna (May 27, 2016). "Dr Henry Heimlich uses Heimlich maneuver to save a life at 96". TheGuardian.com.
  12. ^ Samways, Ana (October 28, 2021). "Sideswipe: Too good to be true?". New Zealand Herald. Retrieved December 12, 2021.
  13. ^ "Choking first aid – adult or child over 1 year – series". MedlinePlus. National Institutes of Health. Retrieved March 11, 2016.
  14. ^ "STEP 3: Be Informed – Conscious Choking | Be Red Cross Ready". www.redcross.org. Retrieved December 4, 2017.
  15. ^ a b c "What should I do if someone is choking? NHS.UK". October 30, 2015. Retrieved July 26, 2018.
  16. ^ a b "Abdominal thrusts". MedlinePlus. National Institutes of Health. Retrieved March 11, 2016.
  17. ^ . Australian Resuscitation Council (2010). Archived from the original on February 14, 2014. Retrieved February 9, 2014.
  18. ^ Heimlich Maneuver for Adults and Children Older Than 1 Year – Topic Overview, WebMD, April 28, 2010.
  19. ^ "Choking Safety Talk". Oklahoma State University. from the original on January 30, 2020.
  20. ^ "Heimlich maneuver on self". MedlinePlus. National Institutes of Health. Retrieved March 11, 2016.
  21. ^ Broomfield, James (January 1, 2007). "Heimlich maneuver on self". Discovery Channel. Retrieved June 15, 2007.
  22. ^ Pavitt, Matthew J.; Swanton, Laura L.; Hind, Matthew; Apps, Michael; Polkey, Michael I.; Green, Malcolm; Hopkinson, Nicholas S. (April 5, 2017). "Choking on a foreign body: a physiological study of the effectiveness of abdominal thrust manoeuvres to increase thoracic pressure". Thorax. 72 (6): 576–578. doi:10.1136/thoraxjnl-2016-209540. ISSN 0040-6376. PMC 5520267. PMID 28404809.
  23. ^ "How to perform the Heimlich manoeuvre on yourself (and yes, it's just as effective)". The Telegraph. Retrieved April 13, 2017.

External links Edit

 
The Wikibook First Aid has a page on the topic of: Obstructed Airway
 
Wikimedia Commons has media related to Abdominal thrusts.
  • The Heimlich Institute promotes various methods of dealing with obstructed breathing
  • Articles and information about Dr. Heimlich's use of fraudulent case reports to promote the Heimlich maneuver for drowning rescue and asthma. Dr. Heimlich died in Cincinnati, Ohio, USA, on December 17, 2016

August 29, 2023
abdominal, thrusts, also, known, heimlich, maneuver, heimlich, manoeuvre, first, procedure, used, treat, upper, airway, obstructions, choking, foreign, objects, american, doctor, henry, heimlich, often, credited, creation, performing, abdominal, thrusts, invol. Abdominal thrusts also known as the Heimlich maneuver or Heimlich manoeuvre is a first aid procedure used to treat upper airway obstructions or choking by foreign objects American doctor Henry Heimlich is often credited for its creation Performing abdominal thrusts involves a rescuer standing behind a patient and using their 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 Abdominal thrustsPerforming the Heimlich maneuver edit on Wikidata 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 1 2 Contents 1 History 2 Universal sign of choking 3 Technique 4 See also 5 References 6 External linksHistory EditThoracic surgeon and medical researcher Henry Heimlich noted for promulgating abdominal thrusts claimed that back slaps were proven to cause death by lodging foreign objects into the windpipe 3 A 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 4 According to Dr Roger White 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 5 From 1985 to 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 citation needed drastically changed course and downgraded the use of the technique For conscious victims the new guidelines recommend first applying back slaps If this method fails to remove the airway obstruction rescuers are to then apply abdominal thrusts For unconscious victims the new guidelines recommend chest thrusts Henry Heimlich also promoted abdominal thrusts as a treatment for drowning 6 and asthma 7 attacks The Red Cross now contests those claims The Heimlich Institute has stopped advocating on their website for the Heimlich maneuver to be used as a first aid measure for drowning victims Heimlich s 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 8 9 The 2005 drowning rescue guidelines of the American Heart Association 10 did not include citations of Heimlich s work and warned against the use of the Heimlich maneuver for drowning rescue as unproven and dangerous due to its risk of vomiting leading to aspiration 10 In May 2016 Henry Heimlich then age 96 claimed to have personally used the maneuver to save the life of a fellow resident at his retirement home in Cincinnati It was alleged to be either the first or second time Heimlich himself used his namesake maneuver to save the life of someone in a non simulated choking situation 11 According to Heimlich s son Peter M Heimlich both rescues were bogus 12 Universal sign of choking EditA choking victim is usually unable to speak and may not be able to make much sound A universal sign of choking has been designated as a silent indication from a person who is unable to breathe and consists of placing both hands on one s own throat while trying to attract the attention of others who might help 13 Technique EditBoth the American Red Cross and UK National Health Service NHS advise that as a first resort a rescuer should encourage the patient to cough out the obstruction As a second resort the rescuer should give five slaps on the back after bending the patient forward Abdominal thrusts are recommended only if these methods fail Point of applying of the abdominal thrusts between chest and belly button The hands press in the in and up direction As with the European Resuscitation Council and the Mayo Clinic they recommend a repeating cycle of 5 back slaps and 5 abdominal thrusts 14 15 1 2 They are not recommended on babies below the age of 1 16 15 In contrast to the prevailing American and European advice the Australian Resuscitation Council recommends chest thrusts instead of abdominal thrusts 17 Performing abdominal thrusts involves a rescuer standing behind an upright patient and using their hands to exert forceful pressures on the bottom of the diaphragm As an example WebMD recommends making a fist with one hand grasping it with the other to press with both just above the person s bellybutton This compresses the lungs and exerts pressure on any object lodged in the trachea hopefully expelling it The pressure amounts to an artificially induced cough To assist a larger person more force may be needed 18 The Mayo Clinic recommends the same placement of fist and hand and upward thrusts as if you are trying to lift the person 2 If the victim can not receive pressures on the abdomen for example in case of pregnancy or excessive obesity chest thrusts are advised instead 19 These are applied on the lower half of the chest bone but not in the very endpoint which is the xiphoid process and could be broken If the victim is not upright the US National Institutes of Health NIH recommends positioning the person on their back then straddling the torso and using chest thrusts 16 It is possible for still conscious choking victims to perform the procedure on themselves without assistance 20 However this can be difficult so in this cases and some others disabled people etc the use of an anti choking device is recommended citation needed Due to the forceful nature of the procedure even when done correctly abdominal thrusts 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 21 The NHS recommend that anyone who has been subjected to abdominal thrusts should seek a medical examination afterwards 15 Researchers at Royal Brompton Hospital have demonstrated that similar intrathoracic pressures 50 60 cmH2O are produced by a first aider performing abdominal thrusts inwards as are produced when the force is directed inwards and upwards 22 23 They argue that this may be easier to perform with less concern about injury to ribcage or upper abdominal organs Self administered abdominal thrusts by study participants produced similar pressures to those generated by first aiders The highest pressures were produced by participants performing an abdominal thrust onto the back of a chair 115 cmH2O See also EditFirst Aid treatment of choking Basic airway management Basic life supportReferences Edit a b Nolan JP Soar J Zideman DA Biarent D Bossaert LL Deakin C Koster RW Wyllie J Bottiger B ERC Guidelines Writing Group 2010 European Resuscitation Council Guidelines for Resuscitation 2010 Section 1 Executive summary Resuscitation 81 10 1219 76 doi 10 1016 j resuscitation 2010 08 021 hdl 10067 1302980151162165141 PMID 20956052 a b c Foreign object inhaled First aid Mayo Clinic staff November 1 2011 Heimlich on the maneuver The New York Times February 6 2009 Retrieved February 7 2009 Lifejackets on Ice August 2005 PDF University of Pittsburgh Medical School Retrieved May 24 2009 Pamela Mills Senn April 2007 A New Maneuver August 2005 Cincinnati Magazine Retrieved December 22 2013 Heimlich Institute on rescuing drowning victims Archived from the original on January 24 2008 Retrieved June 5 2007 Heimlich Institute on rescuing asthma victims Archived from the original on March 14 2011 Retrieved June 5 2007 Heimlich Peter M Outmaneuvered How We Busted the Heimlich Medical Frauds Retrieved June 22 2007 Heimlich s son cites Dallas case in dispute Wilkes Barre News August 22 2007 a b Part 10 3 Drowning Circulation 112 24 133 135 November 25 2005 doi 10 1161 CIRCULATIONAHA 105 166565 Archived from the original on April 4 2008 Retrieved April 4 2008 Walters Joanna May 27 2016 Dr Henry Heimlich uses Heimlich maneuver to save a life at 96 TheGuardian com Samways Ana October 28 2021 Sideswipe Too good to be true New Zealand Herald Retrieved December 12 2021 Choking first aid adult or child over 1 year series MedlinePlus National Institutes of Health Retrieved March 11 2016 STEP 3 Be Informed Conscious Choking Be Red Cross Ready www redcross org Retrieved December 4 2017 a b c What should I do if someone is choking NHS UK October 30 2015 Retrieved July 26 2018 a b Abdominal thrusts MedlinePlus National Institutes of Health Retrieved March 11 2016 Australian and New Zealand Resuscitation Council Guideline 4 AIRWAY Australian Resuscitation Council 2010 Archived from the original on February 14 2014 Retrieved February 9 2014 Heimlich Maneuver for Adults and Children Older Than 1 Year Topic Overview WebMD April 28 2010 Choking Safety Talk Oklahoma State University Archived from the original on January 30 2020 Heimlich maneuver on self MedlinePlus National Institutes of Health Retrieved March 11 2016 Broomfield James January 1 2007 Heimlich maneuver on self Discovery Channel Retrieved June 15 2007 Pavitt Matthew J Swanton Laura L Hind Matthew Apps Michael Polkey Michael I Green Malcolm Hopkinson Nicholas S April 5 2017 Choking on a foreign body a physiological study of the effectiveness of abdominal thrust manoeuvres to increase thoracic pressure Thorax 72 6 576 578 doi 10 1136 thoraxjnl 2016 209540 ISSN 0040 6376 PMC 5520267 PMID 28404809 How to perform the Heimlich manoeuvre on yourself and yes it s just as effective The Telegraph Retrieved April 13 2017 External links Edit The Wikibook First Aid has a page on the topic of Obstructed Airway Wikimedia Commons has media related to Abdominal thrusts The Heimlich Institute promotes various methods of dealing with obstructed breathing Articles and information about Dr Heimlich s use of fraudulent case reports to promote the Heimlich maneuver for drowning rescue and asthma Dr Heimlich died in Cincinnati Ohio USA on December 17 2016 Retrieved from https en wikipedia org w index php title Abdominal thrusts amp oldid 1169212566, wikipedia, wiki, book, books, library,

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