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Reach around the victim from behind. Make a fist with your dominant hand. Wrap your other hand firmly around this fist. Pull inward and upward, pressing into the victim's abdomen with quick, forceful upward thrusts. Continue to perform the Heimlich maneuver.
Circle your hands around the victim's abdomen (stomach).  If the victim is sitting or standing, position yourself directly behind her. If the victim is lying down, lay behind her.  If the victim is already unconscious, check for a pulse. If there is no pulse, proceed straight to CPR (cardiopulmonary resuscitation) at a rate of 100 chest compressions per minute. Do not attempt abdominal thrusts at this time (and do not do rescue breaths in this situation as the airway is obstructed). Your thumb should point into the fist. Place this fist just above the victim's navel (belly button) and under the breastbone. Be sure to keep your thumb away from the victim's body to prevent injury to the victim. Make the motion similar to the letter "J" – in, then up. Do this as long as the person maintains some breathing sounds (including gasping, choking, or any audible air motion).  If the person is unable to breathe at all, and the Heimlich maneuver is unsuccessful at dislodging the object, proceed to tracheotomy. This is a risky procedure and should only be used as a last resort; if possible, it should be performed by a medical professional.