Editing Abdominal thrusts (section)

== Technique ==
Both the [[American Red Cross]] and UK [[National Health Service]] (NHS) advise that for a first attempt, a rescuer should encourage the patient to expel the obstruction by coughing. As a second measure, the rescuer should deliver five slaps to the back after bending the patient forward. Abdominal thrusts are recommended only if these methods fail.

[[File:Abdominal thrusts, point of applying.jpg|thumb|Point of application of abdominal thrusts (between chest and navel). The hands press inward and upward.|alt=]]
The American Red Cross, the NHS, the [[European Resuscitation Council]] and the Mayo Clinic recommend a repeating cycle of five back slaps and five abdominal thrusts.<ref name="redcross.org">{{cite web|title=STEP 3: Be Informed – Conscious Choking {{!}} Be Red Cross Ready|url=http://www.redcross.org/flash/brr/English-html/conscious-choking.asp|website=www.redcross.org|access-date=December 4, 2017}}</ref><ref name="nhs">{{cite web|url=https://www.nhs.uk/common-health-questions/accidents-first-aid-and-treatments/what-should-i-do-if-someone-is-choking|title=What should I do if someone is choking? NHS.UK|date=October 30, 2015|access-date=July 26, 2018}}</ref><ref name=ERC2010>{{cite journal |last1=Nolan |first1=JP |last2=Soar |first2=J |last3=Zideman |first3=DA |last4=Biarent |first4=D |last5=Bossaert |first5=LL |last6=Deakin |first6=C |last7=Koster |first7=RW |last8=Wyllie |first8=J |last9=Böttiger |first9=B |last10=ERC Guidelines Writing Group |title=European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary |journal=Resuscitation |volume=81 |issue=10 |pages=1219–76 |doi=10.1016/j.resuscitation.2010.08.021| pmid=20956052 |year=2010|hdl=10067/1302980151162165141 |hdl-access=free }}</ref><ref name=MayoClinic-Nov-2011/> They are not recommended on children below the age of one.<ref name="Medline" /><ref name="nhs"/> In contrast to the prevailing American and European advice, the Australian Resuscitation Council recommends chest thrusts instead of abdominal thrusts.<ref>
{{Cite web|url=http://www.resus.org.au/policy/guidelines/section_4/airway.htm |title=Australian (and New Zealand) Resuscitation Council Guideline 4 AIRWAY |publisher=Australian Resuscitation Council (2010) |access-date=February 9, 2014 |url-status=dead |archive-url=https://web.archive.org/web/20140214093540/http://www.resus.org.au/policy/guidelines/section_4/airway.htm |archive-date=February 14, 2014 }}</ref>

To perform a Heimlich maneuver, a rescuer stands behind an upright patient, using the hands to exert forceful pressure on the bottom of the [[diaphragm (anatomy)|diaphragm]].<ref>{{Cite web |title=How To Do the Heimlich Maneuver |url=https://my.clevelandclinic.org/health/treatments/21675-heimlich-maneuver |archive-url=http://web.archive.org/web/20250303235904/https://my.clevelandclinic.org/health/treatments/21675-heimlich-maneuver |archive-date=2025-03-03 |access-date=2025-03-18 |website=Cleveland Clinic |language=en}}</ref> As an example, [[WebMD]] recommends making a fist with one hand and grasping the fist with the other in order to press with both just above the patient's [[navel]]. This compresses the lungs and exerts pressure on any object lodged in the [[vertebrate trachea|trachea]] in an effort to expel it. The pressure amounts to an artificially induced [[cough]]. To assist a larger person, more force may be needed.<ref>{{Cite web |title=Heimlich Maneuver for Adults and Children Older Than 1 Year - Topic Overview |url=http://firstaid.webmd.com/tc/heimlich-maneuver-for-adults-and-children-older-than-1-year-topic-overview |archive-url=https://web.archive.org/web/20160306091727/http://www.webmd.com/first-aid/tc/heimlich-maneuver-for-adults-and-children-older-than-1-year-topic-overview |archive-date=March 6, 2016 |website=WebMD}}</ref> The Mayo Clinic recommends the same placement of fist and hand, with upward thrusts as if the rescuer is attempting to lift the victim.<ref name="MayoClinic-Nov-2011" />

If the victim cannot receive pressure on the abdomen (for example, in case of pregnancy or excessive obesity), chest thrusts are advised.<ref>{{Cite web|url=https://ehs.okstate.edu/site-files/docs/cpr-and-choking-5-min-safety-talk.pdf/|title=Choking Safety Talk|website=Oklahoma State University|url-status=live|archive-url=https://web.archive.org/web/20200130145512/https://ehs.okstate.edu/site-files/docs/cpr-and-choking-5-min-safety-talk.pdf/|archive-date=2020-01-30}}</ref> These are applied on the lower half of the chest bone, but not in the very endpoint (the [[xiphoid process]], which could be broken).

For victims who are not in an upright position, The American [[National Institutes of Health]] recommends positioning the victim on the back, then straddling the torso and employing chest thrusts.<ref name="Medline">{{cite web|title=Abdominal thrusts|url=https://www.nlm.nih.gov/medlineplus/ency/article/000047.htm|website=MedlinePlus|publisher=National Institutes of Health|access-date=March 11, 2016}}</ref>

It is possible for conscious choking victims to perform the procedure on themselves, without assistance.<ref name="MedlineSelf">{{cite web|title=Heimlich maneuver on self |url=https://www.nlm.nih.gov/medlineplus/ency/article/001983.htm|website=MedlinePlus |publisher=National Institutes of Health|access-date=March 11, 2016}}</ref>

Because of the forceful nature of the procedure, even when performed correctly, abdominal thrusts can injure the victim. Bruising to the [[abdomen]] is highly likely and more serious injuries can occur, including fracture of the [[xiphoid process]] or [[rib]]s.<ref>{{Cite web|url=http://www.health.discovery.com/encyclopedias/illnesses.html?article=671 |title=Heimlich maneuver on self |publisher=Discovery Channel |last=Broomfield |first=James |date=January 1, 2007 |access-date=June 15, 2007}}</ref> The NHS recommends that victims subjected to abdominal thrusts should seek medical attention after the event.<ref name="nhs" />

Researchers at [[Royal Brompton Hospital]] have demonstrated that levels of intrathoracic pressures (50–60 cmH<sub>2</sub>O) exerted by inward abdominal thrusts are similar to those produced when the force is directed both inward and upward. The researchers argue that this may be easier to perform with less concern for injury to the rib cage or upper abdominal organs. Self-administered abdominal thrusts by study participants produced similar pressures to those generated by administers of first aid. The highest pressures were produced by participants performing an abdominal thrust by pressing onto the back of a chair (115 cmH<sub>2</sub>O).<ref>{{Cite journal |date=April 5, 2017 |title=Choking on a foreign body: a physiological study of the effectiveness of abdominal thrust manoeuvres to increase thoracic pressure |url= |journal=Thorax |language=en |volume=72 |issue=6 |pages=576–578 |doi=10.1136/thoraxjnl-2016-209540 |issn=0040-6376 |pmc=5520267 |pmid=28404809}}</ref><ref>{{Cite news|url=https://www.telegraph.co.uk/science/2017/04/12/perform-heimlich-manoeuvre-yes-just-effective/|title=How to perform the Heimlich manoeuvre on yourself (and yes, it's just as effective)|work=The Telegraph|access-date=April 13, 2017|language=en-GB}}</ref>