Search for tag: "heimlich"

Dr. Gellner: If you've ever seen a child choke, not just gag, but truly chokem then you will probably go into panic mode just like the choking child. But keeping calm can help you do the right thing. I'll discuss what to do for a choking child on today's Scope. I'm Dr. Cindy Gellner.

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Dr. Gellner: First, if the child is breathing and coughing, encourage them to cough hard. Don't give them anything to drink because the fluid might take up space needed for the passage of air and completely block off their airway. Next, give the child first-aid. It's a good thing for all parents to take a CPR class, because they'll also teach the Heimlich maneuver in those classes as well. Also, have someone call 911 in case the object stays lodged, and the child stops breathing.

For children over a year old, you want to give them high abdominal thrusts. Grab the child from behind, and put your hands just below the lower ribs, but above their belly button, like you were giving them a big bear hug. Make a fist with one hand, and fold the other over it, and then give sudden upward and backward jerks with your fist to try to squeeze all the air out of the chest and pop the object out of their airway.

For babies under a year old, you don't want to do that technique, because you could rupture their spleens or livers. You'll want to put the baby face down at a 60 degree incline over your knees, and with their head down. Then give five quick blows with the heel of your hand between their shoulder blades. If they're still choking and not breathing, lay them on the floor, and give them five rapid chest compressions over the lower third of the breastbone using only two fingers. Alternate the back blows and chest thrusts until EMS gets there.

Remember, never be afraid to call 911 as soon as the child chokes.

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Interviewer: The pool covers are starting to come off the pool. It's time to think about drowning and drowning safety. We'll talk about that next on The Scope. Medical news and research from University of Utah physicians and specialist you can use for a happier and healthier life. You're listening to The scope. Have you ever thought for a second what would you do if somebody was drowning? I mean what would you do after you got them out of the water and back up on the pool deck? We're going to find out right now with Dr. Scott Youngquist. He's in the emergency department here at University of Utah Hospital. Drowning, somebody drowns, the get their lungs filled with water. You pull them up on the deck. What then?

Dr. Youngquist: Bring them up and lay them on a flat surface, hard surface and if they're not breathing on their own begin CPR and mouth-to-mouth resuscitation.

Interviewer: All right.

Dr. Youngquist: There are some groups that actually recommend doing the Heimlich maneuver. We don't recommend that.

Interviewer: Interesting.

Dr. Youngquist: And the idea being that maybe you can force some water out of their lungs by doing the Heimlich maneuver which is basically applying a firm upward thrust to upper abdomen. And it works great if you've choked on a piece of chicken or something like that, but there's no evidence that it benefits patients whose lungs are full of water. It kind of makes sense that it wouldn't work as well because you've just got this column of water that you're pushing on. There's not really anything behind it, sort of like a piece of chicken that's got an airbag behind it.

Interviewer: Yeah.

Dr. Youngquist: And patients need immediate oxygenation and circulation of blood so the recommendation is that you begin CPR and mouth-to-mouth resuscitation. The other consideration though is that if the patient has dived into the pool and struck the bottom, and if the drowning is caused by a spinal injury then you want to be careful not to manipulate the neck too much while you're performing mouth-to-mouth resuscitation. So that's why we say lay them out on a flat surface. Try not to move them while help arrives. Have somebody call 911 and begin CPR.

Interviewer: So number one, call 911.

Dr. Youngquist: Yes.

Interviewer: Number two, if they're not breathing, CPR.

Dr. Youngquist: Yes, with mouth-to-mouth.

Interviewer: With mouth to mouth. Because I thought that the current standard was you didn't do the mouth-to-mouth anymore.

Dr. Youngquist: That's correct. In all cases except for causes of respiratory arrest. So if somebody's drowned then we'd begin mouth-to- mouth resuscitation in addition to CPR. It's one of those special cases.

Interviewer: Got you. Does that help clear the water out? I mean what happened to that water? I'd never thought of that.

Dr. Yongquist: Yeah. The idea is that some of that water is going to be absorbed into your circulation. Some of it they're going to choke back up. And the idea is you're trying to ventilate any unfilled parts of the lung, segments of the lung so that you can get some oxygenation in there. With enough airway pressure, a lot of times it comes up and either goes down the back of their throat or it'll be coughed out of the mouth.

Interviewer: Got you. But nothing you can actively do other than just providing CPR with mouth-to-mouth.

Dr. Youngquist: Yeah. The CPR will also drive some water out of the lungs as well.

Interviewer: OK. And then other than that, that sounds like about it, huh?

Dr. Youngquist: Yeah, wait for help to arrive. There's nothing else you can do.

Interviewer: All right. You bring up an interesting point, and it is the last question. So if they did hit their head on the bottom, are there any consideration actually getting them up and out of the pool or is the goal at that point just get them up and out of the pool.

Dr. Youngquist: Yeah. The goal is pretty much to get them out to do CPR as quickly as possible. If you can be careful about manipulating the neck. But the number one priority is getting them oxygenation and circulation restarted so whatever you have to do to get them out of the pool to a place where you can begin to perform resuscitation, that's the number one priority.

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Scot: Somebody's choking on some food, what do you do? Do you give the Heimlich maneuver? Do you even know how? We're going to find out the answers to those and other questions right now, with Dr. Troy Madsen, Emergency of Medicine at University of Utah Hospital.

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Scot: Let's talk about the Heimlich maneuver. Is an effective tool.

Dr. Madsen: It is. You know, the Heimlich maneuver actually works, and we talk about CPR sometimes, and we talk about well maybe CPR works, maybe 5 to 10% of the time. The Heimlich maneuver, in my experience, works most of the time. And it's really surprising to me, because we think about all this research we have on CPR. I just can't find much research at all on the Heimlich maneuver. But I can tell you, I've seen many cases in the E.R. of people who have been brought in, who are say at a restaurant or at home, something happened. Someone administered the Heimlich maneuver, it got that piece of meat or food out, and they came in the E.R. and were fine. You know, they walked out of the E.R. later. So there's no question in my mind it works and it works the majority of the time.

Scot: So there are likely all sorts of videos online, if you want to learn how to do the Heimlich maneuver.

Dr. Madsen: Sure.

Scot: Can you do a brief overview of what you should do? And then I'd like to find out from your perspective, how do I know I'm doing it right?

Dr. Madsen: Yeah. Yes, so the big thing you want to do is number one, stand behind the person. So as long as you can get behind them, that's a great position to be in. And then reach around the front, make one hand into a fist, the other hand on top of it. Place that fist just down below the rib cage in the midline, so you're right over the stomach there, and then with both hands force that stomach up. And so if you really think about what you're doing, like I said, you're thinking you're forcing the stomach. The big thing I'm trying to do is just put lots of pressure on the lungs, because we've got food stuck in the trachea, in the breathing tube. So if I can get a lot of force on the lungs by pushing up on the stomach into the diaphragm, that's going to force that air out of the trachea, and hopefully make that piece of food pop right out.

Scot: So how hard am I doing this? Am I lifting somebody off the ground with each. . . what do you call that when you, each thing.

Dr. Madsen: Yeah so with each thrust there . . .

Scot: Thrust.

Dr. Madsen: You are lifting this person.
Scot: Okay.

Dr. Madsen: If you can you know, it's a lot of force.

Scot: All right.

Dr. Madsen: And again, you're thinking the more force the better. It's kind of like you know, you think about you're in grade school and you got like a . . . you're shooting spit wads at the ceiling or something. It's the same concept. It's just lots of air pressure all at once. Immediate force that shoots something straight up, and that's what you're trying to do with that force down there.

Scot: So how do you actually know if you should start administering the Heimlich maneuver to somebody?

Dr. Madsen: So this is a great question, because you know, the Heimlich maneuver is not without harm. There are plenty things that have shown you put that much force on a person's stomach, you can cause injury to their spleen, their liver, their large vessel, their stomach. So you really need to know this person is choking, and a universal sign of chocking is a person is holding their hands over their throat. Often times they may be turning blue. If a person can speak to you, that means they are moving air through their airway, they do not need the Heimlich maneuver, but that person generally, well they should not be able to speak because their airway is completely blocked, which means they can't get any air through there. You know, if they are speaking to you but feel like something's stuck in there you can call 9-1-1, but you don't need to start doing thrusts or forcing air into their lungs, or pushing on their stomach.

Scot: When we talked about CPR you tell your students that if you're not hearing ribs cracking, you're not doing compressions hard enough. Is there anything equivalent in the Heimlich maneuver?

Dr. Madsen: You don't want to crack ribs. You're going to be down lower there.

Scot: Okay.

Dr. Madsen: But I'm just . . . it's just got to be much force . . .

Scot: Much force.

Dr. Madsen: As you can push there. Yeah.

Scot: So channel any anger that you had towards . . .

Dr. Madsen: Yeah.

Scot: . . . relative right in there.

Dr. Madsen: Channel anger, fear, whatever emotions running through you at that point, channel it into those thrusts to really try and get some pressure there.

Scot: How long do I keep doing that?

Dr. Madsen: Keep doing it until they're responding.

Scot: Okay.

Dr. Madsen: And if they get to a point where they are unresponsive, where they lose a pulse, then you have to start CPR.

Scot: Okay.

Dr. Madsen: And often times, once you're doing in those chest compressions, those nice deep chest compressions, that sometimes will generate enough force on the lungs to make that food pop out. But you keep doing it until they respond.

Scot: What about the balance of somebody starts choking, somebody starts giving the Heimlich maneuver. Do you call 9-1-1 at that point? I mean at what point would you make that phone call?

Dr. Madsen: I would make it immediately. And if you're in a situation where you have other people there, that's one thing you're going to say, call 9-1-1. I'm doing the Heimlich maneuver. If I'm in a situation where it's just me and another person, I'm going to do the Heimlich maneuver.

Scot: Okay.

Dr. Madsen: But then if it gets to a point where you are administering CPR, then you call 9-1-1. But usually most of the time, if you just get the Heimlich maneuver going, you're going to be successful.

Scot: And then do you call 9-1-1 back and say cancel it or . . .

Dr. Madsen: I would still have them come.

Scot: Okay.

Dr. Madsen: And at the very least, the EMTs are going to come. They're going to evaluate the patient. In my experience, they will sometimes transport that patient to the emergency department, just depending if the patient still feels like something may be lodged in there. If the patient is completely symptom free, they may just release them. But at least you can get a medic to check their vital signs and check them out.

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