Choking on Food

Choking on a piece of food or some other object is the cause of ten deaths every day in the United States. Most of these deaths could have been prevented if a simple rescue technique had been applied as soon as distress was noted. The technique, called the Heimlich Maneuver, was devised by Dr. Henry J. Heimlich, director of surgery at Jewish Hospital in Cincinnati, Ohio.

The signs of choking are frequently confused with those of a heart attack. The choking victim will turn pale, then blue, and may perspire and collapse, but the most important and obvious sign is that the victim cannot speak. In contrast, the heart attack patient will be able to talk.

When choking occurs, breathing is interrupted and must be restored within four minutes or irreversible brain damage will occur. Within eight minutes, the patient will be dead. Thus, there is no time to call for a doctor or a rescue vehicle. The victim must be saved by someone present at the moment choking occurs.

Persons most likely to choke are children, who laugh and play while eating or who swallow nonfood objects, and elderly persons who do not adequately chew their food.

To perform the Heimlich Maneuver follow these steps:

1. Stand behind the victim and wrap your arms around his waist.

2. Make a fist with one of your hands and grab it with the other.

3. Place your wrist against the victim’s abdomen, slightly above the navel and below the rib cage.

4. Allow the victim’s head, arms, and torso to hang down.

5. Press your fist into the victim’s abdomen with a forceful upward thrust. Repeat if necessary.

If the victim has fallen to the floor or is in bed, the Maneuver can be applied as follows:

1. Place the victim on his back.

2. Kneel astride his hips with one of your hands on top of the other.

3. Place the heel of the bottom hand on the abdomen, slightly above the navel and below the rib cage.

4. Press into the victim’s abdomen with a forceful upward thrust. Repeat if necessary.

If the Heimlich Maneuver is performed correctly, the food or other obstructing object should “pop” from the patient’s mouth. The principle upon which this technique is based is that of upward pressure on the diaphragm, compressing the air in the lungs so that the object is forced out, in the same way that a cork in the opening of an inflated balloon would pop out if the balloon were squeezed.

The Heimlich Maneuver may be performed on a person of any age, including infants. Less pressure should be applied in the case of a small child. The risks are minimal—some rescuers have grasped the victim too high and cracked a couple of ribs—but the alternative is death or brain damage.

The choking victim may even utilize a self-applied variation of the technique if he happens to be alone at the time. He should fall frontally against the edge of a table, counter top, or chair back—whatever might compress the abdomen enough to pop the obstruction loose.

Persons of all ages and sizes should be taught to perform the Heimlich Maneuver, just as they are taught mouth-to-mouth resuscitation. Why not have all the family members try it during one of your family home evenings? By spending those few minutes, you will be prepared to save a life. Suzanne Dandoy, M.D., M.P.H, Director, Arizona Department of Health Services