Case Presentation:
An 87‐year‐old man with a medical history of dementia, stroke, hypertension, seizure disorder, and ITP began to choke on an orange, when his daughter successfully performed the Heimlich maneuver. Following this, the patient complained of mild abdominal pain. He denied chest pain, dyspnea, fever, chills, nausea or vomiting. On physical examination, vital signs were normal. Crepitations were felt on the left side of the neck. The rest of the exam was normal; residual right‐sided weakness was noted. Laboratory data was notable for thrombocytopenia and mild anemia. An esophagogram showed subcutaneous emphysema on the left neck; CT scan of the chest showed a pneumomediastinum and pneumopericardium. A repeat chest x‐ray showed bibasilar atelectasis and residual left neck subcutaneous emphysema. The patient was evaluated by CT surgery, and no surgical intervention was deemed necessary. He was discharged home in a stable condition.
Discussion:
The Heimlich maneuver was devised in 1974 by Dr. Henry Heimlich to relieve a “café coronary” — a fatal choking on food. The Heimlich maneuver involves the application of a sharp, brief force to the upper abdomen that is directed upward and causes displacement of the diaphragm. The applied subdiaphragmatic pressure results in increased intrathoracic pressure that helps in dislodging the foreign body causing the upper airway obstruction. The combination of direct trauma and increased intrathoracic pressure most commonly leads to rib fractures but can infrequently cause esophageal perforation, hollow viscus rupture, pneumomediastinum, mesenteric lacerations, diaphragmatic ruptures, aortic aneurysm thrombosis, and aortic valve rupture. The coexistence of multiple complications as a consequence of a single Heimlich maneuver in the same patient has rarely been reported. Treatment depends on the inflicted complication and the clinical status of the patient. Although surgical intervention is rarely warranted, prophylactic antibiotic use remains controversial.
Conclusions:
With widespread use of the Heimlich maneuver, physicians must remain vigilant for its potential life‐threatening complications. More importantly, physicians need to be aware that current American Red Cross guidelines endorse back blows as the first‐line rescue response in choking victims, and the American Heart Association has started to down‐regulate Heimlich maneuver use.
Author Disclosure:
C. Whinney, none; T. Hamieh, none; V. Dimov, none.