What is the proper technique for performing the Heimlich maneuver on a choking person?

Heimlich Maneuver Technique

For adults and children over 1 year with complete airway obstruction, perform alternating cycles of 5 back slaps followed by 5 abdominal thrusts (Heimlich maneuver) until the object is expelled or the victim becomes unconscious. 1

Recognition of Choking

Identify choking by these key signs:

• Sudden onset of respiratory distress while eating or after placing an object in the mouth 2
• Universal choking sign: victim grips their throat with their hand 2
• Partial obstruction: distressed, coughing, may have inspiratory wheeze 2
• Complete obstruction: unable to speak, breathe, or cough; will eventually lose consciousness 2

Initial Management Algorithm

Step 1: Assess Obstruction Severity 1

Partial obstruction (victim can cough and make sounds):

• Do not interfere - encourage continued coughing 2
• Observe closely for progression to complete obstruction 1

Complete obstruction (victim cannot make any sound):

• Immediate intervention required - proceed to Step 2 2, 1

Step 2: Technique Based on Age

For Adults and Children Over 1 Year (Standing/Sitting)

Back Slaps (perform 5 first): 2, 1

• Stand to the side and slightly behind the victim 2
• Support the chest with one hand and lean the victim well forward (critical positioning to allow object to exit mouth rather than descend further) 2
• Deliver up to 5 sharp slaps between the shoulder blades with the heel of your hand 2
• Aim to relieve obstruction with each slap rather than automatically giving all five 2

Abdominal Thrusts/Heimlich Maneuver (perform 5 after back slaps): 2, 1

• Stand behind the victim and place both arms around the upper abdomen 2
• Ensure the victim is bending well forward 2
• Make a fist and place it between the umbilicus and xiphisternum 2
• Grasp the fist with your other hand 2
• Pull sharply inward and upward to dislodge the object 2

Continue alternating 5 back slaps with 5 abdominal thrusts until the object is expelled 1

For Infants Under 1 Year

Critical difference: Abdominal thrusts are contraindicated in infants due to risk of liver damage and rupturing abdominal viscera 2, 1

Back Slaps (perform 5 first): 2, 1

• Place infant in prone position with head lower than torso 1
• Support the infant's head and jaw with your hand 2
• Deliver 5 sharp back slaps between the shoulder blades with the heel of your hand 2

Chest Compressions (perform 5 after back slaps): 2, 1

• Turn infant supine, supporting the head 2
• Perform chest compressions similar to cardiac compressions but more vigorously 1
• Use 2-finger technique on lower sternum 2
• Deliver at approximately 20 compressions per minute 1

Continue alternating 5 back slaps with 5 chest compressions until object is expelled 2, 1

For Unconscious Victims (Any Age)

If the victim becomes unconscious at any point: 2, 1

1. Activate emergency response system (call for help) 2
2. Begin CPR with chest compressions - do not check pulse first 2
3. After 30 compressions, open the airway and look for the foreign body 2, 1
4. Remove visible objects only - never perform blind finger sweeps as they may push the object deeper or damage the oropharynx 2
5. Attempt 2 rescue breaths 2, 1
6. Continue CPR cycles (30 compressions: 2 breaths) until object is expelled 2
7. Check the mouth for visible objects after each compression cycle 1

Loss of consciousness may cause laryngeal muscle relaxation, potentially allowing air passage 2

For Lying Victims (Conscious)

Back Slaps: 2

• Kneel beside the victim and roll them onto their side facing you 2
• Support chest with your thigh 2
• Deliver up to 5 sharp slaps between shoulder blades 2

Abdominal Thrusts (adults/children >1 year): 2

• Turn victim onto their back 2
• Kneel astride the victim 2
• Place heel of one hand between umbilicus and xiphisternum, avoiding pressure on ribs 2
• Place other hand on top 2
• Thrust sharply downward and toward the victim's head 2
• Give up to 5 thrusts 2

Common Pitfalls and Complications

Critical positioning error: Failure to lean the victim forward during back slaps and abdominal thrusts may cause the object to descend deeper into the airway rather than exit through the mouth 2

Blind finger sweeps: These are dangerous and may push objects deeper or cause oropharyngeal injury - only remove visible objects 2

Potential complications: The Heimlich maneuver can cause pneumomediastinum, pneumopericardium, and surgical emphysema, particularly with repeated attempts 3. However, these risks are acceptable given the life-threatening nature of complete airway obstruction.

Infant-specific error: Never use abdominal thrusts on infants under 1 year - use only back slaps and chest compressions 2, 1

Delayed activation of emergency services: If alone with an unconscious choking victim, perform CPR for 2 minutes before leaving to call for help 2