The Heimlich maneuver and chest compression relieve mask ventilation difficulties caused by asymptomatic laryngeal mass: A case report and review of literature.

RATIONALE: Some laryngeal masses are typically asymptomatic and easily ignored. However, they can be rare causes of unanticipated difficult airway, leading to critical situations such as "cannot ventilate" or "cannot ventilate and cannot intubate" during anesthesia induction. Inappropriate airway management in such scenarios can have catastrophic consequences for an anesthetized patient. Here we report a case of sudden, unanticipated difficult mask ventilation caused by an asymptomatic supraglottic mass during sedative induction, which was quickly and effectively relieved by the Heimlich maneuver and chest compression. PATIENT CONCERNS: We report a rare case of airway crisis occurred during sedative induction in a 63-year-old patient scheduled for a routine flexible bronchoscopy, and no evidence of respiratory difficulty or signs of obstruction was found in preoperative evaluation. DIAGNOSES: A detailed examination of laryngopharyngeal structure under bronchoscopy revealed a supraglottic soft-tissue mass with a size of 1.6 × 0.8 cm covering the membranous part of the glottic area, which was the true cause of difficult mask ventilation in this patient during sedative induction. INTERVENTIONS: As the unanticipated difficult mask ventilation occurred, 2-handed mask ventilation was initiated immediately for 9 attempts but failed. Fortunately, the airway crisis was successfully relieved with 2 Heimlich attempts and 3 chest compressions, and no need for a laryngeal mask airway. OUTCOMES: Once the airway crisis was relieved and the supraglottic mass was confirmed, the patient underwent a second sedative anesthesia and a successful laryngeal mask airway-assisted bronchoscopy, with no post-bronchoscopy adverse events. LESSONS: Asymptomatic supraglottic masses can cause valve-like upper airway obstruction and lead to unanticipated difficult mask ventilation. The Heimlich maneuver and chest compression may be effective in such critical situations and can serve as an emergency intervention.

Esophageal rupture after Heimlich maneuver: a case report and literature review.

The Heimlich maneuver (HM) is lifesaving in a patient choked by a foreign body. It is safe and effective and does not require specific instruments. Nevertheless, rare severe complications have been reported, such as traumatic injury of the gastrointestinal tract, pneumomediastinum, rib fracture, diaphragm rupture, acute thrombosis of abdominal aortic aneurysm and mesenteric laceration. Abdominal injuries are the most common complications, especially esophageal and gastric wall rupture. This anatomic site is the most common location of organ injuries, in consequence of the main target of the force generated by the HM. Furthermore, the execution of HM by an untrained person may increase the risk for possible serious complications. Usually, HM complications are treated surgically, but based on clinical conditions, a conservative approach is possible. In our report, we described a case of esophageal rupture after a forceful HM, and we made a brief revision of literature concerning HM complications. We have also assessed the correlation between HM complications, abuse of non-steroidal anti-inflammatory drugs and the execution of the abdominal thrusts by untrained rescuers.

O conhecimento a respeito da Manobra de Heimlich por mães da rede social Facebook / The Knowledge about the Hemlich Manuver by mothers on the Facebook social network / El conocimiento de la Maniobra de Heimlich por parte de las madres en la red social Facebook

Objetivo: analisar o conhecimento a respeito da Manobra de Heimlich por mães da rede social Facebook, tendo como problema de pesquisa o seguinte questionamento: "Durante o pré-natal na rede pública a mãe recebeu orientações sobre a manobra de Heimlich? Que conhecimento as mães tem sobre a manobra de Heimlich." Método: Foi utilizada a abordagem qualitativa e método descritivo para este estudo, seguindo os pressupostos de Ludke e André (1986). Resultados: Foram entrevistadas 7 mulheres com idade entre 23 e 40 anos que responderam os questionamentos a respeito da Manobra de Heimlich no pré-natal e falaram sobre seus conhecimentos prévios a respeito do tema. Conclusão: As entrevistas realizadas revelam que as mulheres possuem conhecimento superficial a respeito da Manobra de Heimlich, no entanto esse conhecimento não foi obtido em seu pré-natal, mas sim por conta própria ou por necessidade.

Objective: to analyze the knowledge about the Heimlich Maneuver by mothers of the social network Facebook, having as research problem the following question: "During prenatal care in the public network the mother received guidance on the Heimlich maneuver? What knowledge do mothers have about the Heimlich maneuver." Method: The qualitative approach and descriptive method for this study were used, following the assumptions of Ludke and André (2008). Results: We interviewed 7 women aged between 23 and 40 years old who answered the questions about the Heimlich Maneuver in prenatal care and talked about their previous knowledge about the subject. Conclusion: The interviews revealed that women have superficial knowledge about the Heimlich Maneuver, however this knowledge was not obtained in their prenatal care, but rather on their own or by necessity.

Objetivo: analizar el conocimiento sobre la Maniobra de Heimlich por parte de las madres de la red social Facebook, teniendo como problema de investigación la siguiente pregunta: "¿Durante la atención prenatal en la red pública la madre recibió orientación sobre la maniobra de Heimlich? ¿Qué conocimiento tienen las madres sobre la maniobra de Heimlich?" Método: Se utilizó el enfoque cualitativo y el método descriptivo para este estudio, siguiendo los supuestos de Ludke y André (2008). Resultados: Entrevistamos a 7 mujeres de entre 23 y 40 años que respondieron a las preguntas sobre la Maniobra de Heimlich en la atención prenatal y hablaron sobre sus conocimientos previos sobre el tema. Conclusión: Las entrevistas revelaron que las mujeres tienen conocimientos superficiales sobre la Maniobra de Heimlich, sin embargo este conocimiento no se obtuvo en su atención prenatal, sino por su cuenta o por necesidad.

Withholding the Heimlich Maneuver: Ethical Considerations.

The topic of withholding the Heimlich maneuver as part of a do-not-attempt-to-resuscitate (DNAR) order or an advance directive has not been widely discussed in the clinical ethics literature. This discussion addresses a request by family members to withhold the Heimlich maneuver from a patient in a long-term care facility. A request to forgo the Heimlich maneuver seems to have prima facie categorical similarities to justifications for withholding life-saving treatments such as cardiopulmonary resuscitation (CPR). Further examination reveals significant distinctions. Such distinctions call into question the ethical appropriateness of including the Heimlich maneuver among interventions to be withheld as part of end-of-life care planning, and encourages a broader discussion of an increasingly uncritical deference to autonomy in end-of-life decision making. Most notably, the Heimlich maneuver is the only intervention known to effectively relieve the distressing symptoms of accidental choking. The Heimlich maneuver serves a palliative function and is the standard of care for accidental choking. The Heimlich maneuver should not be conflated with other life-prolonging interventions that may be withheld as part of end-of-life care planning.

Interstitial Cystitis/Bladder Pain Syndrome as Referred Pain From Injured T12/L1 Nerves: Symptomatic Improvement With Resection of Ilioinguinal and Iliohypogastric Nerves.

OBJECTIVE: To evaluate the specific contribution of ilioinguinal (II) and iliohypogastric (IH) nerve injury and referred pain to interstitial cystitis/bladder pain syndrome and patient-reported chronic pelvic pain, and to enumerate the effects of II and IH nerve resection on the pain and voiding symptoms in patients with IC/BPS. MATERIALS AND METHODS: This was a prospective cohort study of 8 patients with ICS/BPS who had prior abdominal surgery. All patients received diagnostic image guided T12/L1 nerve blocks, followed by II and IH nerve resections. Validated O'Leary-Sant ICS symptom indices (OSPI) and pelvic pain and urgency/frequency patient symptoms scale (PUF) scores were collected at specified intervals pre- and post-operatively. RESULTS: Median scores at pre-operative (OSPI 13.9, PUF 20.4) and 1 week time points (OSPI 5.9, PUF 11), as well as differences between pre-operative and 10 month time points (OSPI 3.7, PUF 6) were all statistically significant (P = .008 and .009 at 1 week, and .007 and .008 at 10 months, for OSPI and PUF respectively). The mean difference in score from pre-operative to longest follow-up as measured by the OSPI was -14.4 (P < .001) and by PUF -10.3 (P < .001). All time points registered demonstrated improvement in pain scores. There were no surgical complications or adverse events. CONCLUSION: II and IH nerve resection may be an effective and durable treatment option for those with prior abdominal surgery who have referred interstitial cystitis/bladder pain syndrome pain from these injured nerves.

Cholesterol embolization and arterial occlusion from the Heimlich maneuver.

The Heimlich maneuver is a lifesaving bystander intervention to assist an individual with airway obstruction however, cholesterol embolization syndrome is a rare, but serious potential complication of the Heimlich maneuver. We present the case of the 56-year-old female presenting to the emergency department with acute right foot pain following performance of the Heimlich maneuver who was found to have distal arterial occlusion resulting from cholesterol embolization syndrome. The patient underwent right popliteal artery exploration, right popliteal and tibial thrombectomy, and popliteal patch angioplasty resulting in restoration of blood flow to her right foot.

Avaliação do conhecimento materno sobre manobra de heimlich: construção de cartilha educativa / Assessment of maternal knowledge of heimlich maneuver: educational booklet building / Evaluación del conocimiento materno sobre la maniobra de heimlich: elaboración de un folleto educativo

Introdução: No Brasil, a asfixia é uma das principais causas de morbimortalidade em crianças. A manobra de Heimlich é uma técnica de primeiros socorros utilizada em casos de emergência em asfixia. Assim, é importante que as mães sejam orientadas e capacitadas para uma eventual necessidade de socorro à criança, diante dessa ocorrência. Objetivo: Identificar o grau de conhecimento de puérperas sobre a manobra de Heimlich e elaborar uma cartilha educativa sobre a manobra e o atendimento emergencial. Método: Pesquisa descritiva, exploratória, quali-quantitativa, realizada junto a puérperas de uma maternidade do interior paulista. Resultados: Participaram do estudo 50 puérperas. Foi elaborada uma cartilha explicativa no socorro à criança sob risco ou em asfixia. Quanto ao conhecimento sobre a manobra de Heimlich, 44% das mulheres desconheciam-na, 40% alegaram conhecê-la e 16% declararam ter pouco conhecimento sobre a técnica. Com relação às técnicas que executariam para atender a criança, 32% detalharam técnicas incorretas, 32% demonstraram algum conhecimento, 18% buscariam ajuda de pessoas leigas, 16% chamariam um socorro especializado e apenas 2% tinham conhecimento suficiente. Sobre educação em saúde e conhecimento da manobra de ressuscitação: 80% informaram não haver recebido orientação sobre a manobra de Heimlich, destas, 78% demonstraram interesse em conhecer o conteúdo explicativo da cartilha. Conclusão: O conhecimento insuficiente das puérperas e a falta de orientações sobre como socorrer a criança asfixiada requer intervenções específicas. Assim, a elaboração da cartilha educativa intitulada "Criança engasgada: orientações e primeiros socorros" se mostrou adequada para a população do estudo.(AU)

Introduction: In Brazil, asphyxiation is one of the main causes of morbidity and mortality in children. The Heimlich maneuver is a first aid technique used in cases of asphyxiation emergencies. Thus, it is important that mothers are guided and trained for a possible need to help the child, given this occurrence. Objective: To identify the degree of knowledge of puerperal women about the Heimlich maneuver and to elaborate an educational booklet on the maneuver and emergency care. Method: Descriptive, exploratory, qualitative-quantitative research, carried out with postpartum women from a maternity hospital in the interior of São Paulo. Results: 50 puerperal women participated in the study. An explanatory booklet was elaborated to help the child at risk or in asphyxia. As for the knowledge about the Heimlich maneuver, 44% of the women were unaware of it, 40% claimed to know it and 16% said they had little knowledge about the technique. Regarding the techniques they would perform to care for the child, 32% detailed incorrect techniques, 32% showed some knowledge, 18% would seek help from lay people, 16% would call for specialized help and only 2% had sufficient knowledge. On health education and knowledge of the resuscitation maneuver: 80% reported not having received guidance on the Heimlich maneuver, of which 78% showed interest in knowing the explanatory content of the booklet. Conclusion: The insufficient knowledge of postpartum women and the lack of guidance on how to rescue the asphyxiated child requires specific interventions. Thus, the elaboration of the educational booklet entitled "Child choking: orientations and first aid" proved adequate for the study population.(AU)

Introducción: En Brasil, la asfixia es una de las principales causas de morbilidad y mortalidad en niños. La maniobra de Heimlich es una técnica de primeros auxilios utilizada en casos de emergencia en asfixia. Por lo tanto, es importante que las madres sean orientadas y entrenadas para una posible necesidad de ayuda al niño, en vista de este acontecimiento. Objetivo: Identificar el grado de conocimiento de las mujeres puerperales sobre la maniobra de Heimlich y elaborar un folleto educativo sobre la maniobra y la atención de emergencia. Método: Investigación descriptiva, exploratoria, cualitativa y cuantitativa, realizada con mujeres puerperales de un hospital de maternidad en el interior de Sao Paulo. Resultados: Cincuenta mujeres puerperales participaron en el estudio. Se preparó un folleto explicativo para ayudar a los niños en riesgo o en asfixia. En cuanto al conocimiento sobre la maniobra de Heimlich, el 44% de las mujeres no lo sabían, el 40% afirmaba conocerla y el 16% informaba tener poco conocimiento sobre la técnica. En cuanto a las técnicas que realizarían para cuidar al niño, el 32% de técnicas incorrectas detalladas, el 32% demostró algunos conocimientos, el 18% buscaría ayuda de laicos, el 16% llamaría a una ayuda especializada y sólo el 2% tenía suficiente conocimiento. En cuanto a la educación sanitaria y el conocimiento de la maniobra de reanimación: el 80% informó no haber recibido orientación sobre la maniobra de Heimlich, de los cuales el 78% mostró interés en conocer el contenido explicativo del folleto. Conclusión: El conocimiento insuficiente de las mujeres puerperales y la falta de orientación sobre cómo ayudar al niño asfixiado requiere intervenciones específicas. Así, la elaboración del folleto educativo titulado "Ninõ asfixiante: pautas y primeiros auxilios" resultó adecuada para la población del estudio.(AU)

Alimentação e Comunicação: Vídeo para Orientação de Cuidadores de Idosos / Food and Communication: Video for Guiding Elderly Caregivers

Objetivo: Analisar o conhecimento dos cuidadores formais com relação aos aspectos da alimentação e da comunicação com a pessoa idosa e elaborar um vídeo com orientações para o cuida-dor formal. Metodologia: Pesquisa realizada em instituições de longa permanência para idosos no Município de João Pessoa, Paraíba. Tornaram-se participantes 34 cuidadores de idosos. O instrumento utilizado para coleta de dados foi um questionário construído a partir das explanações da literatura sobre disfagia, linguagem e cognição. Na análise dos dados foi utilizada a es-tatística descritiva por meio da frequência absoluta, percentual e do teste de proporções. Foi elaborado o script do vídeo e as cenas avaliadas por 6 juízes. Todos concordaram com as cenas de forma unânime, sendo então o vídeo considerado confiável. Os juízes realizaram sugestões nas cenas e as mesmas foram analisadas por meio da estatística descritiva. Em seguida, foi realizada a edição do vídeo. Resultados:Os cuidadores não têm conhecimento das dificuldades de fala, audição, cognição do idoso e das estratégias que facilitam essas funções. Tam-bém, não mostram conhecer as dificuldades de alimentação dos idosos, embora realizem estratégias facilitadoras. Como produto final foi elaborado um vídeo de orientação ao profissio-nal cuidador. Conclusão: Ressalta-se a importância do vídeo para orientações com relação a alimentação e a comunicação, propiciando melhora na qualidade de vida da pessoa idosa institucionalizada. (AU)

Objective: To analyze the knowledge of formal caregivers regarding aspects of eating and communication of the elderly and to elaborate a video with guidelines for the formal caregiver. Methodology: Methodological research conducted in long-term care facilities for the elderly in the city of João Pessoa, Paraiba. 34 elderly caregivers became participants. The instrument used for data collection was a questionnaire built from the literature explanations on dysphagia, language and cognition. Data analysis was performed using descriptive statistics through the absolute frequency, percentage and the proportions test. The script of the video was elaborated and the scenes evaluated by 6 judges. Everyone agreed with the scenes unanimously, so the video was considered reliable. The judges made sugges-tions in the scenes and they were analyzed using descriptive statistics. Then, the video was edited. Results: Caregivers are unaware of the difficulties in speech, hearing, and cognition of the elderly and the strategies that facilitate these functions. They also do not show knowledge of the feeding difficulties of the elderly although they perform facilitating strategies. As a final product, a guidance video was prepared for the professional caregiver. Conclusion: We emphasize the importance of the video for guidance regarding food and communication, providing improvement in the quality of life of the institutionalized elderly, (AU)

Silent Aortic Dissection after the Heimlich Maneuver: A Case Report.

BACKGROUND: The Heimlich maneuver is a simple and universal resuscitative procedure that is performed to relieve foreign-body airway obstruction. We present a case of silent Stanford type A aortic dissection, a rarely reported complication of the Heimlich maneuver. CASE REPORT: A 67-year-old male presented to the emergency department with left-sided hemiplegia shortly after receiving a Heimlich maneuver. Acute ischemic stroke was suspected, and the thrombolytic protocol was initiated. Fortunately, Stanford type A aortic dissection was diagnosed before the thrombolytic therapy was initiated. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Aortic dissection can develop after the Heimlich maneuver. For patients who develop a neurologic deficit after the Heimlich maneuver, vascular dissection should be considered as a possible cause.

Esophageal perforation as a complication of the Heimlich maneuver in a pediatric patient: A case report.

We report a case of cervical esophageal perforation caused by the Heimlich maneuver in a healthy 16-year-old boy. The patient reported a short coughing episode while eating rice, and his mother performed the Heimlich maneuver on him. Five days later, he presented to the emergency department with throat pain, odynophagia, secretion intolerance, muffled voice, and neck stiffness. He was admitted to the pediatric intensive care unit for conservative management. The next day he underwent transcervical incision and drainage of purulence, but the esophageal perforation could not be visualized at that time. The perforation was identified several days later and successfully repaired surgically. Esophageal perforation as a complication of the Heimlich maneuver is exceedingly rare, but the clinician should be aware of this entity in the differential diagnosis, as it is associated with a high mortality rate and warrants multidisciplinary care, including timely surgical intervention.

Choking on a foreign body: a physiological study of the effectiveness of abdominal thrust manoeuvres to increase thoracic pressure.

The Heimlich manoeuvre is a well-known intervention for the management of choking due to foreign body airway occlusion, but the evidence base for guidance on this topic is limited and guidelines differ. We measured pressures during abdominal thrusts in healthy volunteers. The angle at which thrusts were performed (upthrust vs circumferential) did not affect intrathoracic pressure. Self-administered abdominal thrusts produced similar pressures to those performed by another person. Chair thrusts, where the subject pushed their upper abdomen against a chair back, produced higher pressures than other manoeuvres. Both approaches should be included in basic life support teaching.