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Doctor's Consultation  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 dislodged.
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 forward slightly.
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 airway.

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Henry Heimlich and you