SEVERE OR COMPLETE foreign-body airway obstruction can kill the victim in minutes if he doesn't get appropriate treatment. The primary technique to clear an obstruction in a conscious adult is administration of abdominal thrusts-the Heimlich maneuver. In these photos, you'll learn how to help a choking victim by following the latest American Heart Association's guidelines.1 (See Out with the old, in with the new for details on the latest revisions made in 2005.)

Follow standard precautions for all patient contacts, but don't delay performing the Heimlich maneuver to search for protective gear-the victim could die in even the minute or two you spend getting gloves and a mask, and clearing a foreign body from a conscious adult's airway shouldn't expose you to body fluids. But if the victim becomes unconscious and needs rescue breathing or cardiopulmonary resuscitation (CPR), use a barrier device with a one-way valve, such as a pocket mask or shield.

Reading the signs

Ineffective or absent respirations, a weak ineffective cough, and high-pitched sounds or no sound with inhalation in a conscious person signal severe airway obstruction. Most conscious adults with a foreign body in their airway clutch their neck with their thumbs and fingers-an action known as the universal choking sign. If you suspect choking, proceed as shown.

Following up

Even when properly done, the Heimlich maneuver can injure the patient's abdominal or thoracic viscera or internal organs. A health care provider should assess the victim for these complications or pulmonary aspiration.

Report the event to the health care practitioner. For example, tell her you found the victim using the universal choking sign and didn't detect air movement with respiratory effort. You administered six abdominal thrusts, dislodging a large piece of food from the victim's airway. Now he can speak and doesn't have any complaints.

Out with the old, in with the new

In 2005, the American Heart Association revised its guidelines for relief of foreign-body airway obstruction. The Don'ts are steps that have been replaced:

* Don't use the tongue-jaw lift to open the victim's airway. Do use the head-tilt-chin-lift maneuver.

* Don't perform a blind finger sweep of an unconscious victim's mouth. This action hasn't been shown effective and it could injure his mouth or your finger. Remove an object only if you see it.

* Don't perform abdominal thrusts on an unconscious victim. Studies have shown that chest compressions performed during CPR increase intrathoracic pressure as much as or more than abdominal thrusts.

* Don't use a 15:2 compression-to-ventilation ratio during CPR. A single rescuer provides better blood flow to the victim's heart, brain, and other vital organs with a 30:2 compressions/ventilations ratio.

* Don't deliver rescue breaths lasting longer than 1 second. Too many breaths or too large a volume may actually reduce the blood flow generated by chest compressions.

Source: Highlights of the 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, Currents in Emergency Cardiovascular Care, Winter 2005-2006.

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