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Experiencing a choking incident can escalate into a critical situation within moments.
Whether it’s affecting you or someone else, the ability to clear an obstruction while maintaining composure may prove to be lifesaving.
The Heimlich maneuver is a widely endorsed first-aid technique, recommended by numerous health organizations, which employs abdominal thrusts to expel an obstruction from a person’s airway.
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Mass General Brigham, a healthcare provider based in Boston, has published comprehensive instructions on how to successfully execute the Heimlich, with insights from emergency medicine physician Wendy Macias-Konstantopoulos, MD.
Before attempting the Heimlich maneuver, it is crucial to confirm that the individual is unable to breathe, speak, or cough, as advised by professionals. (iStock)
1. Contact Emergency Services
In the event of choking, Mass General Brigham emphasizes the importance of immediately calling 911 to seek professional medical assistance.
If there is another individual present, one should handle the emergency call while the other begins administering the Heimlich maneuver.
2. Evaluate the Situation
According to Macias-Konstantopoulos, performing the Heimlich maneuver is not advised if the person remains capable of talking, breathing, or coughing.
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In such cases, it is essential to encourage the individual to keep coughing to help clear the blockage.
If the person shows no signs of effective breathing, coughing, or talking—often referred to as the universal choking sign—begin by delivering up to five firm back blows with the heel of your hand between the shoulder blades.
Recognizing the universal choking sign is key to determining the course of action, specialists advise. (iStock)
3. Perform the Heimlich Maneuver
If the choking persists after the back blows, it is time to initiate the Heimlich maneuver.
Dr. Macias-Konstantopoulos instructs to position yourself behind the individual, or kneel if they are a child.
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Wrap your arms around their midsection from behind, forming a fist with one hand and securing it with your other hand.
Position your hands just above the belly button and below the rib cage.
When executing the Heimlich, aim your fist below the rib cage and above the belly button. (iStock)
Then, thrust inward and upward against the diaphragm, which will force air from the lungs to dislodge the obstruction. Repeat up to five times as needed.
Should the choking continue, alternate between delivering five back blows and five abdominal thrusts until the air passage is cleared or help arrives.
For individuals who are pregnant or obese, instead of abdominal thrusts, execute five chest thrusts aimed at the breastbone or center of the chest.
Responding to Choking in Infants
Mass General Brigham cautions against using the Heimlich maneuver on infants under 12 months of age.
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When dealing with a baby under one year, position them face down along your arm or thigh, ensuring their head is lower than their bottom.
Deliver up to five firm blows to the back—be careful to avoid causing injury, as advised by the healthcare provider.
Techniques for executing the Heimlich vary considerably for adults and children. (iStock)
After dislodging the blockage, check the baby’s mouth and remove any visible obstacles using your finger.
If back blows fail, perform chest thrusts by holding the baby face up while keeping their head lower than their body.
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Support the baby’s head and neck, using two to three fingers pressed sharply on their chest, administering up to five thrusts in an upward motion.
Parents and guardians should be particularly vigilant about potential choking hazards for children, such as popcorn, nuts, grapes, hot dogs, and hard candies.
“Cut food into small pieces before serving it to children,” she recommends.
“Keep choking hazards out of reach and be attentive while your child eats and plays.”
Self-Help for Choking
If you find yourself choking alone, you can apply the Heimlich maneuver on yourself, as per Mass General Brigham’s guidelines.
Position your fists just above your belly button, then pull inward and upward toward your diaphragm.
Alternatively, bend over a firm surface, like the back of a chair or a countertop, and thrust your abdomen against it to create sufficient pressure to help expel the obstruction.
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If you can’t speak, text messaging to 911 is allowed in many states. The guidelines recommend typing ‘9-1-1’ into the recipient field and sending your location and details of the emergency immediately.
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