LIFE-THREATENING PROBLEMS - Medicine for Mountaineering and Other Wilderness Activities - page 25

bespentthisway.Airwayobstructionbyaspiratedfoodisatrueemergency,andonlythree
or four minutes are available to correct the problem.
The Heimlich maneuver, which should be learned in a life-support class, consists of
thrusting a hand or fist into the upper abdomen in such a way that the diaphragm is sud-
denly forced upward. The abrupt pressure on the diaphragm forces air out of the lungs and
usually pops the obstructing food out of the larynx. The food is commonly ejected com-
pletely out of the person's mouth. The maneuver is so effective it can be used to evacuate
aspirated objects that do not completely obstruct the airway.
Aconscious individual can bestoodup.Without delay,the rescuer'sarms shouldbeex-
tended around the individual and one fist placed in the top of the V formed by the ribs just
below the sternum. The second hand should be placed on top of the first, and both should
be pulled inward and upward as sharply as possible ( Fig. 3-8 ) . Several attempts may be re-
quired to expel the food.
When performing the maneuver in this manner, little pressure should be placed on the
person's ribs. (Some is unavoidable.) Squeezing the ribs does not expel the food; thrusting
against the diaphragm does. Squeezing the ribs has led to fractures, in a few cases multiple
fractures, but that is less harmful than asphyxia by the aspirated food.
If the individual is unconscious or obese, he should be placed on his back on the flattest
surface that can be found. The rescuer should straddle the person (not kneel beside him)
andplacebothhands,oneontopoftheother,ontheupperabdomenjustbelowthesternum.
Pressing downward and toward the head briskly forces the diaphragm upward and dis-
lodges the food ( Fig. 3-9 ) .
If the Heimlich maneuver does not dislodge the food after several tries, a tracheostomy
or cricothyrotomy must be performed as quickly as possible. Artificial respiration through
the opening may be necessary for a short time if the person has stopped breathing.
However, most poor outcomes have not resulted from lack of success with the Heimlich
maneuver but from failure to use it in time to prevent permanent brain damage.