What is the Heimlich Maneuver and How is it Performed?

The Heimlich maneuver is a fundamental first-aid technique used to save the lives of people facing a choking hazard due to food or a foreign object getting stuck in their windpipe. By applying sudden, forceful pressure to the abdominal area, this technique forces the residual air in the lungs to push the object out. When performed correctly and promptly, it clears the airway in seconds and saves lives.

• It is only applied to people experiencing a complete airway obstruction—those who cannot cough or speak.
• In cases of partial obstruction (if the person can still cough), do not intervene; encourage them to keep coughing.
• The application method differs for babies, pregnant women, and severely overweight individuals.
• Even if the intervention is successful and the object is expelled, a hospital visit is essential due to the risk of internal organ damage.
• If the person loses consciousness, stop the maneuver immediately, call 112 without delay, and begin basic life support (CPR).

What is the Heimlich Maneuver and When is it Used?

Our respiratory system works by drawing air in through the mouth and nose, which then travels down the trachea (windpipe) to the lungs. During swallowing, a small flap called the epiglottis covers the windpipe, ensuring food goes down the esophagus instead. However, sometimes when we talk, laugh, or eat hurriedly, this mechanism can fail, and food can slip into the windpipe. When the windpipe is completely blocked, it is called a total obstruction, and the oxygen supply to the brain stops within minutes.

The Heimlich maneuver is a mechanical first-aid intervention that comes into play when a total obstruction occurs. Even if we completely exhale, there is always a small amount of residual air in our lungs. When a sudden, firm pressure is applied from the outside to the diaphragm—the muscle separating the abdominal and chest cavities—this residual air is rapidly pushed upward. The trapped air forcefully expels the object blocking the windpipe, much like popping a cork out of a bottle. This method is globally recognised as a life-saving standard exclusively for emergencies where the airway is completely blocked and the person cannot breathe.

Causes and Risk Factors of Airway Obstruction

Airway obstructions are accidents that can happen to any age group, usually resulting from carelessness or chewing difficulties. In adults, the most common cause of choking is poor eating habits. Trying to swallow without chewing properly, or talking and laughing enthusiastically during a meal, paves the way for food to go down the wrong pipe. Large pieces of meat, or traditional treats like lokum (Turkish delight), leblebi (roasted chickpeas), and hazelnuts are frequent culprits in adult choking cases. Additionally, alcohol consumption slows down swallowing reflexes, increasing the risk of choking during a meal.

Swallowing difficulties (dysphagia) are common in the elderly and those with neurological conditions. Elderly patients using dentures are at risk of choking because they cannot fully feel the size or hardness of the food in their mouths. Conditions like stroke, Parkinson's, or Alzheimer's disease also disrupt the coordination of swallowing muscles, elevating the risk.

Babies and children under three form the highest risk group because they tend to explore the world with their mouths. In this age group, foods like grapes, hot dog slices, hard candies, and popcorn, alongside foreign objects like coins, small toy parts, batteries, and marbles, are the items most frequently lodged in the windpipe. Children running or playing while eating is another major factor that triggers this dangerous situation.

Choking Symptoms: Partial vs. Total Obstruction

When an object enters the windpipe, distinguishing whether the obstruction is partial or total is vital for providing the correct first aid. In a partial obstruction, the airway is not completely closed. The person can breathe, speak, cry, and, most importantly, cough forcefully. In this scenario, the patient's skin colour remains normal, or they might be slightly flushed from the effort of coughing. You must never perform the Heimlich maneuver or slap the back of someone experiencing a partial obstruction. Slapping the back can cause the dislodged object to drop deeper, completely sealing the airway. The only thing you should do is encourage the person to cough and stay by their side to monitor their condition.

In the case of a total obstruction, the situation is much more severe and deteriorates within seconds. Because the airway is completely blocked, the person cannot breathe, speak, or cough. The most obvious sign of a total obstruction is the person clutching their own neck with both hands in a panic; this is known as the universal sign of choking.

• The person trying to speak but unable to make a sound
• A distinct look of panic and fear in the eyes
• A high-pitched, whistling sound when trying to breathe
• The onset of a bluish tint (cyanosis) on the lips, face, and nail beds
• Clouding of consciousness due to rapidly increasing oxygen deprivation

When the above symptoms are observed, the Heimlich maneuver must be started without losing any time. If the intervention is delayed, the person will lose consciousness and collapse within a few minutes.

Step-by-Step: How to Perform the Heimlich Maneuver

The way the Heimlich maneuver is applied varies depending on the person's age, weight, and physical condition. Using the correct technique ensures both the successful removal of the object and minimises the risk of harming the patient.

Performing on Adults and Older Children

When you see an adult experiencing a total obstruction, first stay calm and move behind the patient. Place one of your legs between the patient's legs to gain support and prevent them from falling. Make a fist with one hand and place the thumb side of your fist just above the patient's belly button, below the end of the rib cage (the pit of the stomach). Grasp this fist tightly with your other hand. After wrapping your arms around the patient's waist, pull your fist inward and upward with a sudden, forceful motion. You should perform this movement as if you are slightly lifting the patient off the ground. Repeat this inward and upward thrusting process five times in a row until the object comes out or the patient loses consciousness. If it does not come out, continue the process.

Performing on Babies (Under 1 Year Old)

Because babies' internal organs are very delicate, abdominal thrusts are not applied to them. Lay a choking baby face down along your forearm. Support the baby's neck by grasping their jaw with your hand, but be careful not to squeeze their mouth or throat. Rest your arm on your thigh for support. Use the heel of your other hand to deliver five firm, sweeping back blows between the baby's shoulder blades. If the object does not come out, carefully turn the baby over onto their back along your other forearm. Ensure their head is slightly lower than their chest. Apply five quick downward chest thrusts using two fingers on the lower half of the breastbone. Continue the cycle of five back blows and five chest thrusts until the object is expelled.

Performing on Pregnant Women and Severely Overweight Individuals

For pregnant women or obese patients with a very wide abdominal girth, placing a fist over the belly button is both difficult and dangerous for the baby. For these individuals, the maneuver is performed over the chest. Stand behind the patient and pass your arms under their armpits. Place your fist on the lower half of the breastbone. Grasp your fist with your other hand and pull it sharply straight back towards you. Be careful to apply pressure only inward, not upward.

Performing on Yourself When Alone

If you are in danger of choking while alone, you can perform this maneuver on yourself. Make a fist with one hand, place it just above your belly button, grasp your fist with your other hand, and push inward and upward. If your own strength is not enough, find a hard, angular object at waist height. The back of a chair, the edge of a table, or a kitchen counter are suitable for this. Press your body quickly downward by wedging your fist between your abdomen and the object, or by pressing your abdomen directly against the edge of the object. This will provide the sudden pressure needed on the diaphragm.

What to Do After the Intervention

When the Heimlich maneuver is successful and the object is expelled, the person takes a deep breath of relief, their colour returns to normal, and they begin to cough. Often, the patient feels fine and thinks the danger has completely passed. However, the first-aid process does not end with the removal of the object. Small fragments of the object that caused the choking might have slipped into the lungs. Although this might not be noticed initially, it can lead to serious lung infections known as aspiration pneumonia in the following days.

Furthermore, hard or sharp objects forced out of the throat can cause scratches, irritation, and swelling (oedema) in the windpipe. This swelling can worsen within hours, making breathing difficult again. No matter how well the patient feels, they must visit a healthcare facility and be examined by a doctor to ensure their airways are clear and there is no residual tissue damage.

Possible Complications and Risk Groups

By its very nature, the Heimlich maneuver is a highly forceful intervention requiring sudden strength. Because saving a life is the primary priority, the use of this force is unavoidable, but it can bring about some physical complications. The severe pressure applied to the abdomen and lower ribs can cause rib fractures, especially in elderly patients with osteoporosis. Fractured ribs carry the risk of damaging the lining of the lungs.

In addition to this, injuries to internal abdominal organs can occur. Damage to the stomach valve, bruising of organs like the liver or spleen, and, rarely, internal bleeding cases are documented in medical literature. While these complications may seem intimidating, it must be remembered that the risk of death in a total obstruction is one hundred percent. Following this life-saving intervention, a detailed examination, ultrasound, or X-ray at the hospital can quickly identify and treat any potential complications.

When to Call 112 and Go to the Emergency Room

Choking emergencies are a race against time. If someone else is with you, they should immediately call the 112 Emergency Call Centre while you assess the patient's condition and prepare for the Heimlich maneuver. If you are alone and need to treat the patient, you can put your phone on speaker, call 112, and perform the maneuver simultaneously. If you are choking by yourself, it is vital to leave your door ajar, call 112, and report your location before you lose consciousness.

If the object does not come out despite the Heimlich maneuver and the person loses consciousness, you must stop the maneuver immediately. Carefully lay the unconscious patient on their back on a hard, flat surface. Call 112 right away to report that the patient has lost consciousness and begin basic life support (CPR) without losing time. The chest compressions during CPR increase intrathoracic pressure, which can also help dislodge the object. Before giving rescue breaths, check inside the patient's mouth; if you can clearly see the object and believe you can remove it in a single swipe, do so. However, if you cannot see the object, never blindly sweep your finger into the throat, as this can push the object deeper.

Emergency Procedures at BHT CLINIC İstanbul Tema Hastanesi

After a choking hazard has been averted or in emergencies where the object cannot be removed, going to the emergency department of a fully equipped hospital is crucial. BHT CLINIC İstanbul Tema Hastanesi, with its 24/7 Emergency Department, has the infrastructure to instantly intervene in all types of respiratory emergencies. For choking cases arriving at our hospital, our specialist doctors first check whether the patient's airway is completely open and monitor their blood oxygen levels.

When necessary, imaging methods are used to detect small fragments left in the respiratory tract or any resulting irritation. If a foreign object has descended deeper into the windpipe, our multidisciplinary approach brings in our Ear, Nose, and Throat (ENT) or Pulmonology specialists to safely remove the object using advanced endoscopic methods like bronchoscopy. Any rib fractures or internal organ trauma that may develop due to the Heimlich maneuver are also evaluated in detail in our emergency department, and the necessary treatment plan is mapped out. For general health check-ups outside of emergencies, you can book an appointment via BHT CLINIC.

Frequently Asked Questions

Can someone who doesn't know how to do the Heimlich maneuver perform it?

Yes, in an emergency total obstruction, even someone with no training can save a life by applying the basic steps. The fundamental logic is to apply firm inward and upward pressure to the abdominal cavity. However, taking a first-aid training course when you have the opportunity is always the safest option.

Is the Heimlich maneuver performed for a partial obstruction?

No, absolutely not. If the person can cough, make sounds, or cry, the airway is not completely closed. In this case, do not slap the patient's back or perform the Heimlich maneuver; simply encourage them to cough forcefully.

Why is the Heimlich maneuver different for babies?

Babies under one year old do not have fully developed abdominal muscles, and their internal organs are very delicate. Because firm pressure on the abdomen could cause serious tears in organs like the liver or spleen, only back blows and chest thrusts are applied to babies.

What should be done if the object doesn't come out and the patient faints?

If the person loses consciousness, stop the Heimlich maneuver and carefully lay the patient on the floor. Call 112 immediately and begin basic life support (CPR) until professional teams arrive.

Does drinking water clear the obstruction?

In the event of a total obstruction, because the windpipe is closed, any water given will not go to the lungs but to the stomach, and it will not resolve the choking. In partial obstructions, trying to make the person drink water can disrupt their coughing reflex, causing the object to slip deeper.

This article is for informational purposes only; please consult your doctor for diagnosis and treatment.