Heimlich reception for an adult standing lying down. Man choking and coughing

In continuation of 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. With a complete blockage of the airways, the victim clutches his throat with his hands, is unable to breathe, cough and speak, his face quickly becomes bluish. The meaning of the reception is to create a strong flow of air from the lungs, which will simply push the foreign body out. With a sharp pressure on the area under the diaphragm, a supply of air is forced out of the lower lobes of the lungs, which is not used during breathing.

The Heimlich maneuver is used differently in infants and adults, conscious and unconscious people, and there is also a peculiarity in pregnant women. Consider different options for the Heimlich maneuver.

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

Stand behind the victim. Wrap it around your waist. Tilt it slightly forward.
- Clench one hand into a fist. Place it just above the victim's navel.
- Grab the clenched fist with the other hand. With a quick upward movement, forcefully press on the abdomen, as if trying to lift the victim.
- Perform a series of five subdiaphragmatic thrusts (if necessary). If the foreign body that caused the suffocation has not moved, repeat the entire cycle ("five plus five").
Helping a conscious person, you can see in the video to this message.

If you need help personally, you will not be able to hit yourself on the back properly. However, you can try to eject the stuck object with subdiaphragmatic thrusts.
Conducting subdiaphragmatic thrusts (Heimlich maneuver) to oneself:
1. Make a fist and place it just above the navel.
2. Grab your clenched fist with the palm of your other hand and lean over a hard surface (such as a kitchen table or chair back).
3. Make a quick push with your fist up, at the same time, as if pressing it into the abdomen.

The Heimlich maneuver is the act of helping an unconscious person.
Put the victim on his back on a hard surface, sit on the hips of the victim facing his head. Turn the victim's head to the side. Put 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, press vigorously towards the victim's shoulder blades (down and forward) 5 times. Examine the oral cavity of the victim, clean with two fingers from foreign bodies. Repeat the Heimlich maneuver if necessary.

For children up to a year

1. Place the child on the forearm of the hand (if someone has forgotten, then 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 drawing.
2. Apply with the edge of the palm of your free hand 5 strokes between the shoulder blades.
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, putting him on his knees. The baby's head is below the body. Produce 5 shocks in the chest at the level of the lower third of the sternum. Don't press on his belly! If a foreign body is visible, it is removed.
5. If the foreign body is not removed after these measures, then carry out mechanical ventilation and repeat the techniques until the ambulance arrives.

Man is mortal. And mortal, unfortunately, suddenly. Cars, household appliances, unscrupulous builders, hooligans and Islamic fundamentalists are ready to cut off the thin thread of our lives at any moment. The higher essence arranged us in such a way that we risk our lives, even when we are doing the most ordinary thing - eating. The fact is that the human oropharynx participates simultaneously in the act of breathing and in the act of swallowing..html#comments). The swallowing reflex protects us from getting a food bolus into the respiratory tract. When he, a 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 lump moves into the esophagus.

The swallowing reflex separates breathing and swallowing. You can't 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 the elderly, the reflex begins to fade - in drunken people, all reflexes are inhibited and muscle tone decreases due to the specific effect of alcohol on the nervous system. (which is why fasting is especially relevant now, before the New Year holidays and corporate parties, when alcohol libations are combined with excessive food intake) - chronic irritation of the oropharyngeal mucosa in smokers, people with chronic inflammatory diseases in this area can also lead to extinction of the swallowing reflex. - diseases of the nervous system and anomalies of the upper respiratory tract

If a bolus food bolus or a foreign object enters the airways, the situation can develop according to two scenarios - incomplete closure of the airways (the person coughs intensively, can pronounce short phrases) - complete closure of the airways (the person suffocates, turns blue, a whistling sound is heard instead of breathing, not can talk, cough is absent or weak)

If the airway is not completely closed, invite the person to take a deep slow breath and straighten up, and then exhale sharply with a forward bend. Have the person cough. Don't hit him on the back, especially if he's upright - you'll push the bolus even further into the airway. Patting on the back can only be effective if the person is leaning over.

With complete closure of the airways (the person is blue and breathes, holds on to the throat or performs energetic pantomime with signs, does not answer questions), the need to perform the Heimlich maneuver (Heimlich maneuver, Heimlich's manual). It is necessary to go behind the person’s back, sit down a little, tilt his torso slightly forward. Then you need to grab it from behind with your hands, putting a clenched fist on the abdominal wall exactly under the place where the sternum ends and the last ribs join it. In the middle between the top of the angle formed by the ribs and the sternum and navel. This area is called the epigastrium.

The second hand must be placed on top of the first. With a sharp movement, bending the arms at the elbows, it is necessary to put pressure on this area without squeezing the chest. The direction of the jog 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 a fist on the stomach, you can put your fist on the lower third of the sternum.

Heimlich spied on this technique from our smaller brothers. Many animals use this technique to help each other.

Pressing on 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 with complete obstruction of the airways. With incomplete, the most effective way is to cough.

If it is not possible to immediately clear the airways, then repeat the Heimlich maneuver 5 more times.

In case the person is unconscious, lay him on his back, on a flat, hard surface. Sharply press your hands on the epigastrium (where it is - see above) in the direction of the back-head (back and up).

If after five shocks it was not possible to free the airways - call 112 and start cardiopulmonary resuscitation according to the CAB protocol http://website/92913.html#comments

If you are choking and there is no one around to help you, help yourself. Do yourself a Heimlich maneuver. To do this, put your fist on the epigastric region, with your thumb towards you. Cover the fist with the palm of the other hand and with a sharp movement press on the epigastric region, directing the jerking movement towards you and up. The second way is to lean on the back of the chair with the same area and, due to body weight, make sharp jerky movements in the same direction until you achieve airway patency.

It is necessary to seek qualified medical help even with a favorable outcome of the maneuver to exclude damage to internal organs.

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

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

If the 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 picture)

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

The Heimlich maneuver is an emergency method used to remove foreign objects that have entered 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 in airway obstruction can lead to permanent brain damage or death in 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 the age of one year. Indications for its use in airway blockage 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 with subsequent loss of consciousness.

Asphyxiation statistics

Every year, countless people, including tens of thousands of infants and older children, end up in hospital emergency departments with strangulation incidents. More than 80 percent of them are children aged four and under. Death from airway obstruction and related injuries is particularly common in children under four years of age due to their anatomy (small airways), natural curiosity, propensity to put things in their mouths, and poor chewing skills. In young children, choking usually results from inhaling small objects (such as coins or small toys and their parts) that they put into their mouths.

How did the Heimlich technique come about?

In 1974, Henry Heimlich first described the technique of pushing out 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 in rescuers 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 with rapid abdominal thrusts, an “artificial cough” is caused. The air is pushed out of the lungs and knocks out the obstruction (foreign object) from the trachea into the mouth. The Heimlich maneuver can be performed on all people; however, there are some considerations when performing it on infants, children, obese people, and pregnant women.

Interestingly, in all his life, Henry Heimlich never performed the reception of his name in practice.

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

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

With the reception of his name, Henry finished his dinner.

The rescued old lady became a local celebrity, and Henry shared his joy in 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, it is necessary to go behind the victim, who can sit or stand. The person providing assistance brings his hand, clenched into a fist on one side, and places it with his thumb to the victim below the chest and above the waist. Next, he wraps his other hand around his waist, placing it over his fist, and performs a series of five quick, palpable inward and upward thrusts. If the foreign object is not dislodged, the cycle of five pushes is repeated until the object is ejected. As the victim is deprived of oxygen, the muscles of his trachea relax, and it is possible that a foreign object can be pushed out on the second or third attempt.

If the victim is unconscious

If the casualty is unconscious or unconscious, the first aid provider should place the casualty on the floor, bend the chin forward, making sure the tongue is not blocking the airways, being careful not to put pressure on them, place the hands between the lower part of the sternum and abdomen victims in the navel area and perform a series of five quick pressure-presses inward and upward. After the abdominal thrusts, the rescuer repeats the chin lift process by moving the tongue, groping and, if possible, removing the foreign object from the mouth. If the airway has not cleared, repeat the series of abdominal thrusts as often as necessary. If a foreign object has been removed, but the victim is not breathing, artificial respiration should be started.

Heimlich maneuver for children and overweight people

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

The main difference in performing the Heimlich maneuver on overweight 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 down, not up. If the casualty is unconscious, punches to the chest are similar to CPR techniques. In the same way, the Heimlich maneuver is performed on pregnant women with a bulging abdomen.

Performing the Heimlich maneuver in infants

The Heimlich maneuver, as described above, is not performed on children under one year of age. Instead, a series of reverse punches and pushes to the chest is used. The first responder sits down and lays the infant face down on his thigh, supporting the infant with one arm while giving five quick blows to the infant's back between the shoulder blades with the other. After a series of back blows, the child is turned face up, supporting with a hand. Using the free hand, its index and middle fingers are placed on the center of the sternum and give five quick thrusts and continue until the child's trachea is released. If the child loses consciousness, cardiopulmonary resuscitation should be started.

Heimlich maneuver: how to help yourself

There are situations when a choking person is alone, or others are confused and do not know what to do. In this case, you can (and should) help yourself. To do this, place the hand clenched into a fist on the side where the thumb is located on the stomach between the navel and costal arches. Place the palm of the other hand on top of the fist and with a quick push up, press the fist into the stomach. Repeat pushing several times until the airway is clear.

Instead of a fist, you can use any horizontal object, such as the back of a chair or chair, 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 talk or cry, the Heimlich maneuver should not be performed. If the airway is not completely blocked, the victim should try coughing to remove the foreign object. When performing the Heimlich maneuver, vomiting may occur. All infants and children after its use should be taken to the hospital and checked for damage to the respiratory tract.

Risks and consequences

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

In many cases, after removal of a foreign object using the Heimlich technique from the throat, the victim does not experience any permanent consequences. If the foreign object is not removed in time, irreversible brain damage from lack of oxygen and death is possible.

Choking Prevention

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

Denial of responsibility: The information provided in this article on how to correctly perform the Heimlich maneuver is intended to inform the reader only. It cannot be a substitute for the advice of a health professional.

1. Stand behind the victim, wrapping his arms around him.

2. Squeeze one hand into a fist and with the side where the thumb is, put it on the stomach in the epigastric region.

3. Put the palm of the other hand on top of the fist and with a quick push up, the fist is pressed into the stomach. The arms are bent at the elbows, do not press on the chest.

4. Reception can be repeated several times.

Ticket number 4.

Sample answer to problem number 1.

1. Violated need: to live

Patient problems:

Real:

Syncopal drowning (death on the water)

clinical death

Potential:

Risk of death

2. The priority problem proper conduct of basic cardiopulmonary resuscitation.

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

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

GRADE: With positive dynamics in the patient, the goal is achieved. The patient came out of a state of clinical death.

Technique

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

3.1 turn the head on its side and remove foreign bodies of the oral cavity and pharynx with a forefinger wrapped in some material.

3.2 turn the head face up, with the left hand placed on the forehead, tilt the head of the victim.

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

Stand next to the victim. Place your left hand on your forehead and pinch your nose tightly.
Put a napkin on your mouth (or use improvised means - a handkerchief, a piece of clothing, etc.). Tightly clasping the mouth of the victim with your lips, take a short, sharp breath to the victim (the duration of the breath is 1-1.5 seconds).
Stand up, take a deep breath and re-breath the victim. Assess the effectiveness of artificial respiration by chest excursion.
Put one hand, with the base of the palm, on the sternum (2-3 fingers above the xiphoid process), put the second on top with a “butterfly” or “lock”.
Perform 30 compressions with arms straightened at the elbows, using the weight of your body (the frequency of compressions is 100-120 per minute and the depth is 4-5 cm).
9. After 1 min. (after 3 approaches) check for a pulse on the carotid artery.
In the absence of a pulse and spontaneous breathing, continue resuscitation until the ambulance arrives.

Sample answer to problem number 2.

1. Nurse didn't do tetanus prophylaxis.

Finding out from honey. Documentation whether the child received a prophylactic DTP vaccination in childhood was necessary, according to the instructions, to give him injections of tetanus toxoid or tetanus toxoid according to the Bezredko method after a preliminary test.

Ticket number 5.

Sample answer to problem number 1.

1. Bite wounds.

2. Amount of assistance:

Toilet wound surface.

a) treatment of the edges of wounds with r-m iodonate.

b) washing the wounds with 3% hydrogen peroxide solution.

c) applying an aseptic dressing with an antiseptic.

d) the imposition of bandage spiral bandages on the shins, documenting the dressing.

f) referral to a treatment room for tetanus prophylaxis injections.

Sample answer to problem number 2.

1. Violated needs: to be healthy

Patient problems:

Real:

Fear of dying

2.Priority issue:

- learn how to reduce an attack on your own with the help of defoamers and treatment of the underlying disease

Short term goal: pain honey. the sister explains to the relatives, 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 gives the patient a half-sitting position.	2. To reduce stagnation in the pulmonary circulation.
3. The nurse applies tourniquets to the patient on the lower and upper limbs in turn.	3. To reduce venous return.
4. The nurse conducts oxygen inhalation through alcohol or a defoamer (antifomsilan).	4. To reduce the production of foamy sputum.
5. The nurse inserts the catheter into the bladder.	5. Hourly diuresis measurement.
6. The nurse connects the patient to a heart monitor or take an ECG.	6. To determine further medical practice.

GRADE: After the manipulations, the patient's condition improved, breathing and pulse returned to normal, the skin turned pink. Honey. nursing activities were carried out correctly, the assessment is 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 problem number 1.

1. Violated needs: to be healthy

Patient problems:

Real:

Circulatory disorders

Labored breathing

Potential:

Complications fear before surgery for an open fracture of the n/limb

2. Priority issue: pain syndrome in the region of the left leg.

Short term goal: after providing the first honey. help reduce the pain.

Long term goal: the onset of recovery after 3-6 months.

PLAN	MOTIVATION
1. The nurse injects analgin + diphenhydramine intramuscularly.	1. To reduce pain, relieve symptoms of shock of the first degree.
2. A nurse examines an injured limb. Apply an aseptic bandage.	2. To reduce infection.
3. The nurse bandages the leg tightly from the center to the periphery.	3. To reduce the outflow of venous blood and reduce swelling.
4. The nurse immobilizes the injured limb.	4. To create peace.
5. The nurse covers the victim's leg with cold.	5. To reduce the inflammatory process.
6. The nurse gives the patient an alkaline plentiful drink.	6. To restore the acid-base balance.
7. The nurse conducts oxygen therapy.	7. To reduce hypoxia.
8. The nurse injects tetanus toxoid, antibiotics.	8. For the prevention of complications.
9. The nurse conducts infusion therapy.	9. To combat shock.
10.Transportation on a stretcher to an educational institution in the presence of honey. sisters.	10. To provide qualified assistance.

GRADE: The patient is admitted to the hospital in a state of moderate severity. The goal has been reached.

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 take others out. Therefore, knowledge and skills are something that everyone should have. Especially those of them 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 getting a foreign object there. A frequent situation, by the way - a person eats, looks at his favorite smartphone, is in a hurry, in a word - creates all the conditions for choking. And then how it goes.

If the victim is actively coughing, this is good. This means that 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 one. At least the same Heimlich maneuver spend. As a maximum - conicotomy. By the way, I will also tell you about this.

Heimlich maneuver

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

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

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

If 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 vigorously several times. As practice has shown, this also helps.

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

Conicotomy

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

Conicotomy

For some reason, many mistakenly consider it a tracheotomy. But the differences are significant: with a 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 much 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 is no risk of catching the vagus nerve, and subsequent rehabilitation is easier. And with a tracheotomy, you have to directly cut the cartilage. In a hospital setting and the need to provide long-term 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 moment of piercing the ligament is specifically different, so be careful. Next, we move the blade a centimeter parallel to the cartilage lines, pull it out, insert a tube, which can also be a fountain pen refill. And we are waiting for help.

A conicotomy should only be done if Heimlich maneuver did not help, and the ambulance will not arrive soon. The sterility of the knife and tube is important, as with any other instrument used for surgical procedures. Anesthesia is not considered necessary, because there is no time for it - it is much more important to restore breathing. Qualified medical assistance in any case will be needed.

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