Re: [Paddlewise] Heimlich & CPR

	I've been a paramedic and Dive Rescue Specialist for approximately 17 yrs
at the Albany Fire Dept. which is approx. 60 miles inland from the Oregon
coast.
       During that time we've had four different physician advisors who
have presented monthly training which included drowning. At no time did
they recommend using the Heimlich maneuver.  While I'm not well read on the
subject, my reading has without exception concurred.
	Having said that, I think there is a situation in resuscitation which
lends itself well to a veriation of the Heimlich maneuver.  I have used it
several times with great results.
	The normal reason the Heimlich maneuver is used is for airway obstruction.
 Secondarily, it may be used to remove water from the lungs which is
currently out of favor.  I've used it to remove air from the stomach.
	During CPR the stomach often gets pressurized which forces out the gastric
contents in the supine patient - very bad news.  Oftentimes continual
suctioning is required and an NG tube or a specialized airway tube which
blocks the esophagus is use.
	It occurred to me that if the patient was quickly placed in a sitting
position and Heimliched from behind, the stomach may be depressurized and
the continual stream of vomitting stopped.  The gastric contents would
remain low in the stomach while the air would be at the outlet to the
esophagus.  This proved effective for me and requires no specialized
equipment.  
	This is not a medically sanctioned technique, and I've not heard of it
used for this situation.  But, finding oneself
in this situation may call for this.  
	Air may be blocked from the stomach during ventilations by using the
Sellick maneuver.  This is done by applying pressure over the adams apple
which collapses the esophagus but not the more rigid trachea.  This may be
used to keep gastric contents in the stomach and is widely accepted and
taught.  But, it may be difficult to use for long periods of time after the
stomach has been hyperinflated.

				Good Paddling,    

                            BillAt 11:36 AM 6/12/99 -0700, Frank Lucian wrote:
>I was at a paddling club meeting recently where the a recent death of a
>paddler (on a whitewater river) was being discussed. One of the paddlers
>on the trip was at the meeting and told the story of rescue and the
>attempt to revive the boater with CPR.
>It was quite sobering to hear the story from someone who had been there.
>
>One thing brought up since the accident was trying the Heimlich (sp?)
>before beginning CPR. (Done without being behind the victim as with a
>regular Heimlich, but rather with the victim laying on his or her back.)
>This was described as helping to clear out any water before beginning
>CPR.
>
>Several people on the trip where this accident took place were trained
>and up to date on rescue skills and CPR, and did everything possible. I
>do not mean to second guess what they did. One of them, however,
>suggested doing the Heimlich first if we are ever in the same situation,
>as it has since been suggested to him from several different sources.
>
>I have had only a basic CPR course and I don't remember this being
>discussed (just clearing the airway by sweeping the mouth with your
>fingers). I'm sure there are people on this list with more advanced
>training. Is using the Heimlich before CPR something included in
>rescue/first aid training specific to watersports or wilderness first
>aid, etc? Is this something paddlers with CPR training should know?
>
>Frank
>
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