by Dr. Iain Corness
Henry Heimlich and you
My daughter choked on a steak sandwich
last week. Sitting opposite me she gave a muffled sound and looked as if she
were about to vomit, then quite panicked, managed with her fingers to
dislodge a large chunk of partially chewed steak, before I could rush round
the table and administer First Aid. It was a frightening experience for her.
And for her father!
Some fairly famous names have gone before her in the choking situation.
Tennessee Williams, the playwright, died after choking on a bottle cap.
An urban legend states that obese singer Mama Cass choked to death on a ham
sandwich. This theory arose out of a quickly discarded speculation by the
coroner, who noted a partly eaten ham sandwich and figured she may have
choked to death. In fact, she died of a heart condition, often wrongly
referred to in the media as heart failure.
Queen Elizabeth The British Queen Mother notably experienced three major
choking incidents where a fish bone became lodged in her throat: initially
on 21 November 1982, when she was taken from Royal Lodge to the King Edward
VII Hospital for an operation at 3am; secondly in August 1986 at Balmoral,
when she was taken to the Aberdeen Royal Infirmary, though no operation was
needed that time; and in May 1993, when she was admitted to the Aberdeen
Infirmary once again for an operation under general anesthetic.
And for a bit of real life/Hollywood drama, Dr. Royce Johnson performed an
emergency tracheostomy on Pauline Larwood (Bakersfield California resident)
at “The Mark” a local restaurant. Pauline was choking on her steak when Bo
Fernandez, General Manager / Executive Chef at The Mark said, “She’s
choking! She’s choking!” After attempting the Heimlich maneuver Dr. Johnson
made an incision on Larwood’s throat and inserted the casing of a ballpoint
pen into her trachea. Larwood was then rushed to a local hospital and was
further treated, but the biro pen case was enough to give her an airway. For
those who follow movies, the biro pen was used in James Thurber’s The Secret
Lives of Walter Mitty, ta-pocketa-pocketa-pocketa.
So what do you do when someone is choking? The following comes from the Mayo
Clinic. Choking occurs when a foreign object becomes lodged in the throat or
windpipe, blocking the flow of air. In adults, a piece of food often is the
culprit. Young children often swallow small objects. Because choking cuts
off oxygen to the brain, administer first aid as quickly as possible.
The universal sign for choking is hands clutched to the throat. If the
person doesn’t give the signal, look for these indications:
Inability to talk
Difficulty breathing or noisy breathing
Inability to cough forcefully
Skin, lips and nails turning blue or dusky
Loss of consciousness
If choking is occurring, the Red Cross recommends a “five-and-five” approach
to delivering first aid:
Give five back blows. First, deliver five back blows between the person’s
shoulder blades with the heel of your hand.
Give five abdominal thrusts (also known as the Heimlich maneuver).
Alternate between five blows and five thrusts until the blockage is
The American Heart Association doesn’t teach the back blow technique, only
the abdominal thrust procedures. It’s OK not to use back blows, if you
haven’t learned the technique. Both approaches are acceptable.
To perform abdominal thrusts (Heimlich maneuver) on someone else:
Stand behind the person. Wrap your arms around the waist. Tip the person
Make a fist with one hand. Position it slightly above the person’s navel.
Grasp the fist with the other hand. Press hard into the abdomen with a
quick, upward thrust - as if trying to lift the person up.
Perform a total of 5 abdominal thrusts, if needed. If the blockage still
isn’t dislodged, repeat the five-and-five cycle.
In addition to the above recommendation from the Mayo Clinic, I would
suggest that at all times you should be looking for signs that the person is
not getting enough oxygen, and it may be necessary to institute CPR and ring
for an ambulance.
If the person becomes unconscious, perform a sweep of the mouth to attempt
to dislodge the object, being careful not to push it further into the