The following procedures are used to expel an airway obstruction
in a casualty who is lying down, who becomes unconscious, or is
found unconscious (the cause unknown):
- If a conscious casualty who is choking becomes unconscious,
call for help, open the airway, perform a finger sweep, and attempt
rescue breathing (paragraphs 2-2 through 2-4). If you still cannot
administer rescue breathing due to an airway blockage, then remove
the airway obstruction using the procedures in steps a
through e below.
- If a casualty is unconscious when you find him (the cause
unknown), assess or evaluate the situation, call for help, position
the casualty on his back, open the airway, establish breathlessness,
and attempt to perform rescue breathing (paragraphs 2-2 through 2-8).
| a. Open the airway and attempt
rescue breathing. (See task 081-831-1042, Perform Mouth-to-Mouth Resuscitation.)
b. If still unable to ventilate the casualty, perform
6 to 10 manual (abdominal or chest) thrusts. (Note that the abdominal
thrusts are used when casualty does not have abdominal wounds;
is not pregnant or extremely overweight.) To perform the abdominal
thrusts:
(1) Kneel astride the casualty's thighs (Figure 2-22).
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(2) Place the heel of one hand against
the casualty's abdomen (in the midline slightly above the navel
but well below the tip of the breastbone). Place your other hand
on top of the first one. Point your fingers toward the casualty's
head.
(3) Press into the casualty's abdomen with a quick, forward and
upward thrust. You can use your body weight to perform the maneuver.
Deliver each thrust slowly and distinctly.
(4) Repeat the sequence of abdominal thrusts, finger sweep, and
rescue breathing (attempt to ventilate) as long as necessary to
remove the object from the obstructed airway. See paragraph d
below.
(5) If the casualty's chest rises, proceed to feeling for pulse.
c. Apply chest thrusts. (Note that the chest thrust technique
is an alternate method that is used when the casualty has an abdominal
wound, when the casualty is so large that you cannot wrap your
arms around the abdomen, or when the casualty is pregnant.) To
perform the chest thrusts:
(1) Place the unconscious casualty on his back, face up, and open
his mouth. Kneel close to the side of the casualty's body.
- Locate the lower edge of the casualty's ribs with your fingers.
Run the fingers up along the rib cage to the notch (Figure 2-23A).
- Place the middle finger on the notch and the index finger
next to the middle finger on the lower edge of the breastbone.
Place the heel of the other hand on the lower half of the breastbone
next to the two fingers (Figure 2-23B).
- Remove the fingers from the notch and place that hand on top
of the positioned hand on the breastbone, extending or interlocking
the fingers (Figure 2-23C).
- Straighten and lock your elbows with your shoulders directly
above your hands without bending the elbows rocking, or allowing
the shoulders to sag. Apply enough pressure to depress the breastbone
1 1/2 to 2 inches, then release the pressure completely (Figure 2-23D). Do this 6 to 10 times. Each thrust should be delivered slowly
and distinctly. See Figure 2-24 for
another view of the breastbone being depressed.
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(2) Repeat the sequence of chest thrust,
finger sweep, and rescue breathing as long as necessary to clear
the object from the obstructed airway. See paragraph d
below.
(3) If the casualty's chest rises, proceed to feeling for his
pulse.
d. Finger Sweep. If you still cannot administer rescue
breathing due to an airway obstruction, then remove the airway
obstruction using the procedures in steps (1) and (2) below.
(1) Place the casualty on his back, face up, turn the unconscious
casualty as a unit, and call out for help.
(2) Perform finger sweep, keep casualty face up, use tongue-jaw
lift to open mouth.
- Open the casualty's mouth by grasping both his tongue and
lower jaw between your thumb and fingers and lifting (tongue-jaw
lift) (Figure 2-25). If you are unable
to open his mouth, cross your fingers and thumb (crossed-finger
method) and push his teeth apart (Figure 2-26)
by pressing your thumb against his upper teeth and pressing your
finger against his lower teeth.
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- Insert the index finger of the other hand down along the inside
of his cheek to the base of the tongue. Use a hooking motion from
the side of the mouth toward the center to dislodge the foreign
body (Figure 2-27).
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WARNING
Take care not to force the object deeper into the airway by pushing it with the finger.
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