Question for EMS guys.

T

task force k

Joined
Feb 10, 2007
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I was once told that if the Heimlich is ineffective and preventing artificial respiration to try AR anyway, forcefully. The reasoning was, and it seems...well...reasonable, the patient will die without oxygen but if you force the blockage into one of the bronchi it will allow AR the chance to be effective. The patient will probably need surgery to remove the blockage but at least it won't be removed during autopsy.

Comments?

I've performed tracheotomies in situations like this but that was in veterinary medicine and well...let's face it...it's bound to be different.
 
That's what I was taught in EMS school back in the early 90's, if you absolutely cannot get it "out" then try to force it "down" enough to clear the airway.

Not sure if they have revised that since I was taught, and with Endotracial Intubation being WAY more common in EMS than it was then, they may have.

If they ain't breathin' it's all kinda a moot point until they are!
 
I'm with ashtxsniper. Took EMT-B in 98, and currently in the middle of a refresher class. I've never heard of the technique mentioned by the OP. Nothing at the State level here in WI, and nothing from National Registry.

Infact, I would think that would be less of a concern, given that the AHA 2005 guidelines for CPR involve more compressions and less rescue breaths. there are even studies in progress that have removed rescue breath from the CPR equation completely. The reason for this is they claim there is plenty of oxygen that is contained in the hemoglobin in the body. By doing more compressions we are circulating that blood around the body (mainly so it gets to the brain) more effectively. Every time we stop to allow a ventilation, we stop that flow of oxygenated blood. Less breaths = more O2 circulating = higher survival percentages. Believe it, or not.
 
I was not taught that in any of my ems training (while it does make sense) I am a slave to protocol and "Scope of practice" I was taught to perform the heimlich repeatedl untill the object is dislodged or the person becomes unconcious. once unconcious you can attempt ot give to rescue breaths if they do not go in re positon the head and try again if still none tha start the abdominal thrusts after 5 you may do a blind fingersweep (in an adult) to and than attempt to give 2 rescue breaths...if an advanced lifesupport provider is there they might be able to intubate the patient.... In all my years of working ems in NYC i've only scen one trach job.
 
Thanks for the rapid response but, we all hope and trust, that's what y'all are all about. Chances are that anybody who's ever needed an EMS guy and wasn't completely doomed, will agree when I say, "Thank you" and "may the lights always be green for you".

I originally went into veterinary medicine (as a second military MOS) because I wanted to learn medicine and at the time I didn't want to get too specialized plus, at the time, I really didn't care much for my own species. I learned the emergency stuff (try AR on a patient with true dog breath sometime) to husbandry (try artificial insemination on an angry mastiff). Obviously, some of the procedures are different but some are remarkably similar.

Anyway, thanks again.
 
As I sit at this computer at my ambulance base, on-duty, I can tell you I have never heard such a thing. RescueRiley nailed it pretty good. I can tell you that blind finger sweeps are frowned upon. But as it goes A B C..... airway is always first. In my experiance I have never encountered a FBAO that wasnt able to be retrieved from abd thrusts and/or finger sweeps.
 
j williams said:
As I sit at this computer at my ambulance base, on-duty, I can tell you I have never heard such a thing. RescueRiley nailed it pretty good. I can tell you that blind finger sweeps are frowned upon. But as it goes A B C..... airway is always first. In my experiance I have never encountered a FBAO that wasnt able to be retrieved from abd thrusts and/or finger sweeps.
Click to expand...

ATTENTION!! The Heimlich family sued the American Medical Association, The American Heart Association and the American Red Cross.. They now want $1,000 every time the phrase "Heimlich Manuver" is used.. The phrase William used is the new correct terminology. Abdominal Thrusts is what we call it.. PLease make the necessary changes..

Rescue Mike
AHA Healthcare Provider Instructor

OFFICIAL NOTICE OVER..

Can you believe that crap?? Oh, and I have used Abdominal thrusts a dozen or more times.. I have never failed to clear an airway. Your fingers aren't long enough to "push" the obstruction down to clear an airway.. Besides, how could you control whether it goes down the airway, or esophogus??
 
You cant controll it. thats why you never do blind finger sweeps. Abdominal thrusts are a very effective measure to clear a FBAO. The AHA guidlines work. Time and time again.
 
sweeps aren't meant to push the obkect in but to sweep any expelled matter out...Maybe I'm mistaken...I am do for a refresher this year but I thought finger sweeps were only fowned upon in pediatric patients. I could be mistaken...haven't read that protocol on a bit
 
i am a nationally registered paramedic as well as a maine licensed paramedic who has worked in NY, CT and maine (in urban, suburban, rural and wilderness environments) I have been an ACLS, PHTLS and CPR instructor for over a decade. also have been a certified wilderness medic...firefighter 2, attended the NFA numerous times, been a medic instructor at three colleges and taught for Yale Medical School, 32, 26...hut hut hike.:p

i currently teach a new Survival Health course.

blind finger sweeps have been taught for adult FBAO for years. so i am amazed people are saying they never heard of those (if i read that correctly).

there are MANY types of objects that will not easily come out or come out at all will abdominal thrusts. magills may be in order.

i have found amazing amounts of food in people's airways.

if anyone needs to give me abdominal thrusts and its not working......bag me ....with a BVM...it's preferable to the other type of bag. and i'd rather be treated for aspiration pneumonia.

it's airway. do what you can.
 
Blind finger sweeps are a no-no in pediatric pts because it can set off spasms in their airway. AHA guidelines differ in some respects to the proticals set up by the medical director. In my proticals you can do finger sweeps in adults, they just frown upon blind ones. Unless you are an ALS provider and you are performing a digital ET intubation. I was taught never to put anything into a patients airway that you cannot see the end of. Vocal chords are easily damaged and taking away someones ability to speak sounds like an incredible liability issue. abdominal thrusts, if performed correctly will almost always clear an obstruction. If the pt is not apnic, and is able to move some air, ventilations and abd thrusts are very adequate.
 
Also ALS treatment is different than BLS treatment. A paramedic is allowed to "play" alot more than an EMT is. EMS you overcome and adapt to situations and make judgement calls on a case by case basis. Nothing is ever perfect, and textbook tx sometimes isnt your best option. A B C..... Treat your pt. and not your textbook.
 
task force k said:
I was once told that if the Heimlich is ineffective and preventing artificial respiration to try AR anyway, forcefully. The reasoning was, and it seems...well...reasonable, the patient will die without oxygen but if you force the blockage into one of the bronchi it will allow AR the chance to be effective. The patient will probably need surgery to remove the blockage but at least it won't be removed during autopsy.
Click to expand...

protocols have changed a bit, now for adults it's 5 back blows, 5 abdominal thrusts, like it was for infants. if they're unconcious, you're now supposed to do chest compressions.

On an unconscious subject there's a chance you will clear it giving the rescue breaths to see if you've opened the airway, in which case, it's effectively clear and the A of your ABC's has been satisfied.

Just did my CPR refresher 3 hours ago :D
 
I was originally taught that you alternate between abdominal thrusts and ventilations. Either your going to expel the object or force it into the bronchii. Doesn't matter which one. You can live with breathing with one lung, you cannot survive with a complete airway obstruction. It also use to be that we would do blind finger sweeps on adults but not pedis. The new AHA protocol (about 1 year now) for FBAO we no longer do blind finger sweeps on anyone. We do look into the mouth and remove any foreign material we see. This is BLS by the way. ALS (medics) have macgills that they can use as well as everything I talked about.

KR
 
Common sense dictates:

No airway the patient is dead within minutes without a mechanical or natural airway.

Remove object!!

If alert use the Heimlich and abdo thrusts until unconscious.

Then abdo thrusts alternating with chest compressions may pop the cork. Pay particular interest to the state of the airway and monitor as you may establish a partial. At which point you ventilate with compressions 30:2 (latest protocol, just recerted wilderness EMT).

Removal with fingers or suction when you have a visual or with forceps if possible.

No vitals, no airway all bets are off as they are dead do what you can until help arrives.

At the end of the day with no vitals unless ALS is on scene in minutes and an airway established they are dead. In the SAR world we can get on the horn to a Dr and get legal waiver to cric the patient outside of scope. If it were my family member far from help I would be cutting without authorization but thats me.


Airway spasms and damaged cords are a secondary issue to the patient being dead without an airway.;)

You cant make them any more dead.

Get the airway.

Skam
 
snare said:
i am a nationally registered paramedic as well as a maine licensed paramedic who has worked in NY, CT and maine (in urban, suburban, rural and wilderness environments) I have been an ACLS, PHTLS and CPR instructor for over a decade. also have been a certified wilderness medic...firefighter 2, attended the NFA numerous times, been a medic instructor at three colleges and taught for Yale Medical School, 32, 26...hut hut hike.:p

i currently teach a new Survival Health course.

blind finger sweeps have been taught for adult FBAO for years. so i am amazed people are saying they never heard of those (if i read that correctly).

there are MANY types of objects that will not easily come out or come out at all will abdominal thrusts. magills may be in order.

i have found amazing amounts of food in people's airways.

if anyone needs to give me abdominal thrusts and its not working......bag me ....with a BVM...it's preferable to the other type of bag. and i'd rather be treated for aspiration pneumonia.

it's airway. do what you can.
Click to expand...

That's GREAT.. Way to go.. Very proud of you..

FACT: You are quoting ALS and BLS protocols..

FACT: ALS and BLS Protocols are different in Every state and in some cases, every county!

FACT: Those do not apply for the lay provider..

FACT: If you tell a lay provider to do something OTHER than what they were taught, YOU are liable.

Guys.. I realize that quite a few of us are Firefighters/EMT B/IV/P Military Corpman, whatever.. But lets remember that the majority of the people here on this forum ARE NOT.. Let's keep the explanations to a lay provider level, unless we preface it with an explanation that the response is an advanced skill for others with the appropriate training..

*putting soapbox away*

That said, I love the great explanations here, and love the fact that someone can ask a question, and get an answer from so many knowlegable people!
 
Wow, we need an 'EMS forum' we have so many trained folks around here!

I will now only refer to it only as the HeimLICK MANURE. :D

Geeesh, you think folks would want their family's name associated with something that saves lives, not with a Legal entanglement.

HeimLICK MANURE. got it :thumbup: ;)
 
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