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What to Do When a Choking Victim Is Too Large for the Heimlich Maneuver

Daniel Harris
Biomedical Researcher and Public Health Advocate
Updated on Nov 13, 2024
What to Do When a Choking Victim Is Too Large for the Heimlich Maneuver

When someone is choking when there is no air getting into the lungs, there is always panic among those around and swift action is needed for there is no time to waste. Although most people are familiar with the Heimlich maneuver when someone is choking, it may not always be applicable, particularly when the person who is providing assistance is significantly smaller than the choking victim. Titled Prepare Yourself for a Choking Emergency, this blog provides alternative methods and variations of the classic Heimlich technique for such anthropometric difficulties scenarios. These five articles will provide insights about things to look for in order to make an assessment of the scenario, explaine the best methods how to help the person in distress and picture by picture illustrate how to perform a modification in a step-wise manner to successfully remove an obstruction. Knowing these methods allows for greater preparedness during a choking emergency and leads to greater safety while aiding someone.

How Can You Identify the Signs of Choking?

How Can You Identify the Signs of Choking?

In the event when someone is being choked, there are specific pointers that show that the victim requires quick assistance. Such signs that may be visible include the lack of verbal communication, difficulty in breathing or whistling. The person may also be seen with both or a single hand raised to the neck which is a sign that the person is unable to breathe. Furthermore, you can also see their face turn red and then proceed to blue because of the lack of oxygen. If the underlying cause of choking is an obstruction of the airway, the victim may not even be able to cough or speak that much. As soon as the signs are apparent and active effort is required on the part of the individual, there is no room for further delay.

Recognize the Signs of Choking in Adults

Knowing how to assist someone who is choking or at risk of choking is essential in any grown person. If any such adult has choked, the chances are that the person would find it hard to talk or create sounds and would most likely gasp lightly for air. The most alarming signal is a frightened face with hands on the throat as this almost always points to the person choking themselves. This scenario where at least one of the airways is completely blocked cannot be ruled out, and thus it requires active help without faltering. Their face can also be red and finally blue which is the stage when they are suffocated. Even in these cases where significant damage or even worse has already occurred, it is still possible, with proper quick thinking, to prevent the individual from further harm.

Understanding Airway Obstruction and Its Symptoms

Is there a clear picture that someone is breathing not quite right? When I review this case history I look for a number of factors. Most often, an airway obstruction happens when any object or thing makes it difficult or impossible to breathe through the mouth or the nose. It appears to me that clammy skin, unconsciousness or an inability to speak, or even produce sounds are some of the symptoms. More often than not, those in distress would grasp their throat, change skin color or develop facial redness or blueness. Sometimes, even the violent type of action might be observed due to inhalational obstruction. It is important for me to comprehend these signs so that I can locate the difficulty and the necessary action or instantiation that needs to be put in place to aid the person in panic.

What to Do When a Choking Person Cannot Cough or Speak

In a situation when a choking person does not cough or speak, the condition requires an immediate and correct action of the rescuer. I would consider calling emergency number and informing them about the situation because this is best done as soon as possible. While waiting, I would practice the Heimlich maneuver on someone who is standing up and crouching down in front of me by wrapping their arms around my waist and positioning’s their fist’s thumb just over my sternum. With my first clenched in my other hand, I would position the weapon between their navel and below their ribs. I would now perform swift upward thrusts with my hand until the object gets released or help comes. If such an individual loses consciousness, I would carefully, but not so forcefully, lower him or her to the ground, secure their mouth and nose, and give them mouth-to-mouth resuscitation if they remain unconscious until medics come to render assistance.

What Are the Steps in First Aid for a Large Choking Victim?

What Are the Steps in First Aid for a Large Choking Victim?

In a case of an overweight person who has been choked, it's crucial to remember that the technique will have to be modified. First, if the victim is standing and you do not have sufficient reach to hug their waist for the Heimlich maneuver, try chest thrusts instead. Insert one’s arms under the victim’s armpits and place one’s fist over the center of the really broad chest. Pulsating movements are quick thrusts inwards and upwards at an angle. Should the victim be pregnant or should you not be able to carry out this action, request the victim to lean forward about 30 degrees and hit hard the area between the shoulder blades. If the victim losses consciousness and fails to dislodge the obstruction, Lower them slowly to the ground and commence CPR until medical help is at hand. Make sure that someone contacts the emergency department during these procedures.

Approach a Choking Victim Safely

Caution and effective speech must be adhered to when handling a choking person. Let’s consider an example; introducing yourself first and then asking if you can assist the patient. First, check if the area is safe and remains so for both you and the person who is the victim. If the person is able to, encourage them to cough forcefully in order to clear the obstruction from their airway. If the victim is unable to cough or breathe or speak, continue back slaps or deep abdominal thrusts like the heimlich maneuver. If the victim is a child, change the procedure and kneel to their height. Be ready to change measures for CPR in case the patient loses consciousness and through phone, get in touch with the required help. Keep focus on the area of the body that you are responding to and provide words of assurance continuously.

How to Wrap Your Arms Around a Larger Victim

When I had to perform Heimlich maneuver on larger victim, I would first stand behind them and would put my one foot between their two for ease providing the thrust. One of my arms becomes a fist and is thrust above the navel area, and the others grasps the fist so formed. Depending on the size of the target, I definitely have to put my hands on their chest or change the angle while thrusts which have to be sharp and brisk. When it is impossible for me to hug his waist, I go for the chest thrusts. It is very important that I am calm and confident and have a good mindset to change my approach whenever required to make sure my help is beneficial.

Alternative Techniques to the Heimlich Maneuver

  1. Back Blows: For someone who is choking but not able to receive traditional abdominal thrusts, back blows can be an effective alternative. Stand to the side and slightly behind the victim, support their chest with one hand, and lean them forward slightly. Deliver five strong back blows between the shoulder blades with the heel of your hand. This method can be particularly useful if abdominal thrusts are not possible due to the person's size or medical conditions.
  2. Chest Thrusts: When abdominal thrusts are impractical or ineffective, such as with pregnant individuals or those who are obese, chest thrusts are a viable technique. Stand behind the victim, wrap your arms around their chest, and place your fist on the middle of the breastbone. Grasp your fist with your other hand, and deliver quick, backward thrusts.
  3. Self-Heimlich Maneuver: If alone and choking, leaning over a solid object such as the back of a chair and performing quick thrusts against it can simulate the Heimlich maneuver. Make sure the pressure is focused below the ribcage to effectively dislodge an object from the airway.

For these techniques, ensure that each maneuver is performed with adequate force and positioning to maximize effectiveness while avoiding harm. Always assess the situation continually and call for emergency help immediately when needed.

What to Do If a Choking Victim Becomes Unconscious?

What to Do If a Choking Victim Becomes Unconscious?

In the event that a victim of choking loses consciousness, speed and calmness is vital for the rescuer. The first thing to do is to seek help. After calling for help, it is important to turn the person onto his or her back against a hard platform. Start CPR, beginning with chest compressions. Schemes forcefully take over the center of a person’s chest with the heel of one of their hands, clutch it with the other hand, and pump downwards hard and at an incredibly fast rate: for at least 2 inches deep – at least 100-120 times every minute. After every thirty compressions, the victim’s mouth should be opened to search for an object which could be possibly hampering the victim’s breath. This goes on for as long as necessary until two rescue breaths are administered with the head tilted backwards to open airway, but the nose pinched and blowed forcefully into the mouth, till the chest visibly expands. This procedure should be repeated until the rescuer has new assistance or the person commences breathing. It must be known that without resumption of circulation, and oxygen delivery to the brain- with continuing CPR, chances for recovery are slim.

Transitioning from Conscious Choking to Unconsciousness

When an actively choking victim becomes unconscious, there is a need for urgent intervention. The first thing to do is gently lower the victim to the ground to prevent any more injuries. There is also a need to call for emergency services as soon as possible if this has not been done. In this instance, bear down with 30 chest compressions (as in CPR) to try and get rid of the blockage. Do not give rescue breaths until the obstructing object is removed from the mouth including by using a finger sweep if the obstruction is visible. If after clearing the airway the chest does not rise, go back to compressions and check for obstructions again. Repeat this process until help comes or the person regains consciousness. These measures taken together make sure that the airway is clear enough to allow air flow and blood flow to be maintained for the time being, until further medical care is provided.

Perform CPR on an Unresponsive Victim

When dealing with a victim who is not responding to CPR, the first thing I do is assess their responsiveness by lightly striking the person’s shoulder and yelling “Are you alright?” In case of no response, I scream for assistance and also call the emergency services. Then I make sure that the individual is lying flat on his back on a firm surface. I go to the person’s side and begin chest compressions by placing the heel of one of my hands onto the center of their chest while the other hand is interlaced on top. I exert pressure that is both efficient and fast maintaining 100 to 120 compressions a minute, letting the chest go all the way in between presses down. After about 30 such compression, I tilt the head backwards slightly and raise the chin to open the airway. I try to listen for breathing; if they are not breathing, I make use of the rescue breaths by covering their mouth with my mouth, closing their nose, and giving very gentle breaths until I see the rib cage expand- twice. I repeat cycles of 30 compressions followed by two breaths until help arrives or the victim recovers.

How to Clear the Airway in Unconscious Victims

In situations when lost consciousness clients are being positioned, turn the client onto their back carefully. While doing this, one hand is on the person’s forehead and two fingers of the second hand are placed on the chin — now tilt the head back. Examine the mouth for obstructions and find out what it is – food or a foreign body – to eliminate them, gently use a finger sweep. Do not allow or do anything that would force an obstruction further towards the airway. When these actions still do not result in the chest moving during assisted rescue breaths the compressions should be followed. These rules are: head-tilt, chin-lift technique to obtain a better airway, placing of the fingers in such a way not to injure a person – and monitor the person during breath and mouth movement. Even if the steps described have not been followed, act with caution to limit further injury or exposure to the victim.

How Can Choking Prevention Save Lives?

How Can Choking Prevention Save Lives?

Preventing choking is important as it helps to minimize the chances of respiratory crises. Individuals can learn better ways of eating by identifying the reasons behind choking, like chewing large chunks of food or being in a hurry to finish meals. Besides, the knowledge of objects that can be potential threats such as small toys which can be used by children is also important. Such emergencies can be avoided by taking precautions in daily living such as cutting food into biteable sizes and watching the young children during mealtime. Imparting the knowledge to the people of the appropriate techniques like the Heimlich maneuver enables them to act quickly whenever it is necessary and this enhances safety and protection of lives. With these preventive measures and awareness of the ‘how, these incidents can be greatly minimised thereby saving lives.

Preventing Choking Incidents in Adults

Based on recommendations of specialists and available literature choking in adults can be prevented with several pragmatic approaches. First of all, it is very important to chew food properly and take the time to eat, so that small pieces do not get lodged and the chances of a large piece getting stuck in the airways is minimal. Refrain from talking or laughing when food is in the mouth, as that may result in incorrect swallowing and ingestion. Also, it is helpful to remember certain types of foods that are considered to be the best examples of choking hazards such as steak, hot dogs, or hard candy. These may be eaten as long as the individual knows the hazards and may cut the items into smaller portions. They will certainly need reassessing in relation to the food they can consume or seeing the doctor so diet can be adjusted to limit choking risks. Moreover, it is useful to know how to perform the Heimlich maneuver or any other first aid practices in case of an emergency. Hence, it is possible to limit material and general factors that contribute to choking by practicing safe eating practices and reducing the risk of exposure to these scenarios.

Understanding and Reducing Choking Hazards

Being proactive and knowledgeable in avoiding choking risks, particularly for adults has proven to be quite important. Such practices are typical when the most credible resources are consulted. Of key importance are: thorough chewing, not being distracted while eating, and being cautious with tough meats and hard candies. Further, having the appropriate knowledge and skills such as performing first air, in particular, the Heimlich maneuver enables me to assist someone experiencing choking. There are ways of avoiding choking hazards, which I learned from top sources and they include detailed suggestions on how to reduce the dangers of chocking us and people around us.

Educating Others on Emergency First Aid Techniques

When someone is teaching the public about the techniques of first aid for emergencies, a lot of emphasis should be laid on the aspect of making the instructions simple so that they can be understood and practiced in real situations. The specialty aim is to prepare people who can act appropriately in a time of an emergency and within seconds changes the course of an event and hence saving life.

The key techniques to cover should include the Heimlich maneuver for choking cases, CPR (cardio pulmonary resuscitation) for cardiac arrest and Automated External Defibrillator (AED) use. For Heimlich, arm around the person’s waist in a fist standing just above the navel, quick strong thrusts upwards. CPR is performed by cycles of thirty compressions of the chest followed by two breaths; compressions of the chest must be at least two inches deep, at a rate of a hundred to hundred and twenty per minute. Last but not least, answer any questions that may arise and, above all, teach how to use AEDs focusing on carefully following the audible and visual prompts provided by the device.

Bringing learners through such practical ‘real’ practice, in addition to the above mentioned core instructions, will achieve the learning objectives and encourage confidence. It is important for everybody who is involved to be confident about these competencies in order to enable them respond to emergencies in a cool manner and effectively.

What Alternatives Exist If the Victim Is Too Large for Traditional Techniques?

What Alternatives Exist If the Victim Is Too Large for Traditional Techniques?

In cases when the size of the victim makes the application of traditional first aid techniques like the Heimlich maneuver impractical, other options must be explored in order to attend to the emergency. In such instances, chest thrusts wherein hands are placed on the middle of the chest may give favorable results in place of the abdominal thrust. On the same note, if encircling the victim’s waist is not possible, the victim can be positioned to lean forward while the heel of one’s hand is used to strike the area between the shoulder blades. These variations are still within the principles of the technique where quick and forceful movements directed to the obstruction are required for its displacement. If there is still some effective respiration occurring, victims should also be encouraged to cough by themselves, as this can also be useful for airway clearance. In any case, the readiness to call for help should be coupled with the expectation of the victim’s state of affairs remaining unresolved for a long period of time.

Exploring Back Blows and Chest Thrusts

How annoying is it to run into the frustration of trying to perform the Heimlich maneuver on an obese victim? Frustrating. In order to avoid having to face this situation again, through focus on a specific myself, I begin by executing chest thrusts while placing my hands in the center of the chest and using quick movements to apply firm pressure. If deep pressure on the chest is not possible, then back blows may be used as long as the victim leans forward and the heel of my hand strikes between the shoulder blades. Moreover, it is necessary to advise the victim to cough, as doing so may aid in the expulsion of the object. Where the obstruction does take a long time to resolve, it becomes imperative that I turn to the telephone and request emergency services right away. Such changes in techniques have availed from several reliable sources and guarantee practicality at the time of emergency.

How to Give Abdominal Thrusts Effectively

To master the abdominal thrusts in a proper way, one should do as follows: First of all, the rescuer stands behind the victim and grasps around the victim’s waist. One of the thumbs is tucked in and an abdominal fist is placed horizontally in the center of the victim slightly above the belly button but below the rib cage. The other guy grasps your fist. Then, let’s go and say the word twop fast & strong words that are thrusting in the center of the victim’s fingers. Each of the thrusts should be emphatically and forcefully applied, in a conservative level, to remove the obstruction. Do not attempt exceeded five times or until either the obstruction is removed or expelled. Continuous scenario updates and readiness to seek the emergency services number 999 of the medical assistance is the most important thing here. If the victim is unconscious the most important pieces of this chain are recustomized. Consider when initiating CPR protocol to appropriate measures of distress.

Using Rescue Breaths and Compression in Large Victims

In performing rescue breaths and compressions on bigger individuals, what stands out is the positioning and modification of stance for effective delivery. I first check the positioning of the victim and ensure that he or she is on a still and flat surface. When providing rescue breaths, I position the victim with their head extended backwards in order to open the airway, while pinching the victim’s nose with one hand and sealing their mouth with mine. With each breath, I blow steadily and over the span of a second, looking for the chest to rise up. In performing compressions, I place my hands on the lower half of the ‘x’ of the victim’s spine so that I thrust down quickly and deeply at the rate of 100 and 120 compressions in a minute and this should be done allowing the chest to recoil completely in between the compressions. If needed, I change my position and hand placement depending on the size of the victim and use my weight in performing compressions. During the entire procedure, I remain attentive to the victim’s condition and readiness to change techniques. However, severe cases should always be referred to an appropriate trained professional.

References

Choking

Cardiopulmonary resuscitation

Abdominal thrusts

Frequently Asked Questions (FAQ)

Q: What are the symptoms of choking?

A: The symptoms of choking include difficulty breathing, inability to speak or make noise, coughing, and using the universal choking sign, which involves clutching the throat with one or both hands.

Q: What should you do if a choking victim is too large for traditional methods?

A: If a choking victim is too large for you to wrap your arms around the waist, perform chest thrusts instead of abdominal thrusts. Position yourself behind the person and place your arms under their armpits, around the victim's chest.

Q: How can you assist a conscious choking victim who is too large?

A: For a conscious choking victim who is too large, use chest thrusts. Stand behind them, make a fist with one hand, place the thumb side of your fist against their chest, and perform thrusts inward and upward.

Q: What steps should be taken if the person becomes unresponsive?

A: If the person becomes unresponsive, you should start CPR immediately and call emergency services. Ensure to check the mouth for any visible object and attempt to clear the airway obstruction if possible.

Q: Is it necessary to ask if someone is choking?

A: Yes, it is important to ask "are you choking?" to confirm the person is choking and not experiencing another medical issue. If they nod or cannot speak, proceed with appropriate choking treatment.

Q: What is the alternative to abdominal thrusts for a person who is choking and too large?

A: The alternative to abdominal thrusts for a person who is too large is to perform chest thrusts. This method is effective when you cannot encircle the person’s waist.

Q: What should be done if a child choking cannot be helped with back slaps?

A: If a child choking cannot be helped with back slaps, try chest thrusts or abdominal thrusts if possible. If the child becomes unresponsive, begin CPR and seek emergency assistance.

Q: How can you perform chest thrusts on a victim who is too large?

A: To perform chest thrusts on a victim who is too large, stand behind the person, place your arms under their armpits, and around the chest. Use the thumb side of your fist against the center of their chest and pull inward sharply.

Q: Can infant choking be treated the same way as adults?

A: No, infant choking should not be treated the same way as adults. For infants, use a combination of 5 back slaps and 5 chest thrusts, ensuring to support the infant's head and neck.

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