Heimlich maneuver for adults while standing and lying down. Man choking and coughing

Continuing the topic of resuscitation in case of sudden cardiac arrest, as promised, I tell (and show) the Heimlich maneuver.

The Heimlich maneuver is used to remove a foreign body from the victim's airway. When the airways are completely blocked, the victim grabs his throat with his hands, is unable to breathe, cough or speak, and his face quickly becomes bluish. The point of the technique is to create a strong flow of air from the lungs, which will simply push the foreign body out. When you sharply press the area under the diaphragm, the air supply that is not used during breathing is forcefully pushed out from the lower lobes of the lungs.

The Heimlich maneuver is used differently in infants and adults, in conscious and unconscious people, and is also used in pregnant women. Let's look at different options for the Heimlich maneuver.

If the victim is conscious.
Carrying out subdiaphragmatic thrusts (Heimlich maneuver) to another person:

Stand behind the victim. Grab it around your waist. Tilt it forward slightly.
- Make one hand into a fist. Place it just above the victim's navel.
- Grab your clenched fist with your other hand. With a quick upward movement, press firmly on the stomach, as if trying to lift the victim.
- Perform a series of five subdiaphragmatic thrusts (if necessary). If the foreign body that caused the suffocation does not budge, repeat the entire cycle (“five plus five”).
You can see how to help a conscious person in the video for this message.

If you need help personally, you can't really hit yourself on the back. However, you can try to push the stuck object out using subdiaphragmatic thrusts.
Carrying out subdiaphragmatic thrusts (Heimlich maneuver) to yourself:
1. Make a fist with your hand and place it just above your navel.
2. Place the palm of your other hand around your clenched fist and lean over a hard surface (such as a kitchen table or the back of a chair).
3. Make a quick push up with your fist, at the same time as if pressing it into your stomach.

The Heimlich maneuver is helping an unconscious person.
Place the victim on his back on a hard surface, sit on the victim's thighs facing his head. Turn the victim's head to the side. Place one palm on top of the other, clench your palms into a fist. Place the base of the lower palm in the middle between the navel and the lower edge of the sternum (in the epigastric region). Using your body weight, apply vigorous pressure toward the victim's shoulder blades (down and forward) 5 times. Examine the victim’s oral cavity, clean foreign bodies with two fingers. If necessary, repeat the Heimlich maneuver.

For children under one year old

1. Place the child on the forearm (in case anyone has forgotten, the forearm is the part of the arm between the elbow and the hand), face down. The forearm is lowered so that the child's head is lower than the body. See picture.
2. Apply 5 blows between the shoulder blades with the edge of the palm of your free hand.
3. Examine the mouth - check if a foreign body has popped out.
4. If the first option does not bring results, then turn the child on his back, placing him on your lap. The child's head is below the body. Perform 5 thrusts into the chest at the level of the lower third of the sternum. Don't press on his stomach! If a foreign body is visible, it is removed.
5. If the foreign body is not removed after these measures, then perform mechanical ventilation and repeat the techniques until the ambulance arrives.

Man is mortal. And death, unfortunately, suddenly. Cars, household appliances, unscrupulous builders, hooligans and Islamic fundamentalists are ready to break the thin thread of our lives at any moment. The Supreme Being has designed us in such a way that we risk our lives even when we do the most ordinary thing - eat food. The fact is that the human oropharynx is involved simultaneously in the act of breathing and in the act of swallowing..html#comments). The swallowing reflex protects us from getting a bolus of food into the respiratory tract. When the lump touches the back wall of the pharynx and the root of the tongue, the pharyngeal muscles reflexively contract, the epiglottis closes the entrance to the trachea, and the soft palate blocks the entrance to the nasal cavity and the food bolus moves into the esophagus.

The swallowing reflex separates breathing and swallowing. You cannot inhale and swallow at the same time.

But in some situations the reflex does not work: - in children, the reflex is not yet fully formed; - in older people, the reflex begins to fade; - in drunk people, all reflexes are inhibited and muscle tone decreases due to the specific effect of alcohol on the nervous system. (this is why fasting is especially relevant now, before the New Year holidays and corporate parties, when alcoholic libations are combined with excessive food consumption) - chronic irritation of the oropharyngeal mucosa in smokers and people with chronic inflammatory diseases in this area can also lead to the extinction of the swallowing reflex. - diseases of the nervous system and abnormalities of the upper respiratory tract

If a food bolus or a foreign object enters the respiratory tract, the situation can develop according to two scenarios - incomplete closure of the respiratory tract (the person coughs intensely, can utter short phrases) - complete closure of the respiratory tract (the person suffocates, turns blue, a whistling sound is heard instead of breathing, can speak, no or weak cough)

If the airway is not completely closed, ask the person to take a deep, slow breath and straighten up, and then exhale sharply while bending forward. Invite the person to clear their throat. There is no need to “hit” him on the back, especially if he is standing straight - you will push the bolus further into the airways. Back pats can only be effective if the person is bent over.

If the airways are completely closed (the person is blue and breathing, holds his throat or makes energetic pantomime with signs, does not answer questions), it is necessary to perform the Heimlich maneuver (Heimlich maneuver, Heimlich manual). You need to go behind the person, sit down a little, and tilt his body a little forward. Then you need to grab it from behind with your hands, placing a clenched fist on the abdominal wall exactly under the place where the sternum ends and the last ribs join it. Midway between the apex of the angle formed by the ribs and the sternum and the navel. This area is called the epigastrium.

The second hand should be placed on top of the first. With a sharp movement, bending your elbows, you need to press on this area without squeezing the chest. The direction of the pushing movement is towards you and up.

If the incident occurred with a very fat person or a pregnant woman, and there is no way to place the fist on the stomach, you can put the fist on the lower third of the sternum.

Heimlich picked up this technique from our smaller brothers. Many animals use this technique to help each other.

Pressing the abdominal wall will sharply increase the pressure in the chest, and the food bolus will clear the airways. Once again, I repeat that the Heimlich maneuver is effective only when the airways are completely obstructed. If it is incomplete, the most effective way is to clear your throat.

If you cannot immediately clear the airways, then repeat the Heimlich intake 5 more times.

If a person has lost consciousness, place him on his back on a flat, hard surface. Press sharply with your hands on the epigastrium (where it is - see above) in the back-to-head direction (back and up).

If after five shocks the airway cannot be cleared, call 112 and begin cardiopulmonary resuscitation using the CAB protocol http://site/92913.html#comments

If you are choking and there is no one nearby who can help you, help yourself. Give yourself the Heimlich maneuver yourself. To do this, place your fist on the epigastric region, with your thumb facing you. Cover your fist with the palm of your other hand and with a sharp movement press on the epigastric region, directing the pushing movement towards you and upward. The second way is to lean on the back of a chair with the same area and, using the weight of your body, make sharp jerking movements in the same direction until you achieve patency of the airway.

It is necessary to seek qualified medical help even if the outcome of the maneuver is favorable to avoid damage to internal organs.

To remove a foreign body from a choking infant's mouth, place it face down in your palm. The child's torso lies on the forearm, the child's head is tilted down. Apply a few pats between the baby's shoulder blades until the contents of his throat are in your palm.

If you can’t get the foreign body out this way, then place the child on a hard surface and sharply press your fingers on the baby’s epigastric region in the same direction (up and back).

If measures are ineffective, start.

UPD: The American Red Cross (from 2011) recommends the following sequence if a person (child) is choking and cannot speak, cough or breathe:

1. Call an ambulance

2. Apply five blows to the upper back, after tilting the person forward.

3. Perform 5 Heimlich maneuvers (in the case of a child, see the picture)

4. Repeat the cycle of blows and abdominal thrusts, and if the person has lost consciousness, begin.

The Heimlich maneuver is an emergency method used to remove foreign objects lodged in the respiratory tract. The Heimlich maneuver is used in cases where a person cannot breathe as a result of such objects entering the respiratory tract. Oxygen starvation from a foreign body due to airway obstruction can cause permanent brain damage or death within four minutes or less. The Heimlich maneuver can save the life of a choking victim.

When is the Heimlich maneuver performed?

This first aid method is not performed on children under one year of age. Indications for its use when the airway is blocked include the following:

inability to cough or speak
blue or purple complexion due to lack of oxygen,
weak cough and difficulty breathing,
all of the above, followed by loss of consciousness.

Statistics of suffocation cases

Each year, countless people, including tens of thousands of infants and children, are admitted to hospital emergency departments with suffocation incidents. More than 80 percent of them are children aged four years or younger. Death from airway obstruction and related injuries is especially common in children aged four years due to their anatomy (small airways), natural curiosity, tendency to put things in their mouth, and undeveloped chewing skills. In young children, choking usually occurs as a result of inhaling small objects (such as coins or small toys and parts) that they put into their mouths.

How did the Heimlich technique come about?

In 1974, Henry Heimlich first described the technique of expelling foreign material blocking the trachea. This technique, now called the Heimlich maneuver, is quite simple and can be performed by any trained person. The Heimlich maneuver is a standard part of first aid for lifeguards and CPR training courses. The theory of the Heimlich technique is based on the fact that when the abdomen is compressed below the level of the diaphragm and rapid abdominal thrusts are performed, an “artificial cough” is caused. Air is pushed out of the lungs and dislodges the obstruction (foreign object) from the trachea into the mouth. The Heimlich maneuver can be performed in all people; however, there are certain considerations when performing it on infants, children, obese people and pregnant women.

It is interesting that in his entire life, Henry Heimlich never performed the technique of his name in practice.

Naturally, he often showed it on mannequins and volunteers during demonstrations, but Dr. Heimlich only got the chance to save the life of a choking man in 2016.

While having dinner at a hotel restaurant, he noticed that his peer was suffocating. Without a moment’s hesitation, he rushed to the rescue, beating hotel employee Perry Gaines by a couple of seconds (who, by the way, had already had to save her life with the Heimlich maneuver)

Having performed the reception of his name, Henry finished dinner.

The rescued old woman became a local celebrity, and Henry shared his joy at saving someone else's life in an interview. Listening to the weakening old voice, it is difficult to imagine how quick this grandfather can be.

Correct execution of the Heimlich maneuver

In order to perform the Heimlich maneuver, you need to go behind the victim, who can be sitting or standing. The person providing assistance raises his hand, clenched into a fist on one side, and places his thumb towards the victim below the chest and above the waist. Next, he clasps the waist with his other hand, placing it on top of his fist, and performs a series of five quick, noticeable inward and upward thrusts. If the foreign object does not dislodge, the cycle of five pushes is repeated until the object is ejected. As the victim is deprived of oxygen, the muscles in his trachea relax and it is possible that the foreign object may be expelled on the second or third attempt.

If the victim loses consciousness

If the victim is unconscious or losing consciousness, the first aid provider should place him on the floor, bend his chin forward, making sure that the tongue does not block the airway, being careful not to put pressure on it, place his hands between the lower part of the chest bone and abdomen the victim in the navel area and perform a series of five quick pressure-presses inward and upward. After abdominal thrusts, the rescuer repeats the chin lift process, moving the tongue, palpating and, if possible, removing the foreign object from the mouth. If the airway is not cleared, the series of abdominal thrusts must be repeated as often as necessary. If the foreign object has been removed, but the victim is not breathing, artificial respiration should be started.

Heimlich maneuver for children and obese people

The technique for performing the Heimlich maneuver in children over one year of age is, in principle, the same as in adults, except that the amount of force used should be less to avoid damage to the ribs, sternum and internal organs of the person being rescued.

The main difference in performing the Heimlich maneuver in obese people is the placement of the fists. Instead of using abdominal thrusts, emphasis is placed on the chest. In this case, the fists are located against the middle of the sternum, and the direction of the push in relation to the chest is downward, not upward. If the victim is unconscious, chest blows are similar to the technique used in cardiopulmonary resuscitation. In the same way, the Heimlich maneuver is performed on pregnant women with a bulging belly.

Performing the Heimlich maneuver on infants

The Heimlich maneuver, as described above, is not performed on children under one year of age. Instead, a series of reverse punches and chest thrusts are used. The first aid provider sits down and places the baby face down on his or her hip, supporting the baby with one arm and giving five quick blows to the baby's back between the shoulder blades with the other. After a series of back blows, the child is turned face up, supported by the hand. Using your free hand, place your index and middle finger in the center of the sternum and give five quick thrusts and continue until the baby's trachea is free. If the child loses consciousness, cardiopulmonary resuscitation must be started.

Heimlich maneuver: how to help yourself

There are situations when a choking person is alone, or those around them are confused and don’t know what to do. In this case, you can (and should) help yourself. To do this, place the hand clenched into a fist with the side where the thumb is located on the stomach between the navel and costal arches. Place the palm of your other hand on top of your fist and with a quick upward push, press the fist into your stomach. Repeat the pushes several times until the airways are cleared.

Instead of a fist, you can use any horizontal object, for example, the back of a chair or armchair, the edge of a table, etc. Lean on it and push upward in the epigastric region.

Precautions when performing the Heimlich maneuver

Anyone can be trained to perform the Heimlich maneuver. Before performing it, it is important to determine whether the airway is completely blocked. If the choking victim can speak or cry, the Heimlich maneuver should not be performed. If the airway is not completely blocked, the victim should try to cough to remove the foreign object. Vomiting may occur when performing the Heimlich maneuver. All infants and children should be taken to hospital after use and checked for airway damage.

Risks and consequences

If used incorrectly, the Heimlich technique can break bones or damage internal organs. The person performing it should never try to reach a stuck object with their hands. This will likely push it further down the trachea. Dysphagia (difficulty swallowing) and obstructive pulmonary edema (accumulation of fluid in the lungs) may occur after Heimlich administration.

In many cases, after removing a foreign object from the throat using the Heimlich technique, the victim experiences no permanent effects. If the foreign object is not removed in time, permanent brain damage from lack of oxygen and death may occur.

Preventing Choking

Since most choking cases occur in the home, the child's parents should be trained in the Heimlich technique. The risk of choking can be reduced by close supervision of children. Most choking cases are food related, especially candy, grapes, nuts, popcorn and carrots. Hazardous items include deflated balloons, buttons, coins, small balls, small toys, small toy parts.

Disclaimer: The information presented in this article about how to properly perform the Heimlich maneuver is intended for informational purposes only. It is not intended to be a substitute for advice from a healthcare professional.

1. Stand behind the victim, clasping him with your arms.

2. Make a fist with one hand and place it on your stomach in the epigastric region with the thumb side.

3. Place the palm of the other hand on top of the fist and quickly push up, pressing the fist into the stomach. Arms bent at the elbows, do not put pressure on the chest.

4. The technique can be repeated several times.

Ticket number 4.

Sample answer to task No. 1.

1. The need to live is violated

Patient problems:

Real:

Syncopal drowning (death by water)

Clinical death

Potential:

Risk of death

2. Priority problem - correct performance of basic cardiopulmonary resuscitation.

Short term goal: restoration of breathing, pulse, consciousness. Long term goal: Returning the patient to a full life.

PLAN	MOTIVATION
1. Honey sister in 3-4 minutes. should restore the victim’s blood circulation, breathing, and consciousness.	Bring the victim out of clinical death.
2. Lay the victim on his back, raising his legs 15-20 degrees.	2. Additional blood supply to the heart.
3. Turn your head to the side, clean the oral cavity from the contents.	3. Restoration of airway patency.
4. Apply the Safar technique.	4. Elimination of tongue retraction.
5. Mouth-to-mouth ventilation. 6. Chest compression 2:30 120-150 per min.	5. Until independent breathing appears.
	6. For the appearance of a pulse in the carotid artery.
7. Assessing the effectiveness of resuscitation.	7. Spontaneous breathing, carotid pulse and presence of consciousness

GRADE: If the patient's progress is positive, the goal has been achieved. The patient recovered from the state of clinical death.

Technique

Lay the victim on a hard, flat surface with his legs elevated.
Record the start time of resuscitation measures
Restore airway patency:

3.1 turn your head to the side and use your index finger, wrapped in some material, to remove foreign bodies from the oral cavity and pharynx.

3.2 turn your head face up, with your left hand placed on your forehead, tilt the victim’s head back.

3.3 approach the victim from behind, with both hands lift and push out the victim’s lower jaw.

Stand to the side of the victim. Place your left palm on your forehead and close your nose tightly.
Place a napkin over your mouth (or use improvised means - a handkerchief, a piece of clothing, etc.). Cover the victim's mouth tightly with your lips and take a short, sharp breath to the victim (inhalation duration - 1-1.5 seconds).
Stand up, take a deep breath and breathe again to the victim. Assess the effectiveness of artificial respiration using chest excursion.
Place one hand, with the base of the palm, on the sternum (2-3 fingers above the xiphoid process), and place the other on top in a “butterfly” or “lock” manner.
Carry out 30 compressions with your arms straight at the elbows, using your body weight (compression frequency – 100-120 per minute and depth – 4-5 cm).
9. After 1 min. (after 3 approaches) check for the presence of a pulse in the carotid artery.
If there is no pulse and spontaneous breathing, continue resuscitation measures until the ambulance arrives.

Sample answer to task No. 2.

1. The nurse did not administer tetanus prophylaxis.

Having found out from honey. To document whether the child received a preventive DPT vaccination in childhood, it was necessary, according to the instructions, to inject him with antitetanus toxoid or antitetanus serum using the Bezredko method after a preliminary test.

Ticket number 5.

Sample answer to task No. 1.

1. Bite wounds.

2. Scope of assistance:

Toilet of the wound surface.

a) treatment of wound edges with iodonate solution.

b) washing wounds with 3% hydrogen peroxide solution.

c) applying an aseptic dressing with an antiseptic.

d) applying spiral bandages to the lower legs and documenting the dressing.

f) referral to the treatment room for injections to prevent tetanus.

Sample answer to task No. 2.

1.Needs violated: to be healthy

Patient problems:

Real:

Fear of dying

2.Priority problem:

- learn to reduce an attack yourself with the help of antifoams and treatment of the underlying disease

Short term goal: pain honey the nurse explains to relatives and the patient the need to treat the underlying disease

Long term goal: the patient will live

PLAN	MOTIVATION
1. The nurse calls the doctor on duty.	1. To provide qualified assistance.
2. The nurse places the patient in a semi-sitting position.	2. To reduce stagnation in the pulmonary circulation.
3. The nurse applies tourniquets to the patient’s lower and upper limbs alternately.	3. To reduce venous return.
4. The nurse administers oxygen inhalation through alcohol or an antifoam agent (antifomsilan).	4. To reduce the production of foamy sputum.
5. The nurse inserts a catheter into the bladder.	5. Hourly measurement of diuresis.
6. The nurse connects the patient to a heart monitor or takes an ECG.	6. To determine further medical practice.

GRADE: After the manipulations, the patient’s condition improved, breathing and pulse normalized, and the skin became pink. Honey. nursing activities were carried out correctly, the assessment was satisfactory.

Set of instruments for vein catheterization according to Seldinger:

1. A set of plastic catheters, disposable, 18-20 cm long, with an outer diameter of 1-1.8 mm.

2. Conductors made of nylon fishing line, 50 cm long and thick, selected according to the diameter of the vein.

3. Needle for vein puncture, 12-15 cm long.

6. Scalpel.

Ticket number 6.

Sample answer to task No. 1.

1. Needs violated: to be healthy

Patient problems:

Real:

Circulatory disorders

Difficulty breathing

Potential:

Complications: fear of surgery for an open fracture of a limb

2. Priority issue: pain syndrome in the left calf area.

Short term goal: after the first medical help the pain will decrease.

Long term goal: recovery occurs in 3-6 months.

PLAN	MOTIVATION
1. The nurse administers analgin + diphenhydramine intramuscularly.	1. To reduce pain, relieve first-degree shock.
2. The nurse is assessing the injured limb. Apply an aseptic dressing.	2. To reduce infection.
3. The nurse wraps the leg tightly from the center to the periphery.	3. To reduce the outflow of venous blood and reduce swelling.
4. The nurse is immobilizing the injured limb.	4. To create peace.
5. The nurse applies ice to the victim’s leg.	5. To reduce the inflammatory process.
6. The nurse gives the patient an alkaline drink.	6. To restore the acid-base balance.
7. The nurse is administering oxygen therapy.	7. To reduce hypoxia.
8. The nurse administers antitetanus serum and antibiotics.	8. To prevent complications.
9. The nurse is administering infusion therapy.	9. To combat shock.
10.Transportation on a stretcher to an educational institution in the presence of medical personnel. sisters.	10. To provide qualified assistance.

GRADE: A patient in a state of moderate severity is admitted to a medical facility. The goal has been achieved.

The main task of the art of survival is to prevent various unpleasant situations. And if this does not work out, then get out of them with the least losses. Or pull others out. Therefore, knowledge and skills are what everyone should have. Especially those that may be needed at any time. Such as, Heimlich maneuver.

For those who are not in the know, this is a set of actions that help clear the airways from foreign objects entering there. A common situation, by the way, is a person eating, looking at his favorite smartphone, in a hurry, in a word - creating all the conditions for choking. And then whatever happens.

If the victim is actively coughing, this is good. This means the airways are partially free, so you can take your time and think. If there is no cough, then there is no time to think and it is necessary to provide first aid to the choking person. At least the same Heimlich maneuver spend. At most - conicotomy. By the way, I’ll tell you about this too.

Heimlich maneuver

A relatively simple way to restore airway patency. Rhythmic pushes into the diaphragm provide a purely mechanical expulsion of a foreign object due to the air that at that time still remained in the lungs. So.

Stand behind the choking person and wrap your arms around him. Make one hand into a fist and place the flat surface on the epigastric region. In the center, just below the ribs. Second hand on top of the first. Next, start making sharp pushes towards yourself and a little upward. We remind you that this is strictly the epigastric region, not the chest. Repeat until it works.

If the patient is already unconscious, then we place him flat on his back, face up. In the same way, we place our hands on the epigastric area and act in the same way. Reminiscent of performing artificial cardiac massage, but not on the chest.

If we are dealing with children, then instead of fists and palms we use fingers. Or, which, of course, is not recommended by official medicine, we simply take the child by the legs and shake him vigorously several times. As practice has shown, this also helps.

But even after effective implementation Heimlich maneuver the victim should still seek medical help. Just in case - you never know.

Conicotomy

If Heimlich maneuver as first aid it does not help, the choked person begins to turn blue and ceases to show signs of life, more severe actions should be taken, for example, conicotomy.

Conicotomy

For some reason, many people mistakenly consider it a tracheotomy. But the differences are significant: during conicotomy, we bluntly dissect the ligaments between the cricoid and thyroid cartilages. That is, between the first ring of the trachea and the Adam's apple, in simple terms. Why there? But because it is already significantly lower than the vocal cords, in which, as in the narrowest part of the respiratory tract, a foreign body usually gets stuck. And this area is easy to find, there are no large arteries there, there is no risk of catching the vagus nerve, and subsequent rehabilitation is easier. And with a tracheotomy, you will have to directly cut the cartilage. In a hospital setting and the need to provide long-term mechanical ventilation is an option, but as first aid it is too difficult.

This is done quite simply - by touch we find the lower border of the Adam's apple and the upper cricoid cartilage. We pierce this area with a knife to a depth of 1.5 cm. The exact moment of piercing the ligament is different, so be careful. Next, we move the blade a centimeter parallel to the lines of the cartilage, pull it out, and insert a tube, which can be a pen refill. And we are waiting for help to arrive.

Conicotomy should be done only if Heimlich maneuver did not help, and the ambulance will not arrive at the scene soon. Sterility of the knife and tube is important, as with any other instrument used for surgical manipulation. Anesthesia is not considered necessary, since there is no time for it - it is much more important to restore breathing. In any case, qualified medical care will be necessary.

We sincerely hope that our advice will never be useful to you. But you still need to know them. Just in case.