Episode Transcript
Scot: Somebody's choking on some food, what do you do? Do you give the Heimlich maneuver? Do you even know how? We're going to find out the answers to those and other questions right now, with Dr. Troy Madsen, Emergency of Medicine at University of Utah Hospital.
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Scot: Let's talk about the Heimlich maneuver. Is an effective tool.
Dr. Madsen: It is. You know, the Heimlich maneuver actually works, and we talk about CPR sometimes, and we talk about well maybe CPR works, maybe 5 to 10% of the time. The Heimlich maneuver, in my experience, works most of the time. And it's really surprising to me, because we think about all this research we have on CPR. I just can't find much research at all on the Heimlich maneuver. But I can tell you, I've seen many cases in the E.R. of people who have been brought in, who are say at a restaurant or at home, something happened. Someone administered the Heimlich maneuver, it got that piece of meat or food out, and they came in the E.R. and were fine. You know, they walked out of the E.R. later. So there's no question in my mind it works and it works the majority of the time.
Scot: So there are likely all sorts of videos online, if you want to learn how to do the Heimlich maneuver.
Dr. Madsen: Sure.
Scot: Can you do a brief overview of what you should do? And then I'd like to find out from your perspective, how do I know I'm doing it right?
Dr. Madsen: Yeah. Yes, so the big thing you want to do is number one, stand behind the person. So as long as you can get behind them, that's a great position to be in. And then reach around the front, make one hand into a fist, the other hand on top of it. Place that fist just down below the rib cage in the midline, so you're right over the stomach there, and then with both hands force that stomach up. And so if you really think about what you're doing, like I said, you're thinking you're forcing the stomach. The big thing I'm trying to do is just put lots of pressure on the lungs, because we've got food stuck in the trachea, in the breathing tube. So if I can get a lot of force on the lungs by pushing up on the stomach into the diaphragm, that's going to force that air out of the trachea, and hopefully make that piece of food pop right out.
Scot: So how hard am I doing this? Am I lifting somebody off the ground with each. . . what do you call that when you, each thing.
Dr. Madsen: Yeah so with each thrust there . . .
Scot: Thrust.
Dr. Madsen: You are lifting this person.
Scot: Okay.
Dr. Madsen: If you can you know, it's a lot of force.
Scot: All right.
Dr. Madsen: And again, you're thinking the more force the better. It's kind of like you know, you think about you're in grade school and you got like a . . . you're shooting spit wads at the ceiling or something. It's the same concept. It's just lots of air pressure all at once. Immediate force that shoots something straight up, and that's what you're trying to do with that force down there.
Scot: So how do you actually know if you should start administering the Heimlich maneuver to somebody?
Dr. Madsen: So this is a great question, because you know, the Heimlich maneuver is not without harm. There are plenty things that have shown you put that much force on a person's stomach, you can cause injury to their spleen, their liver, their large vessel, their stomach. So you really need to know this person is choking, and a universal sign of chocking is a person is holding their hands over their throat. Often times they may be turning blue. If a person can speak to you, that means they are moving air through their airway, they do not need the Heimlich maneuver, but that person generally, well they should not be able to speak because their airway is completely blocked, which means they can't get any air through there. You know, if they are speaking to you but feel like something's stuck in there you can call 9-1-1, but you don't need to start doing thrusts or forcing air into their lungs, or pushing on their stomach.
Scot: When we talked about CPR you tell your students that if you're not hearing ribs cracking, you're not doing compressions hard enough. Is there anything equivalent in the Heimlich maneuver?
Dr. Madsen: You don't want to crack ribs. You're going to be down lower there.
Scot: Okay.
Dr. Madsen: But I'm just . . . it's just got to be much force . . .
Scot: Much force.
Dr. Madsen: As you can push there. Yeah.
Scot: So channel any anger that you had towards . . .
Dr. Madsen: Yeah.
Scot: . . . relative right in there.
Dr. Madsen: Channel anger, fear, whatever emotions running through you at that point, channel it into those thrusts to really try and get some pressure there.
Scot: How long do I keep doing that?
Dr. Madsen: Keep doing it until they're responding.
Scot: Okay.
Dr. Madsen: And if they get to a point where they are unresponsive, where they lose a pulse, then you have to start CPR.
Scot: Okay.
Dr. Madsen: And often times, once you're doing in those chest compressions, those nice deep chest compressions, that sometimes will generate enough force on the lungs to make that food pop out. But you keep doing it until they respond.
Scot: What about the balance of somebody starts choking, somebody starts giving the Heimlich maneuver. Do you call 9-1-1 at that point? I mean at what point would you make that phone call?
Dr. Madsen: I would make it immediately. And if you're in a situation where you have other people there, that's one thing you're going to say, call 9-1-1. I'm doing the Heimlich maneuver. If I'm in a situation where it's just me and another person, I'm going to do the Heimlich maneuver.
Scot: Okay.
Dr. Madsen: But then if it gets to a point where you are administering CPR, then you call 9-1-1. But usually most of the time, if you just get the Heimlich maneuver going, you're going to be successful.
Scot: And then do you call 9-1-1 back and say cancel it or . . .
Dr. Madsen: I would still have them come.
Scot: Okay.
Dr. Madsen: And at the very least, the EMTs are going to come. They're going to evaluate the patient. In my experience, they will sometimes transport that patient to the emergency department, just depending if the patient still feels like something may be lodged in there. If the patient is completely symptom free, they may just release them. But at least you can get a medic to check their vital signs and check them out.
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