14481 Adedokun Comfort

Myth of THE MEAT: The Heimlich Manoeuvre Extension to Advance Trauma

Aspiration of a food bolus causing airway obstruction is an airway emergency. It can lead to hypoxia, haemodynamic compromise and death.

Administration of the Heimlich manoeuvre (abdominal thrust) as part of basic life support (BLS) for dislodging an obstructing foreign body is indicated when coughing is ineffective. However, traumatic complications arising from this procedure can be life-threatening especially in elderly population.

We present a case of 90 year old lady, brought in by ambulance to ED, with hypoxia  and respiratory distress after a choking episode. She had received prehospital BLS including the Heimlich manoeuvre. Imaging revealed a haemothorax, an acute T6 and sternal fracture, bilateral third to seventh rib fractures with right sided fracture displacement, para-mediastinal bullae, aspiration pneumonitis, and bilateral lower lobe atelectasis with left sided effusion. She was admitted to the high dependency unit and had a length of stay of 11 days. She made a full recovery.

LEARNING POINTS

The Heimlich manoeuvre/abdominal thrust remain key part of BLS for choking victims and can be a lifesaving intervention. Practitioners need to be aware of the possibility of sustaining traumatic injury and complications as a result of this manoeuvre, especially in elderly patients who are a group prone to aspiration. Various modifications of the Heimlich manoeuvre exist which have been reported to generate lesser pressures.

Early identification of the complications of this manoeuvre and  initiation of appropriate management should improve patient outcomes, decrease length of hospital stay and mortality.