How to perform Heimlich Maneuver for quadriplegic, bedridden and fragile patient?

[Ariana30]

Hello, can someone tell me how to perform Heimlich maneuver for quadriplegic and fragile patient?I'm a new nurse and I'm anxious about my patient if something will happen in the future. I am very careful when turning him because he's so tiny and fragile as well.I've been searching around but I couldn't get the best answer. Please share me the link if any. Thank you in advance.

[brownbook]

Where are you working?

I hope that you are not doing home health nursing. That, as a new grad, you are not alone taking care of a fragile quadriplegic patient with no orientation.

What type of feeding is the patient getting? Is there suction equipment at the bedside?

If you're in a nursing facility I would hope there is suction equipment at the bed side. That there are support staff you can call for assistance if your patient aspirates.

How to do the Heimlich on a tiny, fragile, quadriplegic? I can't imagine. Just remember that if you break a few ribs to clear the airway at least the patient is alive, the ribs will heal.

[adventure_rn, MSN, NP]

It seems unlikely that a quadriplegic patient would require the Heimlich, since they wouldn't aspirate a solid object on their own accord. They're not eating, and they're not playing with toys that they could choke on. The only way a solid object could get lodged in their airway is if an able-bodied person placed it in or around their mouth, right?

Now, in the more likely event that the patient is aspirating on liquids, like tube feeds or emesis, then you'd suction. However, with liquids, there's obviously no need to Heimlich.

If for some reason you did have to do the Heimlich (i.e. if a toddler family member placed a toy in the patient's mouth), then you just have to do the best you can. Like @brownbook said, you might break some bones, but bones heal.

The actual technique will depend on the age/size of the patient and their ability to be repositioned--infant-style of flipping them over for tiny babies vs. sitting them up in the conventional 'reaching around' style for medium-sized patients vs. abdominal trusts for contractured or larger bed-bound patients who you literally can't sit up.

@brownbook made another important point--as a new grad, I'm hoping your in a facility with more experience nurses who can help you through situations like this, and not flying solo in home health. It sounds like things could go pear-shaped real fast, and in home health/private duty, there will be nobody there who can help you.

[Here.I.Stand, BSN, RN]

On 1/29/2020 at 12:34 AM, adventure_rn said:

It seems unlikely that a quadriplegic patient would require the Heimlich, since they wouldn't aspirate a solid object on their own accord.

They could choke while being fed...?

[adventure_rn, MSN, NP]

2 minutes ago, Here.I.Stand said:

They could choke while being fed...?

I guess my thought is that if they'd have so much trouble protecting their airway, they might have dietary restrictions in terms of solids, thickened liquids, etc.

[Here.I.Stand, BSN, RN]

OP I would think you would use the methods for seated victim and/or unresponsive victim as taught in BLS.

[Here.I.Stand, BSN, RN]

2 minutes ago, adventure_rn said:

I guess my thought is that if they'd have so much trouble protecting their airway, they might have dietary restrictions in terms of solids, thickened liquids, etc.

I didn’t catch that the pt was NPO; and anybody can choke, not just people with dysphagia.

[adventure_rn, MSN, NP]

2 minutes ago, Here.I.Stand said:

I didn’t catch that the pt was NPO; and anybody can choke, not just people with dysphagia.

No, you're right, they aren't necessarily NPO. I jumped to conclusions because I'm used to seeing so many chronically ill bed-bound patients who get tube feeds that I just automatically think all of these patients would have a g-tube. You do make a good point.

[Orion81RN]

13 hours ago, Here.I.Stand said:

OP I would think you would use the methods for seated victim and/or unresponsive victim as taught in BLS.

I have actually never been taught this in my cpr classes.

[chare]

46 minutes ago, Orion81RN said:

14 hours ago, Here.I.Stand said:

OP I would think you would use the methods for seated victim and/or unresponsive victim as taught in BLS.

I have actually never been taught this in my cpr classes.

FBAO maneuvers for a seated victim would be the same as for a responsive, standing victim with the exception that you would kneel behind the seated victim. Unresponsive would be chest compressions, the same as in CPR..

14 hours ago, Here.I.Stand said:

OP I would think you would use the methods for seated victim and/or unresponsive victim as taught in BLS.

This. Procedures to relieve FBAO don't change because the victim is frail, bedridden, or quadriplegic.

[Orion81RN]

Delete

On 1/29/2020 at 5:41 PM, chare said:

FBAO maneuvers for a seated victim would be the same as for a responsive, standing victim with the exception that you would kneel behind the seated victim. Unresponsive would be chest compressions, the same as in CPR..

This. Procedures to relieve FBAO don't change because the victim is frail, bedridden, or quadriplegic.

I don't understand what is so confusing about this question. Its a perfectly reasonable question to wonder how, body mechanics wise, one would perform the heimlich on a wheelchair patient. "Kneel behind the wheelchair..." I can tell you right now, my arms are not making it around the wheelchair and patient's body.

Body mechanic's DO change for immobile patients.

[guest1139088]

lean em over and slap their back, lots suction throughout, get them on the ground or stretcher, mcgill forceps, and last resort cricothyroidotomy

Consider a permanent trache and J-tube