2 months ago, a young doctor died in Trissur when she choked on a piece of food while at the mall food court. What was really tragic was that she was not alone -  there were hundreds of people in the mall at that time. And yet,  none could help dislodge the piece of food that went down her airway. Residing in India, you all would have read this news article,  I assume. You would have lamented the tragic loss and shook your head, I am sure.

Here's my question to you - did you go online and read what should have been done under such circumstances to save a life? 

I am guessing the answer to that is no. 

I had written in detail about this years ago but now is as good a time as any to review this topic on the blog so that everyone can learn/recall what they know about it. 

The Heimlich maneuver requires no specific medical expertise. Dr Henry Heimlich devised this precisely for that reason - because doctors cannot be everywhere and a person can choke to death in minutes. 

Choking is defined as the inability to breathe due to obstruction of the trachea. It is a medical emergency as the obstruction prevents air from entering the lungs. If this obstruction cannot be relieved, the lack of oxygen will eventually lead to death.

Every year, nearly 1,00,000 people die due to accidental suffocation of food or a foreign body.

Signs and Symptoms of a blocked airway :

Choking is usually a sudden event.

  • The person may desperately grab at his throat. 
  • He maybe unable to cough or have a weak cough.
  • He won't be able to speak or cry out.
  • As oxygen-lack sets in, his face will turn blue and he may lose consciousness.

For the sake of clarity, we'll discuss the Heimlich maneuver under six separate categories :

  1. Adults
  2. Children more than 1 year of age.
  3. Infants ( less than 1 year of age. )
  4. Pregnant women / Obese people.
  5. If you start to choke when you are alone.
  6. Pets
In all cases, if the person is able to speak or cough forcefully, do not forcefully attempt the HM on the person. But do keep a strict eye on him as unsuccessful attempts could lead to rapid deterioration and require your active assistance.

1. Adults :

This wonderful illustration does all my work for me : giving a visual idea as well as directions.

Please note:
  • Principle: The HM raises the diaphragm and thus compresses the lungs, forcing air out of it at a pressure high enough to expel the object.

2. Children greater than 1 year 

The same steps apply as in the case of adults with the single change that you may need to kneel to get your hands at the same level of the child's abdomen.

3. Infants ( less than 1 year )

This is slightly more tricky. It involves a bit of tricky maneuvering of the infant and two separate actions.

a) Back slaps.

Kneel or sit and place the infant in your lap.Look at the picture clearly.

Note how we've turned the infant's face downwards while also giving support to the head. Be careful not to inadvertently apply pressure on the neck while doing this.
Also note how you can support both your hand and the infant with your lap by sitting down.
Give up to 5 back slaps between the infant's shoulder blades with enough force to dislodge the foreign body. 
If it hasn't dislodged, you move to Step B.

  • Turning the child over is gonna be tricky. Remember that hand you gave the back slaps with ? Place that hand over the child's back, supporting even the head. The child is now sandwiched between both your hands and with one palm supporting the face and the other supporting the back of the head, turn him over. 

  • Again, support the child with your arm and thigh and place the head lower than the trunk. Give 5 quick downward thrusts ( 1 per second ) over the lower part of the breastbone. Repeat until the infant spits out the object or becomes unresponsive.

4. Pregnant women /Obese people

Instead of abdominal thrusts as seen in HM, deliver chest thrusts.

5. What if you are alone?

Find a surface you can lean forward on ( eg : a chair ) and after positioning your hands as mentioned earlier, give rhythmic forceful thrusts. 

6. Pets

What happens if your attempts have been unsuccessful and the person becomes unconscious ?

Call for help and start compressions. 
When you open the airway to deliver breaths, check if you can visualise the foreign body. If yes, remove it. Otherwise continue till help arrives or the child regains consciousness.

Speaking as a doctor, a big mistake you all make is in assuming that only a doctor can save you at all times. The whole point of the Heimlich maneuver was to help the everyday Joe,  Janet and Jamila save a life in case of an emergency. 

Somebody choking with an obstructed airway does not have a lot of time. Every second counts. You cannot wait for an auto rickshaw or ambulance and wade through traffic to reach a hospital. 
You have minutes before the person or child loses consciousness. 
A few more before brain damage begins. 
A few more before they are lost forever. 

These are fragile lives we have. The unforeseen lurks around every corner. 
I pray you never have a reason to give the Heimlich to anyone in your life. But if the situation arises, I hope you will step up and save a life. 

P. S.  An interesting footnote
Dr Henry Heimlich who devised this maneuver in 1974 and taught it thousands of times over the years used it for the first time in his life a few months ago in May 2016 to save the life of an 87 year old man dining next to him at an assisted living facility. 

Dr Henry Heimlich was 96 years old when he performed it. 

Which means I was 61 years younger than he was when I performed it for the first time in my life last week.

Authors note:

This is my take on the theme "Fragile Lives" for the blogger challenge Blog-A-Thon by Blog-A-Rhythm. You can read other entries for this theme by fellow bloggers here.

During this 7 day challenge, I have written on:
Day 4 - Caught Red Handed - Doggone it! (Dog years)
Day 5 - Robert the Doll (Horror/ Real life)
Day 6 - The Saviour (Short Fiction) 
Day 7 - Recipe - Easy Eggless Chocolate Cake (Food)


Vasantha Vivek said…
Alarming post at the right time. Thanks for educating me about choking and its remedies. Let us celebrate life with Blue Lagoon.
Vasantha Vivek said…
Alarming post at the right time. Thanks for educating me about choking and its remedies. Let us celebrate life with Blue Lagoon.
mahathi ramya A said…
Very informative post Roshan. I have 2 kids and i was always worried on what can be done if they swallow some objects like coins or something which obstruct their throat. Kids are very naughty and unpredictable you know.. ☺
Jaibala Rao said…
Thank You for this post doc. Bookmarking it.
swati bassi said…
This post is very much helpful. Saving your post in my folder. Thanks a lot.
Very vital info doc...I lost my Chachu to choking two years back. unfortunately, his wife who was home with him, didn't know what to do, not that I would have known what to do either. circulating this to my family and friends. who knows whom it might end up helping...

Shubhangi @ The Little Princess
Rachna said…
I have read about and seen this manoeuver being performed. I went over your graphics again. Now I am wondering if I should just practice it on someone to see if I can do it properly. Very useful info, doc.
tulika singh said…
I had no clue it was that common and also that it wasn't really difficult to perform it. I've seen it in films and on television mostly. Thank you for this Roshan.
Vinodini Iyer said…
Thanks for this vital info! You never know when and who would require this.
Rajlakshmi said…
I recently got the news of an infant dying becauseof choking. If only someone knew this. This is a vital information. Thank you for sharing it. Loved the facts at the end.
Neha Gupta said…
That's quite a practical take on the prompt. Excellent and informative.
Kala Ravi said…
Doc, saving and sharing this one! And simply amazing that Heimlich got to do it at 96 and also that you have already carried it out! Wish they taught this one in schools too!
Shilpa Garg said…
I have looked at the diagrams more closely and hoping to remember the technique. It's not difficult for adults but certainly need practice. Thanks for sharing this life saving info, Roshan!
Nabanita said…
I hope I remember the technique. Thanks for this , Doc...
Mithila Menezes said…
Too informational! Will share this with near and dear ones! Most of us just know of the term Heimlich manuever. I've hardly ever pondered about the different manuevers needed for people of different ages!

Thanks for sharing this, doc! :)
Bhavya N said…
So I do know this manuever, but had no clue about how to do it on babies.
It is scary to think that people die just because most of us do not know something as basic as this. Maybe we need classes on First Aid and such basic hacks to save someone's life in an emergency.
Geets said…
That is indeed a very helpful post that you've shared doc. Otherwise most of us only wait for doctor's assistance oblivious to the fact that even we could do it by ourselves!
Thanks for writing this one!


Tina Acharya said…
Its such a informative post, Enlightening and touching!!
Anonymous said…
Dear Dr. Roshan, you have done a great job by a good effort to spread this messgae. As a Anesthesiologist you have taken a good step to motivate common people to save life. Great job
I think you have posted this in FB back then, I remember reading this. Such a tragic happening even when you're surrounded by so many people.
Carol Graham said…
This is exactly what I have been looking for -- a simple guide that covers it all -- THANK YOU. THANK YOU
A very informative post, Doc. And fits the theme brilliantly.
I remember the last post. These posts can not be highlighted and brought forward enough!
thank yu sir... as usual.. u r awsome..
Glad to help. And yes, indeed we need to celebrate life. You never know when a random event can cut it short
Save the post. Hopefully you will never have to use it in real life.
Thanks.. and yes. Please do save it.
That is the problem. People do not realize that this is something that can happen to anyone at any point of time. And knowing this can really be the difference between life and death
Don't know if practising on a live person is gonna be fun on that person :)
But do practise on a pillow or something for sure.
In films, it is usually used as a comic gag. People miss the fact that it is life threatening.
Exactly. That is why sharing is so important
Exactly. so many instances like this happen every day. Knowledge is power in this case.
I wish they taught this to all teachers at least if not the students.
Except for infants, most of the other cases are pretty straight forward.
Save the page.. or get a print out. Just remember the key steps when the time comes.
Not many realize there are different steps for different age groups... and yes, many know the name but not how to do it
That is the problem. Everyday people die of this. And it is something very common that could have been avoided.
Waiting for a doctor when this happens at home is almost sure death... thats why it needs to be shared more.
Thanks a lot for this wonderful compliment :)
Yes... I did feel sad reading that story.
You are welcome :) Do save it.
That is eXactly why I chose this for the theme. Seemed essential to showcase