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The Heimlich maneuver. Best technique for saving any choking victim's life
Abstract
The American Red Cross (ARC) and the American Heart Association (AHA) advocated backslaps, chest thrusts, and abdominal thrusts for 10 years after the Heimlich maneuver was introduced in 1974. Even after the Surgeon General in 1985 declared these methods to be "hazardous, even lethal," the ARC and the AHA continue to recommend backslaps and chest thrusts for infants under 1 year of age. ARC and AHA instructional materials that advocate use of these methods have not been recalled, and the public has not been warned of the dangers. One cause of the confusion about backslaps is the flawed belief that gas pressure alone removes a foreign body. In addition, there is lack of understanding that, compared with the Heimlich maneuver, the backslap produces an insignificant amount of the energy required to expel an object from the airway. In fact, the energy produced by the backslap drives the foreign object in the wrong direction, toward the lungs, while the energy produced by the Heimlich maneuver drives the object away from the lungs, toward the mouth. Backslaps and chest thrusts should be publicly recalled as a treatment for choking infants before further deaths and injuries occur. The Heimlich maneuver is the best rescue technique for treating choking victims of all ages.
... Harpenden callipers following standard procedure [20], and the mid-upper arm circumference (MUAC) was calculated using the formula MUAC=BP-0,314*TSF [21]. TSF represented patient's body fat, and MUAC their lean mass [22]. Undernourishment was defined as BMI<18.5 kg/m2, in accordance with World Health Organisation standards [23]. ...
... Eisenburger et Safar affirment qu'une éducation sur ce point devrait toucher toute la population [20], afin de réduire la mortalité et la morbidité des urgences [21]. La technique d'Heimlich, très connue et simple à réaliser, est efficace [22] et devrait être vulgarisée [23]. Tout infirmier devrait connaî-tre la technique pour l'appliquer en cas de fausse route et pour l'enseigner à l'entourage du patient hémiplégique, particulièrement vulnérable. ...
... At D0, dysphagia affected more than one in three patients, and patients with dysphagia were more likely to be undernourished. In these healthcare settings, information and means should be made available to families and care providers to encourage the use of appropriate food and access to texture modified enriched foods and enteral nutrition.[22] Frisancho AR. ...
Le Burkina Faso (BF) connait les phénomènes de transitions nutritionnelle et épidémiologique. Les hospitalisations pour AVC ou pour HTA et diabète sont en augmentation progressive, atteignant en 2016 trois fois les valeurs de 2012. Pour réduire la morbi-mortalité liée aux AVC, il faut réduire l’incidence des troubles de la déglutition (TD) et la dénutrition liée à la maladie. Les données sur ces sujets sont rares ou absentes en Afrique subsaharienne et au BF. Les objectifs des travaux étaient de i) déterminer la prévalence des troubles nutritionnels et des TD à l’admission pour AVC au BF, ainsi que leur évolution dans les 14 premiers jours de suivi ii) explorer au premier niveau de soins les connaissances et attitudes des infirmiers concernant les TD et les troubles nutritionnels des patients hémiplégiques, potentiellement victimes d’AVC. L’état nutritionnel et les TD de 222 patients victimes d’AVC consécutivement admis aux CHU de Ouagadougou et de Bobo-Dioulasso étaient étudiés à l’inclusion J0, au 8ème jour J8, et au 14ème jour J14. Les prévalences de la dénutrition étaient respectivement de 25,2%, 29,4% et 31,0%, et celles des TD de 37,4%, 28,4% et 15,8%. Tous les critères anthropométriques baissaient entre J0 et J14. A J14, les facteurs associés à la présence d’une dénutrition étaient le sexe féminin (OR=7,01; IC95% :1,51-32,56), le faible poids à J0 (OR=0,69; IC95%: 0,60- 0,79), et le faible pli cutané tricipital tricipital à J0 (OR=0,85; IC95%: 0,74-0,99). La dénutrition était un problème de santé important dès J0 chez ces patients, et les personnes de sexe féminin et les patients les plus dénutries à J0 devraient être particulièrement surveillées et pris en charge. Un questionnaire d’exploration des connaissances et pratiques concernant les TD et les troubles nutritionnels était administré à 125 infirmiers de centres de soins primaires urbains travaillant dans les centres dont le niveau de référence reçoit le plus de patients hémiplégiques au BF. 57% des infirmiers avaient des connaissances modestes sur le rôle du cerveau dans le contrôle de la déglutition et la survenue d’une hémiplégie. Concernant le dépistage des TD, 58,4% donnaient de bonnes réponses sur le chapitre portant sur la toux et 56,0% sur le chapitre portant sur la voix. 42,3% des infirmiers faisaient le lien entre pneumopathie d’inhalation et TD, 36,0% connaissaient une manoeuvre d’urgence à appliquer en cas de fausse route trachéale. Seulement 1,6% des infirmiers savaient que les adaptations des textures, les modifications de goût ou de température des boissons pouvaient influer sur les TD, et 65,6% reconnaissaient l’impact des adaptations posturales. L’impact des TD sur l’état nutritionnel étaient connu par 39,2% des infirmiers. Pour dépister un TD, seulement 11,6% des infirmiers utilisaient à la fois un interrogatoire et un test de réalimentation. 30,1% des infirmiers ne prodiguaient pas de conseils hygiéno-diététiques aux patients. Lors du transfert du malade vers l’échelon supérieur, 41,7% ne renseignaient jamais l’existence ou non des TD. En multivarié, seule la bonne connaissance du chapitre voix était associée à la capacité de détecter un TD (OR=3,5; IC95%: 1,4-8,1). Les éléments du cursus professionnel des infirmiers n’intervenaient pas. L’enseignement de neurologie et celui portant sur la nutrition des patients hémiplégiques devrait intégrer des données spécifiques sur les TD, avec en particulier leurs modalités de dépistage et des conseils simples de textures et de postures. Ces études ont permis de préciser pour la première fois l’état nutritionnel et la prévalence des TD chez les patients post-AVC au BF. Elles suggèrent que les parcours de soins des patients pourraient être sécurisés, grâce en particulier à la mise en place de programmes de formations des personnels de santé, à une meilleure information des patients, quand c’est possible, et des entourages, et également à la mise à disposition de matériels et techniques simples.
... A spike of pressure provides negligible kinetic energy to the obstructing object [2]. Patrick demonstrated it is the flow of air from the lungs toward the mouth, resulting from the Heimlich maneuver that transmits kinetic energy to a foreign body sufficient to carry it out of the airway and mouth [3]. The Heimlich maneuver consists of pressing the diaphragm upward, which diminishes the volume of the chest cavity, and compresses the lungs uniformly, thus producing a flow of 940 cm 3 of air in 1/4 s (a flow rate of 205 l/min) [4]. ...
... It is interesting to note that Ruben and Mac-Naughton [2] found that a pressure of 70 m 3 H 2 O applied in a series of impulses could eject a piece of raw beef, while a steady pressure of up to 100 m 3 H 2 O was ineffective. As referred to in our article, Gordon et al. [3] reported similar airflows with the Heimlich manoeuvre and chest compressions. We are a little uncertain why Heimlich and Spletser refers to Guildner et al. [4] who measured both pressure and air-flows in humans as speculative, as this is in contrast to other scientists who recommend Heimlich manoeuvre. ...
... This study revealed that 85.7% are familiar with "standing behind the child, encircling the child's chest with your hands, and squeezing is the first aid measure for a choking child" or the Heimlich maneuver that aims to open the airway of the choking person [28]. And for mothers, this study's results are not consistent with any other study that demonstrates a lack of knowledge of first aid. ...
Background:
Accidents may occur at any time and in any location. Unintentional accidents may have life-threatening consequences. Anyone with basic first aid knowledge can assess the situation and intervene to provide proper care. This research aims to assess public knowledge and attitudes toward first aid and its related aspects in Saudi Arabia.
Methods:
A cross-sectional online survey was conducted between April and May 2023 to investigate first aid knowledge, attitude, and associated factors among the general public of Saudi Arabia. This study's population consisted of Saudi Arabians aged at least 18 who are part of the general community. This research adapted and used a previously developed questionnaire to evaluate the general public's knowledge, attitudes, and other characteristics about first aid in Saudi Arabia. A binary logistic regression analysis was utilized to determine the variables that influence their knowledge and attitude.
Results:
A total of 1135 participants were involved in this study. Almost one-third of the study participants (36.0%) reported that they had received training in first aid. The vast majority of the study participants (94.5%) reported that they had heard of first aid before. The media was the most commonly reported source of information on first aid (37.6%). Choking (63.2%), breathing difficulty (61.7%), and fainting (56.7%) were the most commonly reported indications (injuries or accidents) that need first aid. The mean knowledge score for the study participants was 4.4 (SD: 2.8) out of 8 (55.0%), which represents a moderate level of knowledge of first aid. The mean attitude score for the study participants was 22.5 (SD: 2.7) out of 28 (80.4%), which reflects a positive attitude toward first aid. Binary logistic regression analysis identified that women, those who have a higher education level, medical students, those with a high monthly income (7500 Saudi Arabian rials (SAR) and above), and those who work in the healthcare sector were more likely to be knowledgeable about first aid (p<0.05). Participants aged 31 to 40 years and university students were more likely to have a positive attitude toward first aid (p<0.05).
Conclusion:
This research highlights the need to educate the public about first aid and emergency treatment. Even though one-third of participants have received first aid training, ongoing training is necessary. First aid information, especially on social media, is often unreliable. Choking, difficulty breathing, and syncope are typical first aid conditions, and awareness of dealing with choking is needed. Gender, socioeconomic status, and education influenced first aid knowledge and attitudes. Women, medical students, and healthcare workers knew more about first aid. Most participants supported first aid provision. This research strongly suggests improving awareness, providing inexpensive first-aid training, and targeting specific populations to improve first-aid knowledge and attitudes.
... The Heimlich maneuver has been described as 'the best rescue technique in any choking situation' [4]. The application of this maneuver has ?een~xpanded to include drowning as well as choking VICtlmS [5,6]. ...
Complications from the Heimlich maneuver are relatively infrequent. Two fatal cases of abdominal aortic thrombosis have been reported following this technique. We report on the first patient that suffered an acute thrombosis of the abdominal aorta and survived. Prompt recognition of this complication provides the only hope of survival from this rare and catastrophic complication.
... There are thus parallels to equipping patients and families with emergency adrenaline/epinephrine (e.g., EpiPen ) in case of anaphylactic reactions, and also the training of family and the general public in cardiopulmonary resuscitation and cardiac defibrillators for emergency use by the general public. Each example has encountered challenges to wider implementation with, e.g., the slow history of portable and public cardiac defibrillators [35,36], perhaps deriving from both professional and public uncertainty about the technology transfer, in contrast to dissemination of emergency medical procedures where the intervention is similarly lifesaving but does not require any medication or special equipment such as public training about the Heimlich manoeuvre when confronted with someone in danger of choking to death [37]. ...
Background and context:
Realization of the life-saving potential of "take-home naloxone" has been a personal journey, but it has also been a collective journey. It has been a story of individual exploration and growth, and also a story of changes at a societal level. "Take-home naloxone" has matured since its first conceptualization a quarter of a century ago. It required recognition of the enormous burden of deaths from drug overdose (particularly heroin and other opioids), and also realization of critical clusterings (such as post-release from prison). It also required realization that, since many overdose deaths are witnessed, we can potentially prevent many deaths by mobilizing drug users themselves, their families, and the wider caring community to act as intervention workforce to give life-saving interim emergency care. Summary of Scope: This article explores 5 areas (many illustrations UK-based where the author works): firstly, the need for strong science; secondly, our improved understanding of opioid overdose and deaths; thirdly, the search for greater impact from our policies and interventions; fourthly, developing better forms of naloxone; and fifthly, examining the challenges still to be addressed. Key Messages: "Take-home naloxone" is an exemplar of harm reduction with potential global impact - drug policy and practice for the public good. However, "having the potential" is not good enough - there needs to be actual implementation. This will be easier once the component parts of "take-home naloxone" are improved (better naloxone products, better training aids, revised legislation, and explicit funding support). Many improvements are already possible, but we hesitate about implementation. It is our responsibility to drive progress faster. With "take-home naloxone," we can be proud of what we have achieved, but we must also be humble about how much more we still need to do.
... Eisenburger asserts that education on this point should reach the entire population [22], to reduce the mortality and morbidity of emergencies [23]. The Heimlich technique is very well known, simple to perform, effective [24], and should be popularized [25]. All nurses should know the technique to be applied in cases of aspiration and teach it to hemiplegic patients' families, particularly vulnerable patients. ...
Introduction
The quality of management of swallowing disorders (SD) from admission onwards influences the patients' nutritional status and their prognosis. Neurological diseases are the main causes of SD, affecting one in three patients with hemiplegia (Hp). In Burkina Faso (BF), primary health care center (PHCC) nurses are the first to manage these patients, but there are no data related to their management of SD. The study aimed to assess knowledge and practices regarding SD in Hp among PHCC nurses in Bobo–Dioulasso, a main center for care of Hp in BF.
Methods
This cross-sectional study was performed August 1–September 15 2014. Subjects underwent a standardized survey to determine their knowledge and practices concerning SD in Hp.
Results
Of 125 nurses surveyed (83.3% of the targeted workers), 82.4% had experience of caring for Hp. The role of the central nervous system in cases of Hp and SD was recognized by 56.8% of nurses; 42.3% knew that SD can cause aspiration, and 36.0% were aware of rescue techniques to use when aspiration occurs; 39.2% correctly assessed the impact on nutritional status of SD. Knowledge in this area was better among respondents who recently completed training school. 65.6% and 1.6% respectively knew about the impact of posture and the texture of food on the ability to swallow. Among the 103 nurses with experience of treating Hp, 68.0% considered clinical interview the best way to detect SD, and 30.1% did not give the patient advice in this area. In multivariate analysis, detection of SD was associated with good knowledge of the value of voice disorders (OR = 3.5, 95% CI = 1.4–8.1; p = 0.005).
Conclusion
Few nurses had been warned of the connection between Hp and SD, which are classic issues and potential complications. Practices varied, but most were not in accord with what are recognized as good strategies for SD screening and management. In order to improve care of Hp, neurological and nutritional training should be accompanied by specific training in SD, emphasizing screening and simple management.
... Eisenburger et Safar affirment qu'une éducation sur ce point devrait toucher toute la population [20], afin de réduire la mortalité et la morbidité des urgences [21]. La technique d'Heimlich, très connue et simple à réaliser, est efficace [22] et devrait être vulgarisée [23]. Tout infirmier devrait connaître la technique pour l'appliquer en cas de fausse route et pour l'enseigner à l'entourage du patient hémiplégique, particulièrement vulnérable. ...
Résumé
Introduction. – Les troubles de la déglutition (TD) sont fréquents dans les centres de soins de santé primaires (CSSP) et la qualité de prise en charge dès l’admission influence fortement l’état nutritionnel des patients et leur pronostic global. Les maladies neurologiques sont les plus pourvoyeuses de TD, avec une prévalence d’environ 1/3 chez les patients hémiplégiques. Dans les CSSP au Burkina Faso (BF), les infirmiers sont les premiers à évaluer ces patients, mais il n’existe pas de données relatives aux modalités de prise en charge des TD. L’objectif de cette étude était d’estimer les connaissances, attitudes et pratiques des infirmiers concernant les TD des patients hémiplégiques accueillis dans les CSSP de Bobo-Dioulasso, dont le centre de référence accueille le plus de patients hémiplégiques au BF.
Méthodes. – Une enquête transversale, réalisée du 1er août au 15 septembre 2014 auprès des infirmiers des CSSP des districts sanitaires urbains de Bobo-Dioulasso, a utilisé un questionnaire standardisé explorant leurs connaissances et pratiques portant sur les TD chez le sujet hémiplégique.
Résultats. – Sur 125 infirmiers enquêtés (83,3% des personnels visés), 82,4% avaient déjà rec¸u un patient hémiplégique. Le rôle du cerveau dans la survenue d’une hémiplégie et d’un TD était connu par 56,8% des infirmiers, 42,3% savaient qu’un TD peut entraîner une pneumopathie de déglutition, 36,0% connaissaient une manœuvre de sauvetage en cas de fausse route. Ils évaluaient correctement le retentissement du TD sur l’état nutritionnel dans 39,2% des cas. Sur ce point, leurs connaissances étaient meilleures s’ils étaient plus récemment sortis de l’école de formation.
Respectivement 65,6 et 1,6% des infirmiers connaissaient le bénéfice des adaptations posturales et l’influence des caractéristiques des aliments sur la capacité à déglutir. Chez les 103 infirmiers ayant déjà rec¸u un hémiplégique, 68,0% estimaient pouvoir détecter un TD par l’entretien clinique et 30,1% ne donnaient aucun conseil au patient. En analyse multivariée, dépister un TD était associé à de bonnes connaissances sur la valeur des troubles de la voix (OR= 3,5 ; IC95%= 1,4–8,1 ; p = 0,005).
Discussion et conclusions. – Peu d’infirmiers étaient avertis de la liaison entre TD et hémiplégie, des enjeux et complications classiques liés aux TD. Ils avaient des pratiques variables souvent non conformes aux bonnes stratégies sur le dépistage et la prise en charge des TD. Dans un but d’amélioration des soins des patients hémiplégiques, l’enseignement en neurologie et en nutrition devrait s’accompagner de formations portant sur les TD, en insistant sur le dépistage et la prise en charge simple.
... Eisenburger asserts that education on this point should reach the entire population [22], to reduce the mortality and morbidity of emergencies [23]. The Heimlich technique is very well known, simple to perform, effective [24], and should be popularized [25]. All nurses should know the technique to be applied in cases of aspiration and teach it to hemiplegic patients' families, particularly vulnerable patients. ...
Introduction: The quality of management of swallowing disorders (SD) from admission onwards influences the patients' nutritional status and their prognosis. Neurological diseases are the main causes of SD, affecting one in three patients with hemiplegia (Hp). In Burkina Faso (BF), primary health care center (PHCC) nurses are the first to manage these patients, but there are no data related to their management of SD. The study aimed to assess knowledge and practices regarding SD in Hp among PHCC nurses in Bobo–Dioulasso, a main center for care of Hp in BF.
Methods: This cross-sectional study was performed August 1–September 15 2014. Subjects underwent a standardized survey to determine their knowledge and practices concerning SD in Hp.
Results: Of 125 nurses surveyed (83.3% of the targeted workers), 82.4% had experience of caring for Hp. The role of the central nervous system in cases of Hp and SD was recognized by 56.8% of nurses; 42.3% knew that SD can cause aspiration, and 36.0% were aware of rescue techniques to use when aspiration occurs; 39.2% correctly assessed the impact on nutritional status of SD. Knowledge in this area was better among respondents who recently completed training school. 65.6% and 1.6% respectively knew about the impact of posture and the texture of food on the ability to swallow. Among the 103 nurses with experience of treating Hp, 68.0% considered clinical interview the best way to detect SD, and 30.1% did not give the patient advice in this area. In multivariate analysis, detection of SD was associated with good knowledge of the value of voice disorders (OR = 3.5, 95% CI = 1.4–8.1; p = 0.005).
Conclusion: Few nurses had been warned of the connection between Hp and SD, which are classic issues and potential complications. Practices varied, but most were not in accord with what are recognized as good strategies for SD screening and management. In order to improve care of Hp, neurological and nutritional training should be accompanied by specific training in SD, emphasizing screening and simple management.
... Eisenburger et Safar affirment qu'une éducation sur ce point devrait toucher toute la population [20], afin de réduire la mortalité et la morbidité des urgences [21]. La technique d'Heimlich, très connue et simple à réaliser, est efficace [22] et devrait être vulgarisée [23]. Tout infirmier devrait connaître la technique pour l'appliquer en cas de fausse route et pour l'enseigner à l'entourage du patient hémiplégique, particulièrement vulnérable. ...
Les troubles de la déglutition (TD) sont fréquents dans les centres de soins de santé primaires (CSSP) et la qualité de prise en charge dès l’admission influence fortement l’état nutritionnel des patients et leur pronostic global. Les maladies neurologiques sont les plus pourvoyeuses de TD, avec une prévalence d’environ 1/3 chez les patients hémiplégiques. Dans les CSSP au Burkina Faso (BF), les infirmiers sont les premiers à évaluer ces patients, mais il n’existe pas de données relatives aux modalités de prise en charge des TD. L’objectif de cette étude était d’estimer les connaissances, attitudes et pratiques des infirmiers concernant les TD des patients hémiplégiques accueillis dans les CSSP de Bobo-Dioulasso, dont le centre de référence accueille le plus de patients hémiplégiques au BF.
... A year later, the National Research Council reported that 500 lives were saved by the HM [2]. Since that time, vigorous promotion of this technique has saved the lives of many choking victims and became widely accepted as the universal method for relieving foreign body upper airway obstruction [3]. However, several rare but life threatening complications have been reported from properly and improperly performed HM. ...
The hemodynamic compromise caused by a large aspirated food particle in the airway can become the focus of medical attention and a distraction from rare but fatal Heimlich maneuver related injuries after an incident of food aspiration. We herein present a case of an 84-year-old man who was brought to the emergency department after an episode of choking at a restaurant followed by several failed Heimlich maneuver attempts. Despite relieving the airway obstruction by extracting a large piece of steak from the airway, the patient remained hypotensive and required continued hemodynamic support. Repeated laboratory tests within 24 hrs of aspiration showed a significant decline in the hemoglobin level. A computed tomography (CT) scan of the abdomen and pelvis showed a lacerated liver with a large subcapsular hematoma draining into the pelvis. Conclusion. Hepatic rupture is a rare complication of Heimlich maneuver; this paper represents the second case report in the literature. It emphasizes the necessity of early identification and surveillance of fatal Heimlich maneuver complications in a high risk population.
... Nevertheless, foreign body can be dislodged from the larynx of a toddler by inverting the child and slapping it`s back. In older children and adults Heimlich maneuver can be performed especially when the foreign body is a bolus of food (Heimlich and Patrick, 1990). Immediate relief of the upper airway obstruction is imperative and if conservative measures fail then a tracheostomy is mandatory. ...
Impacted foreign bodies in the larynx of children constitute a medical emergency and require immediate intervention. Most health workers are not equipped to deal with the challenge posed by this clinical condition. This study was carried out to evaluate our experience of impacted foreign bodies in the larynx of children in Nigeria. It will highlight the factors associated with increase in the occurrence, poor prognosis and proffer preventive measures. This is a prospective study of 128 patients seen in the Ear, Nose and Throat (ENT) department t of University of Port Harcourt Teaching Hospital (U.P.T.H) and Rex Medical Centre both in Port Harcourt, Nigeria. This study was done over a five year period from January 2007 through December 2011. All children (age range 0-14 years) admitted with foreign bodies' impactions in the larynx were selected for the study. Demographic and clinical data were documented and simple statistical tables were used to illustrate the data. Data analysis was done using SPSS for windows 15. A total of 128 patients were found to have impacted foreign bodies in their larynx. The otorhinolaryngological cases seen during the study period was 5,200 giving a prevalence rate of 2.5%. They were 90 males and 38 females (M: F ratio of 2.4:1). Age range was 0-14 years with a mean of 3.88 ± 2.47years. The highest incidence was in the age group 3-5 years. The commonest foreign body encountered was fish bone 90 (70.31%). Impacted foreign bodies in the larynx of children were common in our environment. They were mostly found in the age group 3-5 years. The commonest foreign body was fish bone. It is of public health importance to enlighten our population and health workers on how to prevent and manage the condition.
... However, if such situation occurs awareness of emergency treatment manures like Heimlich maneuver will save many of these lives. [14] ...
Café Coronary syndrome which was first reported as sudden collapse at restaurants while dining was found to be due to fatal occlusion of upper airway by large pieces of food. Many of those individuals had consumed large amounts of alcohol prior to the incident. However, same condition has also been noticed among institutionalized elderly with dementia and psychiatric conditions. This is an un-witnessed death of a café coronary syndrome , where a 70 year old man after having dinner with his children previous night found dead next day morning in his bed. At autopsy a blob of mucoid secretions were found at right nostril and a piece of banana weighing 21g was found impacted within the laryngophrarynx, occluding the air way. He was edentulous. This case highlights the need of being aware of the condition especially in the elderly with mastication problems due to lack of teeth and other deglutition problems.
... The event is usually witnessed and occurs during eating, resulting in progressively worsening aphonia, cyanosis, loss of consciousness, and subsequent cardiac arrest. [37][38][39][40][41][42] Epidemiologic data on deaths caused by FBAO do not indicate whether victims were conscious and observed during the event or were found unconscious. The most common cause of upper airway obstruction in adults is unconsciousness without the presence of any foreign body. ...
Foodborne pathogens are a significant cause of mortality and morbidity worldwide. Conventional methods for detecting these pathogens are culture-dependent, which are time-consuming, laborious, and prone to false negative results. Nanotechnology-mediated biosensors proved to be a boon by offering reliable, cost-effective, rapid, reproducible, sensitive and precise diagnostic tools to meet prerequisites in the area. Microfluidics-integrated nanosensors are gaining ever wider acceptance in order to increase the sample concentration, detection limits and sensitivity of biosensor before the onset of infection. The prospects of these integrated technologies count on the triumph of evolving sophisticated technologies based on novel bioreceptors/bio-recognition molecules viz. antibodies, aptamers, phage display peptides, molecular imprinted polymers etc. and their synergistic effect with advanced nanotechnology. Considering the limitations of aforementioned conventional pathogen detection methods, the current chapter will aim to discuss the properties and role of each component of biosensor viz. specific bioreceptor generation, nanomaterials mediated transducers and their conjunction in sensing platforms, playing a key role in imparting high selectivity, sensitivity, rapidness and early diagnosis in food pathogen detection. The utilization of variously modified nanostructures such as gold, quantum dots, magnetic, carbon, silica, organic and upconverting nanostructures resulted in enhanced sensitivities and early detection in electrochemical and optical approaches, thereby opening new avenues for food pathogens diagnosis.
Choking is a time-sensitive emergency. Community first aid training allows prompt recognition of the classic signs of choking and prompts lifesaving care. The Heimlich maneuver is often effective, but care can also include chest compressions, back blows, or manually removing the foreign body with a finger, Magill forceps, or suction. When bystanders are unsuccessful, EMS personnel can expect to encounter a critical patient. When successful expulsion of the foreign body occurs, the patient should be encouraged to go to the emergency department for further evaluation, as significant injuries can occur during rescue treatment. Patients who have partial obstructions should be given supportive care and monitored closely for potential development of full obstruction while transporting to the emergency department.
The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.
These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.
Bei der Therapieplanung und der Auswahl der geeigneten Therapieverfahren ist das Störungsprofil richtungsweisend. In diesem Kapitel werden zahlreiche Therapiemaßnahmen im Sinne einzelner Therapiebausteine vorgestellt: Praxisnah werden Indikationen, vorbereitende Maßnahmen, Instruktionen und die eigentliche Durchführung detailliert beschrieben; falls ein Wirksamkeitsnachweis der jeweiligen Intervention in der Literatur belegt ist, wird auch darauf eingegangen. Im Einzelnen werden in diesem Kapitel folgende Therapiebausteine näher beleuchtet: Notfallmaßnahmen bei Verschlucken, vorbereitende und begleitende Therapiemaßnahmen, Verbesserung sensibler Störungen und Abbau pathologischer Reflexe, tonusregulierende Maßnahmen, Verbesserung der oralen Bolusvorbereitung, des oralen Transports, der Gaumensegelfunktion, der Rachenpassage, der Kehlkopfhebung und der Öffnung des oberen Ösophagussphinkters sowie Schutz der Atemwege. Tipps zum Trachealkanülenmanagement und zur stufenweisen Steigerung der Entblockungszeiten sowie zur Optimierung der Ernährungssituation runden das Kapitel ab. Abschließend werden Aspekte einer guten Zusammenarbeit mit Patienten und Angehörigen hervorgehoben und Inhalte der Beratung exemplarisch erläutert.
Introduccion. La aspiración de un cuerpo extraño es un evento común en niños y es una causa frecuente de morbilidad y mortalidad, la que se debe a la dificultad respiratoria; ésta puede ser súbita, acompañada de tos. Objetivo: Determinar las características clínicas y los resultados del tratamiento broncoscópico en niños que han aspirado cuerpos extraños. Material y metodo. Estudio retrospectivo de enero del 2000 a diciembre del 2009 de 84 pacientes que aspiraron un cuerpo extraño, a quienes se le extrajeron por vía broncoscópica. Fueron 55 niños y 29 niñas cuyas edades iban de ocho meses a 13 años. Resultados: Las manifestaciones clínicas más frecuentes fueron la asfixia en 75 (90%), la cianosis, 67 (80.4%) y la polipnea en 63 (75.6%). Los datos radiológicos fueron positivos en 82 pacientes (98.4%). El objeto aspirado más común fue el cacahuate (33.6%). Los cuerpos extraños se localizaron en la tráquea en nueve casos (14.4%); en la carina en cuatro (4.8%); en el bronquio derecho en 52 pacientes (62.4%) y en el bronquio izquierdo en 19 (22.8%). Conclusiones: Los cuerpos extraños en la vía aérea son una urgencia que amenaza la vida. La historia clínica es la clave del diagnóstico. La broncoscopia con anestesia general es un procedimiento seguro y eficaz.
In the following article, Henry J. Heimlich, MD, SeD, recommends pushing water out of a near-drowning victim's airway with the Heimlich maneuver before performing cardiopulmonary resuscitation (CPR). This takes only moments and makes so much sense to me that I will follow this procedure if ever I come across one of my grandchildren or anyone else in a drowning situation. I hope that everyone quickly adopts Heimlich's recommendation of doing the maneuver before CPR, which I am convinced will save countless lives.
Choking is a time-sensitive emergency that affects all ages. Recognition of the classic signs of choking, which include aphonia, hyperemia of the face, and hands to the throat, can prompt life-saving care. The Heimlich maneuver is often effective, but care can also include chest compressions, back blows, or manually removing the foreign body with a finger, Magill forceps, or suction. When bystanders have been unsuccessful, EMS personnel can expect to encounter a significantly deteriorated patient. When successful expulsion of the foreign body occurs, the patient should be encouraged to go to the emergency department for further evaluation as significant injuries can occur during rescue treatment. Patients who have partial obstructions should be given supportive care and monitored closely for potential full obstruction while transporting to the closest emergency department.
Like pain, dyspnea is a sensation that is not well understood and may have many causes. It is a frequent symptom in the emergency medical service and presents diagnostic problems and pitfalls in assessing severity. Dyspnea is a very common symptom in patients with cardiorespiratory diseases. Diagnostic tests like pulse oximetry, blood gas analysis, capnometry or fiberoptic bronchoscopy often only allow a better assessment of severity but no diagnostic classification of dyspnea. Basic support includes clearing of upper airways, keeping the airways patent and establishment of artificial ventilation when necessary. Further therapeutic interventions depend on the suspected etiology of dyspnea.
Be prepared to handle life-threatening dental emergencies! Medical Emergencies in the Dental Office, 7th Edition helps you learn the skills needed to manage medical emergencies in the dental office or clinic. It describes how to recognize and manage medical emergencies promptly and proactively, and details the resources that must be on hand to deal effectively with these situations. This edition includes new guidelines for drug-related emergencies, cardiac arrest, and more. Written by respected educator Dr. Stanley Malamed, this expert resource provides dental professionals with the tools for implementing a basic action plan for managing medical emergencies.
With the emergence of the new field of evolutionary developmental biology we are witnessing a renaissance of Darwin's insights 150 years after his Origin of Species. Thus far, the exciting findings from “evo-devo” have only been trickling into college courses and into the domain of non-specialists. With its focus on the human organism, Quirks of Human Anatomy opens the floodgates by stating the arguments of evo-devo in plain English, and by offering a cornucopia of interesting case studies and examples. Its didactic value is enhanced by 24 schematic diagrams that integrate a host of disparate observations, by its Socratic question-and-answer format, and by its unprecedented compilation of the literature. By framing the “hows” of development in terms of the “whys” of evolution, it lets readers probe the deepest questions of biology. Readers will find the book not only educational but also enjoyable, as it revels in the fun of scientific exploration.
Die Entstehung von Atemnot ist wie die vom Schmerz bis heute nicht bekannt. Atemnot ist im Rettungsdienst ein häufiges Symptom
und stellt sowohl in Diagnostik wie in Einschätzung des Schweregrades ein großes Problem dar. Atemnot ist ein häufiges Symptom
bei Patienten mit kardiopulmonalen Erkrankungen. Hilfsmittel wie Pulsoximetrie, Kapnometrie oder Fiberglasbronchoskopie erlauben
nur eine bessere Einschätzung des Schweregrades, aber keine diagnostische Zuordnung. Die Basismaßnahmen beinhalten das Freimachen
und Freihalten der Atemwege sowie die maschinelle Beatmung. Spezielle Therapiemaßnahmen sind in Abhängigkeit von der jeweiligen
Verdachtsdiagnose zu treffen.
Like pain, dyspnea is a sensation that is not well understood and may have many causes. It is a frequent symptom in the emergency
medical service and presents diagnostic problems and pitfalls in assessing severity. Dyspnea is a very common symptom in patients
with cardiorespiratoy diseases. Diagnostic tests like pulse oximetry, blood gas analysis, capnometry or fiberoptic bronchoscopy
often only allow a better assessment of severity but no diagnostic classification of dyspnea. Basic support includes clearing
of upper airways, keeping the airways patent and establishment of artificial ventilation when necessary. Further therapeutic
interventions depend on the suspected etiology of dyspnea.
The most effective resuscitative procedure in choking by foreign bodies is the Heimlich maneuver, described for the first time by Henry Heimlich (1974) and recognized by the US Surgeon General (1985) as the "only method that should be used for the treatment of choking from foreign body airway obstruction." If performed correctly, this lifesaving maneuver is associated with rare complications, of which the most frequent are rib fractures and gastric or esophagus perforations. Other rare traumatic injuries such as pneumomediastinum, aortic valve cusp rupture, diaphragmatic herniation, jejunum perforation, hepatic rupture, or mesenteric laceration have been described.However, we are unaware of previous reports of splenic rupture after Heimlich maneuver. We present an interesting case of fatal hemoperitoneum due to a hilar laceration of the spleen following a correctly performed Heimlich maneuver.
The Heimlich manoeuvre is well recognised worldwide as an emergency technique to clear an obstructed airway. The potential for serious injury to the choking victim is also well reported. We report the first case of significant musculoskeletal injury suffered by a rescuer performing the Heimlich manoeuvre. He eventually made a full recovery from his injury. However, we need to be aware of the possibility of injury in the rescuer as well as the rescued.
Aspiration of foreign material into the lungs can represent a medical emergency requiring timely interventions to assure a favorable outcome. Establishment of a patent airway and maintenance of adequate oxygenation are the initial requirements for successful treatment of all types of aspiration emergencies. The nature of the aspirated material dictates further interventions and potential outcome.
Emphasis on a clear airway is a primary requisite for effective CPR. Airway control in the trauma victim needs special consideration of the possibility of associated cervical vertebrae and spinal cord injury; thus, modification of the patient positioning for transport is essential. Emphasis on visualization of chest movement is the most important factor in assessing adequacy of ventilation. Experience in the use of bag-valve-mask devices requires appropriate instruction and on-going practice. Small bag volume devices limit the ability to provide adequate tidal volumes and prolong inspiratory times. Tracheal intubation provides optimal airway management. In-field use of this procedure will depend upon the skill and experience of the operator. Validation of correctness of tracheal tube placement is critical; seeing the tube pass the glottic opening on laryngoscopy, bilateral and equal chest movement, auscultation of breath sounds in the chest. Methods to measure end-tidal CO2 as a valuable check for tube position is a useful adjunct but must not be relied upon. Foreign body management continues to be controversial and remains unchanged for the present; ie, the infant < 1 year of age the recommendations are back blows followed by chest thrusts. Above 1 year of age, abdominal thrusts (Heimlich maneuver) is recommended.
The overall prognosis for children who sustain a submersion incident is directly related to several variables including length of submersion, initial neurologic evaluation, time to first breath, initial pH, and others. Resuscitation after near-drowning is unsuccessful in terms of death and neurologic deficit in 30% of those children who are treated at our institution. Despite the fact that we have been able to present variables that are somewhat predictive of outcome, it is almost impossible to identify 100% of the time which particular comatose child will survive neurologically intact. Therefore skilled attempts at resuscitation and management are mandatory. The understanding of the sequence of events that occur during the drowning process and the pathophysiologic consequence make it possible for health care personnel to provide aggressive therapeutic interventions that will enhance the likelihood of a normal recovery.
Food asphyxiation is a common problem whenever and wherever people eat. A knowledge of predisposing factors might help to prevent this problem.
We reviewed 34,476 consecutive autopsies done during a 14-year period (1984 to 1997) at the Institute of Forensic Medicine, Vienna. Demographic features and predisposing factors were determined for the 191 cases of fatal foreign body asphyxiation.
Old age, poor dentition, and alcohol consumption were frequent findings. Other risk factors included chronic disease, sedation, and eating risky foods. On 120 (63%) of the 191 occasions, observers were present at the time of the incident and subsequently called the Emergency Service. In 110 (92%) cases, neither the observers nor the majority of the emergency medical technicians and physicians who would have been able to intervene recognized the definite diagnosis. Only 10 cases were correctly identified during cardiopulmonary resuscitation.
These fatal accidents could be prevented easily. Effective prevention depends on understanding the nature and frequency of accidental deaths due to asphyxiation and the factors that lead to their occurrence and having a high degree of suspicion.
In a previous case report a standard chest compression successfully removed a foreign body from the airway after the Heimlich manoeuvre had failed. Based on this case, standard chest compressions and Heimlich manoeuvres were performed by emergency physicians on 12 unselected cadavers with a simulated complete airway obstruction in a randomised crossover design. The mean peak airway pressure was significantly lower with abdominal thrusts compared to chest compressions, 26.4+/-19.8 cmH(2)O versus 40.8+/-16.4 cmH(2)O, respectively (P=0.005, 95% confidence interval for the mean difference 5.3-23.4 cmH(2)O). Standard chest compressions therefore have the potential of being more effective than the Heimlich manoeuvre for the management of complete airway obstruction by a foreign body in an unconscious patient. Removal of the Heimlich manoeuvre from the resuscitation algorithm for unconscious patients with suspected airway obstruction will also simplify training.
Choking is a common emergency problem. The Heimlich maneuver is unquestionably effective in relieving airway obstruction. Serious and life-threatening complications may arise, however, if the maneuver is applied incorrectly. Two cases of gastric rupture after Heimlich maneuver are reported. Lay public, paramedics and the medical professionals should be educated with the correct technique of Heimlich maneuver and its potential complications. All patients receiving Heimlich maneuver should be examined by an experienced physician.
There are only two previous reports of wild barley inhalation into the tracheobronchial tree in the literature. Our aim is to describe the effects, outcome and management of wild barely inhalation into the airways.
In a retrospective study, 18 patients with inhalation of spike of wild barley into the tracheobronchial tree were divided into 2 groups according to their clinical presentation.
Eighteen children below 5 years of age presented between 1989 and 1994 inclusive. Fourteen patients presented with a short duration of choking and cough. The wild barley spike was removed by laryngoscopy (12 patients) or rigid bronchoscopy (2 patients). Four patients presented with a longer history of cough, dyspnea and fever and had serious respiratory disease such as pneumothorax, lobar pneumonia and pleural empyema requiring surgical intervention. All patients made a satisfactory recovery.
Wild barley is a common grass in our area and we should be aware that children are exposed to the risk of inhalation into the airways.
Complications from the Heimlich maneuver are relatively infrequent. Two fatal cases of abdominal aortic thrombosis have been reported following this technique. We report on the first patient that suffered an acute thrombosis of the abdominal aorta and survived. Prompt recognition of this complication provides the only hope of survival from this rare and catastrophic complication.
The Heimlich maneuver has been widely accepted as a safe and effective method of relieving life-threatening foreign-body upper airway obstruction. When applied incorrectly, however, it may result in direct trauma to the intraabdominal viscera. Only two cases of major aortic complications have been reported. Both have involved thrombosis of an abdominal aortic aneurysm. We report two further instances of aortic thrombotic complications due to the incorrect application of the Heimlich maneuver. The first case resulted in thrombosis of an abdominal aortic aneurysm. In the second case the abdominal thrusts caused dislodgement of thrombus from an atherosclerotic nonaneurysmal aorta, which resulted in thromboembolic occlusion of both lower extremities. In both cases, as with the two previously reported instances, massive reperfusion injury resulted, which eventually proved fatal. When applied incorrectly, the Heimlich maneuver may result in direct trauma to the abdominalaorta and is an unusual cause of acute aortic thrombosis.
We present a case of lesser gastric curvature injury after a Heimlich maneuver due to obstruction of the breathing tract that was repaired by laparoscopic surgery.
A patient with perforation of the lesser gastric curvature as a result of closed abdominal traumatism was operated on using the laparoscopic approach with the use of four trocars as work openings. With this technique, the diagnosis was confirmed, the injury repaired, and the abdominal cavity washed.
The postoperative period was favorable and the patient was released from the hospital on day 7 without any complications.
Laparoscopic surgery can be technically reproduced in the treatment of gastric injury as a result of closed abdominal traumatism.
To assess the prevalence of food/foreign body asphyxia in the elderly Viennese population in order to reduce the incidence of these fatal events.
This is an autopsy-based, retrospective study in Vienna, Austria. Participants included all nonhospitalized (n =200) cases of choking in 1984 to 2001, from a total 42,745 consecutive autopsies performed at the Institute of Forensic Medicine. In addition, data from hospitalized adult cases of fatal choking (n =73) in 1984 to 2001, from the mortality registrar of Vienna, were included.
The nonhospitalized choking victims were analyzed according to age (18 to 64 vs >/=65 years), sex, circumstances of death, and predisposing factors. Hospitalized cases were analyzed according to age, sex, and whether an autopsy was already performed by pathologists at the institution where they died. In the study period, 273 adults died of food/foreign body asphyxia, 73% of them out of the hospital and 27% in hospitals. Food/foreign body asphyxia in the elderly was characterized by a significantly higher asphyxiation of soft/slick foods (p <0.007) with agomphiasis (p <0.002), occurring most frequently during lunch (49%), and in 2.5% during feeding of neurologically impaired. In contrast, younger individuals choked significantly more often on large pieces of foreign material (p <0.002) and showed a significantly higher rate of blood alcohol concentration (p <0.001).
This study demonstrates that semisolid foods are the cause of a large number of asphyxiations, especially among the elderly. Knowledge of the fact that semisolid foods are a high-risk factor in elderly individuals should be distributed in public and private healthcare systems, and awareness could be a first step in reducing the incidence of food/foreign body asphyxia.
The aims of the study were to evaluate duration of symptoms, clinical manifestation, radiological findings, fibrobronchoscopic findings, and the complications of airway foreign body (FB).
A retrospective review of 304 children who had airway FB removed via fibrobronchoscopy from January 1997 to June 2003 was conducted in the Children's Hospital of Zhejiang University School of Medicine, China. Two hundred eight boys and 96 girls were included. Their ages ranged from 2 months to 11 years, and the median was 18 months.
Three patients died; 81.24% of the patients had a history of FB aspiration, and the most frequent clinical manifestation was paroxysmal coughing (89.25%). Positive radiological findings were found in 90.13% of patients, and the most common type of FB was peanut (35.53%). Serious complication of lung was found in 65 patients, and the associated factors were age, sex, and times of fibrobronchoscopy and location of FB in the right or left lung.
FB aspiration remains a major cause of morbidity and mortality in childhood. Education aimed at increasing diagnostic acumen of the physicians and heightening of public awareness are the most important steps needed to reduce the morbidity and mortality.
The recent studies of Heimlich (1,2) have re-focused attention on manual and mechanical techniques for the management of foreign body obstruction of the airway. The 1974 Standards for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) (3) recommend:
1.
tilting an unconscious victim’s head backward into maximum extension to relieve obstruction of the throat by the tongue; and
2.
delivering firm blows on the victim’s back and sweeping your fingers deeply into his throat to remove foreign bodies. These recommendations for head tilt are well documented (4,5), but there are no controlled, comparative studies on manual maneuvers or mechanical devices for treating obstruction of the airway by food or other foreign bodies.
Prior studies in dogs have shown improved blood pressure (BP) and carotid flow with abdominal binding during cardiopulmonary resuscitation (CPR). We assessed the effect of abdominal binding at pressures of 60 to 110 cm H2O during CPR in ten patients experiencing cardiac arrest. Abdominal binding for brief periods (30 to 60 s) raised mean arterial pressure from 53.9±7.1 mm Hg before binding to 67.2±8.4 mm Hg after binding. In six patients studied who had abdominal binding performed for four minutes, this beneficial effect was still apparent at the end of the time period. No abdominal visceral injury was found in six patients at autopsy. Thus, abdominal binding is an effective yet simple technique for increasing BP during CPR in man with considerable field use potential.
(JAMA 1981;246:351-353)
A MIDDLE-AGED or elderly person, at a fashionable restaurant, is partaking of filet mignon, or perhaps broiled lobster or prime rib of beef. At the same time, he is conversing with companions at dinner. Suddenly, he ceases to eat and talk. The dinner companions are perplexed but not alarmed for there is no indication of distress. Then, the person suddenly collapses at the table. Attempts at resuscitation are made by the maître d'hôtel, waiters, and friends. In some instances, a physician may be present who also attempts to aid the stricken person. The ambulance arrives and the person is rushed to the nearest hospital emergency room where he is dead on arrival. The emergency room physician, or the family doctor, attributes death to natural causes and probably to coronary artery disease.The above is the characteristic story of death from asphyxiation due to occlusion of the airway by food. The
An abstract is not available.
In 1974 Heimlich described a manoeuvre consisting of forceful upward thrusts with the fist on the epigastrium and directed towards the diaphragm. This was claimed to be superior to other simple manoeuvres in ejecting foreign bodies from the airway. Injuries such as rupture of stomach and spleen and costal fractures have, however, been reported as a result of the manoeuvre. The authors have therefore attempted to compare the efficacy of Heimlich's manoeuvre with that of other first-aid measures used in the treatment of food-choking.
Inhalation of foreign bodies is a major cause of accidental death during childhood. Aspiration of foreign bodies is common in children aged 1 to 3 years, especially in boys. A past history of foreign body aspiration is itself an indication for bronchoscopic examination of the airways, because some children with aspirated foreign bodies are without symptoms and chest x-ray films may not show abnormalities. Bronchoscopic removal of the foreign bodies requires close communication between the anesthesiologist and the endoscopist. Forgotten foreign bodies in the airways cause chronic pulmonary infections, allergic asthma, bronchiectatic changes, and lung abscess. Foreign bodies that cannot be grasped by bronchoscopic forceps should be removed by thoracotomy and bronchotomy. This report describes our experience in 500 children with suspected foreign body inhalation. We routinely use prednisolone, 1 to 2 mg. per kilogram, and nebulization just after bronchoscopic examination of the airways. This medication greatly diminishes the rate of postbronchoscopic complications such as laryngeal edema, which require tracheostomy. In our series of 500 case, the incidence of postbronchoscopic tracheostomy is 1.4 per cent and the total mortality rate is 1.8 per cent.
To investigate the application of a cough-creating thrust for the removal of airway-obstructing foreign material, the thrust was applied to six adult male anesthetized volunteers at the waist, at the low chest level, and at the midchest level, with the subjects in both the horizontal-lateral and the sitting positions. Air volume, peak air flow rate, and airway measurements were made. Both the low chest and midchest thrusts produced significantly better results than did the abdominal thrust. There were no side effects attributable to the thrusts. The ease of application and consistently better level of results indicate that the chest thrust is the technique of choice. The application of the chest thrust should be integrated into the concepts of basic life-support and cardiopulmonary resuscitation.
Subdiaphragmatic compression can sometimes prevent death from airway obstruction due to inhaled material. This 'Heimlich maneuvers' can be done with the victim standing and the resuscitator standing behind him, as with the patient in the supine position. The technique is described. Of the more than 500 documented cases of lives saved by the use of the Heimlicht Maneuver, 15 persons (including an 85 yr old woman) saved themselves when they were alone. This was achieved either by pressing their fist into their own abdomen, or pressing the abdomen against a railing, the back of a chair, or the edge of a sink. The simplicity and ease of understanding of the technique can be appreciated from the following report: An 8 yr old boy, who learned the maneuver in school, saved his 6 yr old brother, who was choking on a large piece of wax candy, while the mother watched helplessly, not knowing what to do.
A previously fit 30 year old woman visited her dentist for treatment under intravenous anaesthesia. While supine 10 mg diazepam was given intravenously over 90 seconds, followed immediately by intravenous 2% methohexitone to enable a local anaesthetic to be injected. After 30 mg methohexitone had been given she began to cough and thick mucus was noted in her pharynx. The injection was stopped and the mucus aspirated but she became apnoeic and cyanosed. She was ventilated with pure oxygen from a Salisbury machine with a functioning reducing valve via a facemask and by squeezing a standard 2 l reservoir bag. The bag did not overfill and her chest was noted to inflate. After 90 seconds her cyanotic colour was replaced by pallor. In view of absent pulses and heart sounds external cardiac massage was begun. After four minutes her pulse returned and she regained consciousness. She was tranferred to hospital and her general condition was satisfactory but she complained of abdominal pain. The abdomen was grossly distended with surgical emphysema of the anterior wall. Shortly after admission a small haematemesis occurred. X ray examination of the abdomen showed pneumoperitoneum but a limited Gastrografin study failed to show the site of the perforation. At laparotomy a 10 cm, full thickness laceration of the stomach was found along the lesser curvature with numerous serosal tears running parallel. The rupture was repaired and recovery was uneventful.
Flooding of the lungs occurs routinely in drowning victims. The cause of death in 90% of them is hypoxemia caused by water in the lungs. Mouth-to-mouth ventilation is ineffective until the water is removed. The Heimlich maneuver expels aspirated water, vomitus, debris, and other foreign matter. In treating near-drowning victims, place the victim in the supine position with head turned to the side and perform the Heimlich maneuver to evacuate water from the lungs, unless you know water is not in the respiratory tract. The Heimlich maneuver is a form of artificial respiration. It elevates the diaphragm, increasing intrathoracic pressure and compressing the lungs, and should be performed intermittently until all water is expelled. It is an especially useful technique because fear of contagion sometimes deters rescuers from using mouth-to-mouth ventilation . Further treatment has not been necessary in most instances. If the victim does not recover after water ceases to flow from the mouth, ventilation techniques, cardiopulmonary resuscitation, and other measures as indicated should be used.
THE HEIMLICH maneuver has recently been adopted as the standard treatment for the obstructed airway in children, adolescents, and adults.1 These same standards and guidelines caution that the Heimlich maneuver should only be used in near-drowning situations when the rescuer suspects that foreign matter is obstructing the airway or the victim does not respond appropriately to mouth-to-mouth ventilation. Heimlich and his colleagues2-5 have been calling for the maneuver to be the first line of treatment for near-drowning victims, to remove water from the lungs and airways. Others have argued that the routine performance of the maneuver without first demonstrating airway obstruction with foreign matter is a waste of valuable time and might produce complications.6-9
This case report describes a neardrowning victim whose first step of treatment with the Heimlich maneuver resulted in emesis with aspiration, which complicated what otherwise should have been a routine resuscitation.
Report of
To the Editor.—
The anecdotal article by Dr Orlowski1 on the Heimlich maneuver for drowning omits references and case details. The author says that the Heimlich maneuver caused the patient to vomit and contributed to his poor outcome. Dr Orlowski does not cite a 1981 case report2 in which the Heimlich maneuver opened a 2-year-old child's intubated airway that was blocked by inhaled water; the child did not vomit. This article was referenced in the June 1986 "Standards and Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care"3 and was discussed in an article by Dr Orlowski in 1982.4 Gordon and Terranova5 reported a similar case of a 2-year-old boy who vomited after cardiopulmonary resuscitation and arrived at the emergency department with a blocked airway, apnea, and no pulse. A Heimlich maneuver relieved the blocked airway and the child survived.Before the Heimlich maneuver was described
Management of foreign body airway obstruction continues to be a major controversy in emergency medical care. Much of the disagreement is without doubt based on lack of a uniformly accepted model of acute airway obstruction representative of the clinical event. A variety of models have been used to assess different aspects of airway obstruction by foreign bodies. These models have analyzed, among other variables, kinetic energy and inertial and aerodynamic forces in attempts to focus on specific aspects of this controversy. Human volunteers, anesthetized and paralyzed patients, and cadavers have also been used. In several recent studies it was concluded that subdiaphragmatic pressure is the treatment of choice, while in at least one additional study firm back blows applied with the patient's head hanging downward were recommended as the treatment most likely to relieve airway obstruction. It seems likely that these apparently conflicting views can be reconciled and that a consensus recommendation for treatment of this emergency can be effected.
WITH this issue, The Journal publishes a supplement that represents a landmark document. It is entitled Standards for Cardiopulmonary Resuscitation and Emergency Cardiac Care. It seems only yesterday in the long history of medicine that resuscitative efforts included such measures as rolling a victim over a barrel and rectal insufflation of smoke. Changes posed by World War II and research that continued into the 1950s culminated in 1966 with the First National Conference on Cardiopulmonary Resuscitation (CPR) that was sponsored jointly by the National Academy of Sciences-National Research Council and the American Heart Association.
The Journal was pleased to publish the standards issued from that conference that became the "law" of the medical world in the field of CPR. The science and art continued to develop rapidly during the ensuing years. As a result of experimental and clinical observations, techniques for artificial ventilation and cardiac compression have evolved to a
Complications of external cardiac resuscitation including rupture of the thoracic aorta were found in a retrospective review of 2 necropsy series. Other complications include fractures of ribs and sternum, bone marrow emboli, hemothorax, hemopericardium, pneumothorax, and laceration of abdominal organs and vessels with hemorrhage. A survey of the literature is presented. Aortic rupture, while rare as a complication of resuscitation, in some instances may be amenable to surgical correction and should be recognized as an entity.
This article has no abstract; the first 100 words appear below.
IT has been 10 years since Haugen¹ demonstrated that sudden deaths during meals — falsely labeled "heart attacks" — are usually due to choking on a large piece of meat. Four years earlier Helpern² was surprised to learn how often the physician, deluded by the suddenness of death, did not suspect choking and attributed death to coronary thrombosis. Though accurately described in numerous lay publications, this lethal emergency has received scanty recognition in the medical literature. This neglect may explain why a physician in a restaurant recently tried desperately and unsuccessfully to give a choking victim mouth-to-mouth resuscitation, which is . . .
Source Information
From the Department of Pathology. Holy Cross Hospital, Fort Lauderdale, Fla. (address reprint requests to Dr. Ellerat 4701 N. Federal Highway, Fort Lauderdale, Fla. 33308).
Nearly 2000 persons in the United States die each year after ingesting or inhaling a foreign body. If a physician suspects a foreign body in a child's air passages, he should turn the child upside down, gently slap his back, clean his mouth of foreign material, and keep him breathing. Cricothyrotomy is an extreme emergency measure.
EXCELLENT reviews have been published on the subject of foreign bodies in the tracheobronchial tree.1,2,5,7,8 The course of illness after inhalation of a foreign body depends on the age of the patient, on the morphological characteristics, on the position and duration of stay of the object in the air passage, and on the mode of therapy. The purpose of this paper is to illustrate and emphasize the importance of early diagnosis and adequate treatment in this disease in order to prevent subsequent cardiopulmonary changes, which may be lethal or irreversible requiring radical surgery. Our recent experience with six complicated cases of foreign body inhalation (Table) prompted us to present this report.
Report of Cases
Cardiac Arrest After Aspiration of a Foreign Body.
—Case 1.
—A 7-year-old boy choked on a loquat seed following which he coughed violently, became unconscious, and stopped breathing. Within ten minutes of the incident
Summary The incidence of cardiac arrest occurring in hospital patients away from the operating room or other locations where anaesthetic
procedures are carried out is impossible to estimate. Of the patients who suddenly and unexpectedly develop a cardiac arrest,
only a few survive. The survival rate is low, for most patients die from their underlying disease. But many are salvageable.
The organization and development of resuscitation services in the hospital is an endeavour towards improving techniques and
methods so that cardiac arrest may be successfully treated. No success can be possible without the wholehearted support of
the administration, the nurses and their supervisors, and especially the members of the Resuscitation Committee. As far as
the St. Boniface General Hospital is concerned this essential co-operation has been conspicuous.
Table VII summarizes our experience: a total of 63 patients were treated. Twenty-five were temporarily resuscitated and five
recovered sufficiently to return home and assume their normal activities. It is felt that even this small number of rescues
justified the expense and the tremendous outlay of effort by a large number of interested people, and it is anticipated that
the survival rate will climb with continued experience.
In the article "First Aid for the Choking Child" (Pediatrics 67:744, 1981), advice is given that is contrary to the vast majority of studies and reports in the medical literature. The methods recommended in the article not only have little scientific support, but also have led to serious complications and death as evidenced by numerous well-documented cases.
BACK BLOWS
The first treatment for the choking child according to the Pediatrics article is forceful administration of four back blows. No reference has been found to indicate why four back blows are better or worse than one or ten.
From the time of the study by Gross1 in 1854, to the present, there have been many published studies warning against the use of back blows.2-22
Back blows produce less pressure than the Heimlich maneuvers in seated subjects. In addition, back blows throw the head and neck forward and upward due to straightening the spine. Such blows theoretically can displace supraglottic foreign bodies further downward and backward into the throat or larynx.
The natural history of Crohn disease* is varied and unpredictable, and its cause is not known. No modality of treatment has definitely been shown to alter its course. Surgical treatment was carried out in a consistent fashion in 141 consecutive patients with Crohn disease. The indications for surgical operation were the complications of the disease only; these included fistula, abscess, obstruction and hemorrhage. Preoperative evaluation included upper gastrointestinal examination, barium enema, intravenous pyelogram, proctoscopy, and nutritional and volume support. In 76 of these patients previous operations had been carried out for Crohn disease. The surgical treatment was based upon the specific complication present, with adherence to the principle of resection of diseased tissue only. Ureterolysis also was necessary in 20 percent of these patients. The operative mortality was 1.4 percent, postoperative complications occurred in 54 patients and the surgical recurrence rate was 26 percent. A favorable result was accomplished in 85 percent of the patients.
SINCE 1960, when Kouwenhoven, Jude and Knickerbocker1 described a method of treating cardiac arrest by external compression of the chest, this emergency maneuver has found increasing acceptance and is replacing thoracotomy in most cases of cardiac arrest. The simplicity, immediate applicability and apparent harmlessness of the closed-chest technic make it an ideal emergency maneuver. Experimental and practical evidence2 , 3 suggests that the circulatory pressures obtained by external compression are as effective as those resulting from direct massage of the heart, without the frequent injuries to the myocardium associated with the latter method. The procedure is not without complications. Most trauma results . . .
A practical treatise on foreign bodies in the air-passages
- S D Gross
Obstructive asphyxia from food inhalation: report to the Committee on
- P Safer
- American Academy of Pediatrics