Choking, a common problem


Choking is unfortunately a condition you may meet at any time.  The commonest cause with adults is choking on food, and with small children after swallowing a toy.

While researching the Heimlich maneuver, I came to the conclusion there was a good movie in the history of Dr. Heimlich’s maneuver.  Money, family jealousies and more money, interspersed with some ‘dodgy’ (doggy) science.  A blockbuster!

The good doctor Henry Heimlich has been called a “fraud” by his son Peter and criticized by some in the medical community for conducting studies on HIV patients in China — studies which were banned in the U.S. — that involved infecting them with malaria in an attempt to cure the HIV.  The technique was called “malariotherapy” but is no longer used as the ‘cure’ was killing more than the disease.

Heimlich (who was a thoracic surgeon) even admitted that he had never practiced his maneuver before publishing the details, and first tested his maneuver on dogs!   Beagles have been used for many medical experiments, for example, especially with cigarette smoking.

When questioned about his use of dogs he is reported to have said, “I thought about writing a medical article, but if I waited for that to be published and for doctors to recommend it to patients to prevent choking to death, I knew it would take months or years for the word to spread.  I did something fun, and I had a well-known medical journalist describe my dog study in a 1974 syndicated column picked up by hundreds of newspapers all around the country.  A week later, an article appeared in the Seattle Times describing a man who tried the maneuver after reading about it, and he saved the life of his neighbor who was choking on a large piece of chicken.”

Symptoms of choking include an inability to talk.

Bluish skin color.

Difficulty breathing — ribs and chest pull inward.

Loss of consciousness (unresponsiveness) if blockage is not cleared.

Inability to cry or make much sound.

Weak, ineffective coughing.

Soft or high-pitched sounds while inhaling.


So how do you perform the maneuver?  (The following is taken from Wikipedia.)  “Performing abdominal thrusts involves a rescuer standing behind an upright patient and using his or her hands to exert pressure on the bottom of the diaphragm.  This compresses the lungs and exerts pressure on any object lodged in the trachea, hopefully expelling it.  This amounts to an artificially induced cough.  For example, WebMD recommends the rescuer placing his or her fist just above the person’s bellybutton and grasping it with the other hand.  To assist a larger person, more force may be needed.  The Mayo Clinic recommends the same placement of fist and hand and upward thrusts as if you are trying to lift the person.

“If the person is able to cough forcefully, the person should keep coughing. If the person is choking and can’t talk, cry or laugh forcefully, the American Red Cross recommends a “five-and-five” approach to delivering first aid:

“Be aware that due to the forceful nature of the procedure, even when done correctly, abdominal thrusts can injure the person on whom it is performed.  Bruising to the abdomen is highly likely and more serious injuries can occur, including fracture of the xiphoid process or ribs.”

The American Red Cross, one of the more sober organizations, is returning to the use of initial “back slaps” to dislodge the foreign body. If the back slaps were unsuccessful, then the Heimlich could be used, but interestingly, removed the name Heimlich and replaced it with “abdominal thrusts”.

The consensus is then to give five back blows first.  Stand to the side and just behind a choking adult.  For a child, kneel down behind. Place one arm across the person’s chest for support.  Bend the person over at the waist so that the upper body is parallel with the ground.  Deliver five separate back blows between the person’s shoulder blades with the heel of your hand.

After the back blows, perform five abdominal thrusts (also known as the Heimlich maneuver).  Alternate between five blows and five thrusts until the blockage is dislodged.  No matter what it is called – Give forceful back slaps, then five Heimlich maneuvers.  And hope for the best!