Foreign-body airway obstruction should be considered in any victim- especially a younger victim -who suddenly stops breathing, becomes cyanotic, or loses consciousness for no apparent reason.

The Heimlich maneuver (subdiaphragmatic abdominal thrusts) is recommended for relieving foreign-body airway obstruction. By elevating the diaphragm, the Heimlich maneuver can force air from the lungs to create an artificial cough intended to expel a foreign body obstructing the airway. Each individual thrust should be administered with the intent of relieving the obstruction. It may be necessary to repeat the thrust several times to clear the airway. Five thrusts per sequence is recommended.

When you perform this maneuver, you should guard against damage to internal organs, such as rupture or laceration of abdominal or thoracic viscera. To minimize this possibility, your hands should never be placed on the xiphoid process of the sternum or on the lower margins of the rib cage. They should be below this area but above the navel and in the midline.

Regurgitation may occur as a result of abdominal thrusts. Be prepared to position the patient so aspiration does not occur.

HEIMLICH MANEUVER WITH VICTIM STANDING OR SITTING.-To perform the Heimlich maneuver with victim standing or sitting, stand behind the victim, wrap your arms around the victim's waist, and proceed as follows:

Step 1-Make a fist with one hand.
Step 2-Place the thumb side of the fist against the victim's abdomen, in the midline slightly above the navel and well below the tip of the xiphoid process.

Step 3-Grasp the fist with the other hand and press the fist into the victim's abdomen with a quick upward thrust. See figure 4-5.

Step 4-Repeat the thrusts and continue until the object is expelled from the airway or the patient becomes unconscious. Each new thrust should be a separate and distinct movement.

HEIMLICH MANEUVER WITH VICTIM LYING DOWN.-To perform the Heimlich maneuver with victim lying down, proceed as follows:

Step 1-Place the victim in the supine position (face up).

Step 2-Kneel astride the victim's thighs and place heel of one hand against the victim's abdomen, in the midline slightly above the navel and well below the tip of the xiphoid.

Step 3-Place the second hand directly on top of the first.

Step 4-Press into the abdomen with a quick upward thrust. See figure 4-6.

Figure 4-5.-Administering the Heimlich maneuver to a conscious victim who is standing.

Figure 4-6.-Administering the Heimlich maneuver to an unconscious victim who is lying down.

If you are in the correct position, you will have a natural midabdominal position and are unlikely to direct the thrust to the right or left. Arescuer too short to reach around the waist of an unconscious victim can use this technique. The rescuer can use their body weight to perform the maneuver.

CHEST THRUSTS WITH VICTIM STANDING OR SITTING.-This technique is used only in the late stages of pregnancy or in the markedly obese victim. To perform chest thrusts with victim standing or sitting, proceed as follows:

Step 1-Stand behind the victim, with your arms directly under the victim's armpits, and encircle the victim's chest.

Step 2-Place the thumb side of your fist on the middle of the victim's sternum (breastbone), taking care to avoid the xiphoid process and the margins of the rib cage.

Step 3-Grab your fist with the other hand and perform backward thrust until the foreign body is expelled or the victim becomes unconscious. See figure 4-7.