FM-LPU-NRSG-06/05

College of Nursing
Telephone No. (043) 723-0706 loc. 109 / 110

PERFORMANCE EVALUATION CHECKLIST

NCM 118- Critical & Emergency Nursing
Heimlich maneuver

Name of Student: ________________________________________________

Year / Clinical Group: ______________ Rating______________

______Infant
______Children
______Adult

Legend:
2 Progress Acceptable (Performance is usually effective and efficient)
1 Needs Improvement (Progress in performance is too slow to judge satisfactorily;
task performance is not done properly for majority of the time)

STEPS PASS REPEAT REMARKS

Assessment
1. Ask the person “Are you choking?” or can you
speak?
2. Seek information of choking from the person when
he/she nods, or does the universal sign for choking
3. Activate Emergency response assistance if
respiratory distress or complete blockage
Performance Perform Heimlich maneuver by:
ADULT
1. Standing behind the victim and reach around the
abdomen (wrap your arms around client’s waist)
2. Making a fist with one hand and grasp it with the
other hand (thumb side into the abdomen). The fist
should be placed midline, below the xiphoid process
and lower margins of the rib cage and above the
navel
3. Thrusting inward and upward into the abdomen with
quick jerks with sufficient force to lift the victim off his
feet
4. Repeat this process 6 to 10 times until the client
either expels the foreign body or loses
consciousness
UNCONSCIOUS ADULT CLIENT OR ADULT CLIENT
WHO BECOME UNCONSCIOUS
5. Repeat action 1 to 3
6. Position client supine; kneel astride the clients
abdomen
7. Place the heel of one hand midline, below the
xiphoid process and lower margin of the rib cage and
above the navel. Place the second hand directly on
top of the first hand.
8. Perform a quick upward thrust into the diaphragm,
repeating six to ten times.
9. Perform a finger sweep
a. Use one hand to grasp the lower jaw and tongue

Capitol Site, Batangas City Telephone No. +6343 723-0706 / 2441 Fax No. 723-0595
www.lpu.edu.ph
 FM-LPU-NRSG-06/05

College of Nursing
Telephone No. (043) 723-0706 loc. 109 / 110

between your thumb and fingers and lift. This will

open the mouth and pull the tongue away from the
back of the throat.
b. Using the index finger of the other hand, insert the
finger into the clients mouth next to the cheek and
using a hooking motion dislodge any foreign body.
Caution must be used to prevent pushing the foreign
body farther down into the airway
10. Open the client’s airway and attempt ventilation
11. Continue sequence of Heimlich maneuver, finger
sweep and rescue breathing as long as necessary
INFANT
12. Straddle infant over forearm in the prone position
with the head lower than the trunk (supported by
rescuer knee)
13. Give 5 back slap between the infant’s shoulder
blades(in between scapula)
14. Keeping the infant’s head down, place the free hand
on the infant’s back and turns the infant over
supporting the back of the child with your hand and
thigh.
15. Give 5 chest thrust (same in external cardiac
compressions)
16. Open airway and assess for respiration. If absent,
attempt rescue breathing
17. Repeat the steps until the object expelled
SCORE

Over-all Performance Rating ____________________ %

Evaluatee: Evaluator:

_________________________________ ________________________________________
Signature of Student Over Printed Name Signature of Clinical Instructor Over Printed Name
Date__________________________ Date__________________________

PREPARED BY: VEREFIED BY:

DR. MARIO R. MARASIGAN RN. MAN DR. BELLA F. MAGNAYE

Faculty Department Chairman

APPROVED BY:

DR. CECILIA C. PRING

Dean College of Nursing

Capitol Site, Batangas City Telephone No. +6343 723-0706 / 2441 Fax No. 723-0595
www.lpu.edu.ph
 FM-LPU-NRSG-06/05

College of Nursing
Telephone No. (043) 723-0706 loc. 109 / 110

NCM 118- Emergency Nursing

Heimlich maneuver
PROCEDURE

STEPS RATIONALE
Assessment
1. Ask the person “Are you choking?” or If there is a good air exchange and the client is able to
can you speak? forcefully cough, you should not intervene or interfere
with the clients attempts to expel the foreign body.
Encourage attempts to cough and breathe, as
attempts to much will provide a more forceful effort. If
complete airway obstruction is apparent, the Heimlich
maneuver or alternative method of subdiaphragmatic
thrust should be performed immediately
2. Seek information of choking from the The universal sign of airway is clutching the neck with
person when he/she nods, or does the hands
universal sign for choking
3. Activate emergency response Provides follow-up care by professionally trained
assistance if respiratory distress or personnel
complete blockage
Performance Perform Heimlich maneuver
by:
ADULT
4. Standing behind the victim and reach Proper positioning is necessary to provide an effective
around the abdomen (wrap your arms subdiaphragmatic thrust
around client’s waist)
5. Make a fist with one hand and grasp the Correct hand placement is important to prevent
fist with your other hand, placing the internal organ damage.
thumb side of the fist against the client’s
abdomen. The fist should be placed
midline, below the xiphoid process and
lower margins of the rib cage and above
the navel
6. Thrusting inward and upward into the This subdiaphragmatic thrust can produce an artificial
abdomen with quick jerks with sufficient cough by forcing air from the lungs
force to lift the victim off his feet
7. Repeat this process 6 to 10 times until Attempts to dislodge food or a foreign body to relieve
the client either expels the foreign body airway obstruction should be continued as long as
or loses consciousness necessary due to serious consequences of hypoxia

UNCONSCIOUS ADULT CLIENT OR

ADULT CLIENT WHO BECOME
UNCONSCIOUS
8. Repeat action 1 to 3 Determines the needs for intervention and summons
essential help
9. Position the client supine; kneel astride Proper positioning is necessary to provide an
the client’s abdomen. effective subdiaphragmatic thrust
10. Place the heel of one hand midline, Proper positioning is necessary to provide an
below the xiphoid process and lower effective subdiaphragmatic thrust
margin of the rib cage and above the
navel. Place the second hand directly
on top of the first hand.
11. Perform a quick upward thrust into the A client who becomes unconscious may become

Capitol Site, Batangas City Telephone No. +6343 723-0706 / 2441 Fax No. 723-0595
www.lpu.edu.ph
 FM-LPU-NRSG-06/05

College of Nursing
Telephone No. (043) 723-0706 loc. 109 / 110

diaphragm, repeating six to ten times. more relaxed so that the previously unsuccessful
Heimlich maneuver may be successful
12. Perform a finger sweep Should only be used on the unconscious client, who
a. Use one hand to grasp the lower jaw will not fight the action.
and tongue between your thumb and a. Draw the tongue away from any foreign body
fingers and lift. This will open the mouth lodge in the back of the throat
and pull the tongue away from the back
of the throat
b. Using the index finger of the other hand,
insert the finger into the client’s mouth
next to the cheek and using a hooking
motion dislodge any foreign body.
Caution must be used to prevent
pushing the foreign body further down
into the airway
13. Open the client’s airway and attempt The brain can suffer irreversible damage if it is
ventilation without oxygen for over 4-6 minutes
14. Continue sequence of Heimlich Life-saving must continue until they are successful; or
maneuver, finger sweep and rescue until the rescuer become exhausted and cannot go
breathing as long as necessary on. Chest thrust should only be used for the very
obese client and a woman in the late stages of
pregnancy
INFANT
15. Straddle infant over forearm in the Proper positioning is essential for success of the
prone position with the head lower than maneuver and prevention of other organ damage
the trunk, support the infant’s head
positioning a hand around the jaws and
chest
16. Deliver 5 back slaps between the infants Technique for dislodging the obstruction
shoulder blades (scapula)

17. Keeping the infants head down, place
the free hand on the infants back and
turns the infant over supporting the back
of the child with your hand and thigh
18. With your free hand, deliver five chest
thrust (same manner as infant external
cardiac compressions)
19. Open airway and assess for a foreign
body in the mouth and assess for
respiration. If no respiration attempt for
rescue breathing.
20. Repeat the steps until the object
expelled
Safely rotates the infant’s position to continue life
saving procedures.
Technique for dislodging the obstruction
Many times some air can get around the foreign body
causing the airway obstruction. This allows for some
oxygenation of the client. Without oxygen, irreversible
brain damage can occur within 4-6 minutes.
Life-saving must continue until they are successful; or
until the rescuer become exhausted and cannot go
on.

PREPARED BY: VEREFIED BY:

MARIO R. MARASIGAN RN. MAN DR. BELLA F. MAGNAYE

Faculty Department Chairman

APPROVED BY:

DR. CECILIA C. PRING

Capitol Site, Batangas City Telephone No. +6343 723-0706 / 2441 Fax No. 723-0595
www.lpu.edu.ph
 FM-LPU-NRSG-06/05

College of Nursing
Telephone No. (043) 723-0706 loc. 109 / 110

Dean College of Nursing

Capitol Site, Batangas City Telephone No. +6343 723-0706 / 2441 Fax No. 723-0595
www.lpu.edu.ph
 FM-LPU-NRSG-06/05

College of Nursing
Telephone No. (043) 723-0706 loc. 109 / 110

Capitol Site, Batangas City Telephone No. +6343 723-0706 / 2441 Fax No. 723-0595
www.lpu.edu.ph