(2) If your attempts are not successful (chest does not rise), reposition the
airway and try to ventilate the casualty again.
(a) If your second attempt to ventilate is successful, check for
spontaneous breathing. If the casualty does not breathe on his own, perform rescue
breathing or CPR if needed.
(b) If your attempts are still not successful, the airway is still being
blocked. Call again for help (if appropriate) and proceed to administer modified
abdominal or modified chest thrusts.
e. Maintain Airway. Adjust the casualty's head so that it is face up and the
airway is open. If an assistant is present, have him keep the casualty's airway open
using the head-tilt/chin-lift or jaw-thrust method, as appropriate.
f. Administer Modified Manual Thrusts. Manual thrusts are performed in an
attempt to expel the object blocking the casualty's airway. The procedures for
administering abdominal and chest thrusts given in paragraph 5-5c must be modified
since the casualty is now lying on his back. Each thrust is delivered with the aim of
expelling the obstruction without having to administer additional thrusts. Administer
modified abdominal thrusts unless the casualty is in the latter stages of pregnancy, the
casualty has abdominal injuries, or the casualty is so overweight that abdominal thrusts
will not be effective. If one of these conditions exists, administer modified chest thrusts.
(a) Straddle the casualty's thighs. If the casualty is larger than you, it
may be necessary to straddle only one of his thighs.
(b) Place the heel of one hand against the casualty's abdomen on the
midline slightly above his navel and well below his xiphoid process. (This is the same
location as for the standing abdominal thrust.)
(c) Place your other hand on top of the hand on the casualty's
abdomen. Fingers can be interlaced or extended away from your body.
(d) Press down with an inward and upward thrust (figure 5-6). Keep
your arms straight and do not push to either side. Use your body weight to help you
perform the thrust. After the thrust, release the pressure on the abdominal area by
If the thrust causes the casualty to vomit, turn his head to one side and clear
the vomitus from his mouth. Then check the casualty for breathing. If
additional thrusts are needed, reposition the casualty's head so his face is in
the up position and his airway is open.)