c. Administer Manual Thrusts. A manual thrust acts like an artificial cough by
forcing air out of the casualty's lungs. The increased air pressure caused by the thrusts
should dislodge the obstruction and cause it to be expelled. The thrust may be
administered either to the casualty's abdomen or to the casualty's chest. The
abdominal thrust is usually preferred, but the chest thrust is used if the casualty is
noticeably pregnant, if the casualty has abdominal injuries, or if the casualty is so large
that you cannot wrap your arms around his waist. Do not alternate between abdominal
and chest thrusts. Each manual thrust is performed with the intent of dislodging the
Wrap your arms around the casualty's waist.
(b) Make a fist with one hand. Place the fist against the casualty's
abdomen in the midline slightly above the navel and well below the tip of the xiphoid
process. The thumb side of your fist should be against the abdomen (figure 5-2 A).
Never place your fist over the xiphoid process or over the lower margin of the rib cage.
A thrust delivered directly to the xiphoid process or ribs can result in a fractured sternum
(xiphoid process separated from sternum) and/or fractured ribs.
Grasp your fist with your other hand (figure 5-2 B).
Figure 5-2. Placement of hands for administering an abdominal thrust to a
casualty standing or sitting.