An interesting complication of the Heimlich manoeuvre
Introduction
The removal of inhaled foreign bodies using the Heimlich manoeuvre is recommended as part of the immediate management of the choking child [1]. However, airway obstruction due to infections such as acute epiglottitis or croup requires urgent transfer to a hospital setting and attempts to clear the airway with physical methods are dangerous. We report on a case of witnessed laryngeal obstruction by a foreign body in which repeated Heimlich manoeuvres temporarily relieved the obstruction, but failed to expel the foreign body. The Heimlich manoeuvres dislodged the foreign body into the trachea and may have contributed to the rapid development of extensive surgical emphysema, pneumomediastinum and pneumopericardium.
Section snippets
Case report
A healthy 7-year-old boy, while playing at home, suddenly presented red-faced and panicking to his mother. He was holding a pen and gesturing to his neck. His mother correctly understood that he had either inhaled or ingested the lid of the pen. She immediately tipped him upside down and slapped him on the back, but this proved ineffective. She then performed the Heimlich manoeuvre three times. These actions did not dislodge the object and although the boy remained fully conscious, he started
Discussion
In 1975 Heimlich published a landmark study on the use of the abdominal thrust technique for the resuscitation of food choking victims 2, 3. The Heimlich manoeuvre has since been found to be a useful method for removing aspirated foreign bodies from the airway. However, several complications have been reported with the use of the Heimlich manoeuvre. These complications include stomach rupture [4], aortic valve rupture, diaphragmatic rupture, oesophageal rupture, jejunal rupture, mesenteric
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Cited by (18)
Removal of foreign body airway obstruction: A systematic review of interventions
2020, ResuscitationCitation Excerpt :Review of 202 full-text papers identified 69 eligible papers. Of these 69 papers, we included three cross-sectional studies (557 patients),20–22 eight case series (755 patients),8,20,23–28 and 59 case reports (64 patients).29–87 One study was included as both a cross-sectional study and case series due to way in which data were presented for different outcomes.20
Hepatic Rupture After Heimlich Maneuver
2007, Annals of Emergency MedicinePart 2: Adult basic life support
2005, ResuscitationManagement of esophageal perforation
2004, EMC - ChirurgiePart 3: Adult basic life support
2000, ResuscitationCitation Excerpt :For this reason, the Heimlich maneuver should never be performed unless it is necessary. Reported complications of the Heimlich maneuver include damage to internal organs, such as rupture or laceration of abdominal or thoracic viscera [301–305]. In fact, victims who receive the Heimlich maneuver should be medically evaluated to rule out any life-threatening complications [303].