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First aid for a Choking Victim, Emergency Aids in Choking
Have you ever been to a restaurant or cafe and witnessed a person gasping or wheezing for air? We consider that the person is choking but it's not life threatening, as uncomfortably as it seems. In fact, they have recommended that we don't interfere with this person. They have a much better chance of getting the obstruction out of their airway via this coughing and gasping than by us performing a Heimlich Maneuver, Here's why: There are two types of airway obstructions, partial and complete. The fact that the victim can make sounds identifies partial obstructions, where a complete obstruction is silent. In order for an object to affect your ability to breathe it has to be in your airway, from the hollow of your throat up. Our vocal cords are also in this area. Therefore, if the victim is making sound, they have some air passage. If they are getting air to the vocal cords, they're getting air to their lungs and vice versa. Now, it's not that a Heimlich Maneuver would "hurt" the victim, it's that this maneuver usually doesn't work.
How the Heimlich Maneuver Works
A physician actually developed this technique, Dr. Heimlich. This is where the maneuver gets its name and that's what most people know it as. A few years ago though, Dr. Heimlich withdrew his affiliation with this title so that technically the name The Heimlich Maneuver should no longer be used. First aid manuals and references call this maneuver now Abdominal Thrusts. The technique is still the same though. Pressure is applied on the victim's abdomen with an upward motion. This compresses the diaphragm. The diaphragm is found across the bottom of your chest cavity beneath the ribcage. It's a dome shaped muscle that regulates your breathing by expanding and contracting, up and down. Relat it to the covering of a drum. It's a thin membrane. Each time it contracts downward, you inhale. When it expands upward, you exhale. With manual pressure, it can be pushed upward to force residual air in the lungs, up into the airway and out. If there should be an object in the airway, this airflow creates pressure beneath it. The hearder the diaphragm is pushed, the greater this pressure until the object is forced out as a projectile. It's like a cork in a champagne bottle. Now, if there is only a partial obstruction in the airway, no pressure is created. The air will be forced upwards but around the obstruction instead of behind it. It's like having the "wind" knocked out of you then, but now you can't even cough and you're still obstructed. So, abdominal thrusts simply aggravate the situation rather than effectively help it. Keep in mind that you are simulating a cough with this maneuver. Take a moment and place your hand on your abdomen, right beneath your ribcage and cough. You'll feel how that area moves in an inward and upward manner. This is the "motion" you want to create when performing it.
Helping a Partially Obstructed Victim
If you feel the need to help, lean the victim forward so that their head is a little lower than their chest. Support their upper body weight with one arm and use your other hand to strike their back between the shoulder blades. Back blows are never recommended normally however, if the victim is leaning forward the object will move down and out their mouth. Imagine a small baby, less than 12 months. When helping an infant with an airway blockage whether partial or complete, it is dealt with in the same manner. Abdominal pressure is a last resort with infants because of their liver development. It's very large at the stage and can be lacerated. The liver holds a large amount of blood and they could bleed to death. Only back blows are performed on infants and it's done by also having the child's head beneath their chest. This way you are working with gravity and not against it. Take care to support a small infant's head and neck by cupping their cheeks with one hand. This will avoid whiplash when you strike them. Repeat these steps until the victim can breathe.
Helping a Completely Obstructed Victim
First, this technique can be used on adults and children over the age of 12 months. Common sense will dictate that you less pressure on smaller victims. If the victim is conscious, you wrap both of your arms around their waistline. Use your strong hand to make a fist and place that above the victim's belly button, cup your other hand over top. Pull inward and upward toward the victim's shoulders until the victim can respond to you. Now, if the victim has already lost consciousness, you can perform the maneuver from the ground. In fact, it's an excellent alternative to the "upright" method when the victim is much larger than you. You cannot get your arms around them, they could be much taller, or you don't quite have enough upper body strength to pull up hard enough. The victim will usually come up off their heels as you pull up. That's how much pressure you have to use. So, you can straddle the victim's thighs and place the heels of your hands, stacked, above the victim's belly button. Instead of pulling in and up, you're oushing in and up. From this angle you'll be using your upper body weight as opposed to your strength. As a result, a five-year-old child could successfully perform this maneuver on an adult from this position. Repeat this maneuver until the victim responds. Whether the victim is unconscious or not, it's always a good idea that we call 911. There have been occasions where "material" remained in the airway.
This maneuver is about 98% successful in clearing a victim's airway yet it isn't always used. As with most things there are exceptions to the rule. Infants for one and pregnant victims are another. When they're in the second and third trimesters of pregnancy and "showing," obviously the baby is right where you'd need to put your hands. So you can't do the maneuver without possibly harming the child. Attempt back blows as used on partially obstructed victims. If that isn't successful, this will be; have the victim place a finger in their mouth to agitate their gag reflex. Get the picture? You want them to induce vomiting. Instead of air pressure to "pop" the obstruction out, the contents of the stomach come up into the airway to "blow" the obstruction out. This is something to keep in mind since there is no effective way to heimlich oneself. Yet we can self induce vomiting! *Animals do this in order to clear their airway.
Hopefully this is something you'll never have to use first hand. It's a good thing to just know. Statistically speaking, the odds are greater for encountering a partially obstructed victim than a complete. Complete obstructions are the scary ones. You may see them put their own hands to their neck in some universal sign of choking. Their face begins to discolor, red to purple to blue. They can't make any air exchange at all. Partial obstructions aren't life threatening normally. It works its self out by our own natural responses. Do keep in mind though, if you're potentially going to help a "stranger," you are supposed to get "permission" from them to assist. This is if they are conscious. It seems ridiculous to most of us, but if you think about it . . . It relates to Good Samaritan Laws, which every state has some form of. You can check with your local government on their statutes. No one has ever been successfully sued as a layperson when using this skill, but we can't legally touch another person without their consent. If they are unconscious there is a provision in this called Implied Consent. Again, check your area for more specific information on that issue.
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