WESLEYAN UNIVERSITY PHILIPPINES College of Nursing and Allied Medical Sciences PERFORMANCE EVALUATION TOOL NCM 106 NURSING

G SKILLS Heimlich Maneuver PROCEDURE 1. ESTABLISH scene safety. Activate medical assistance. Call for help Conscious Adult and Child 2. Assess client for signs of choking, ask if the patient is choking to confirm or if patient tries to expel obstruction by means of coughing forcefully. *If patient is able to cough forcefully, do not interfere but remain with the patient while continuously observing the patients status. 3. Stand behind the patient. Make a fist and place it 1 fingerbreadth above the navel. Give 5 abdominal thrust by supporting the balled fist with the other hand while providing upward inward thrust. 4. Reassess patients status. Check if the obstruction was expelled. If still choking, repeat step 3 until patient is relieved from choking. Unconscious Adult and Child 5. Assess clients consciousness. If unresponsive, open airway by head tilt, chin lift maneuver. 6. Remove obstruction if visible by finger sweeping. If not seen, do not attempt. 7. Assess for pulse and breathing for seven seconds (1, 1002, 10031007) *If with pulse but breathless, give 2 rescue breaths by pinching the nose, ensuring adequate chest rise. If air bounces back for the first RB, retilt and reposition the head for the second RB. if still air bounces back proceed with chest compression. 8. Perform 30 chest compressions (1, 2, 3, 4, 530) 9. Check for the obstruction. If seen, do finger sweep, otherwise, do not attempt to do so. 1 2 3 4 5 REMARK

10. Repeat steps 7 to 9 until obstruction is removed. If upon assessment, the patient exhibits negative pulse and negative breathing, perform CPR. Conscious and Unconscious Infant Sandwich the infant face down. Head should be lower than the body. Give 5 back blows to the infant. Draw an imaginary square in between the shoulder blades and use the heel of the hand in giving back blows. Force of blows depends upon the size and built of the patient. Sandwich the infant face up or place the infant in firm flat table Give 5 chest thrust using 2-finger technique. Imagine a horizontal line drawn between the infants nipples. Place two fingers of one hand just below this line, in the center of the chest. Gently compress the chest about 1.5 inches for 5 times. Assess for the obstruction. If seen, do finger sweep. But if the obstruction is not visible, do not attempt to do finger sweep. Assess for the brachial pulse and breathing. If with pulse but negative breathing, provide 2 rescue breaths (mouth to mouth and nose), ensuring adequate chest rise.

11. 12.

13. 14.

15.

16.

*If air bounces back for the first RB, retilt and reposition the head, and give another blow. If air bounces back again,repeat steps 11 to 15. 17. If infant became pulseless and breathless, perform CPR.