Effectiveness of the Abdominal Thrust Maneuver for Airway Obstruction Removal: Analysis of Data from the National Emergency Medical Services Information System.

BACKGROUND: Foreign body airway obstruction (FBAO) is a life-threatening emergency. Abdominal thrusts are recommended as first aid, but the success rate for this technique is unclear. Using information from a large database of emergency medical services (EMS) data in the United States, we evaluated the success rate of abdominal thrusts and identified patient characteristics that were associated with the success of the technique. METHODS: A retrospective observational study was conducted using data from the National Emergency Medical Services Information System (NEMSIS) to ascertain the success of abdominal thrusts in patients with FBAO from nearly 14,000 EMS agencies. Success was defined by positive evaluations on subjective and objective EMS criteria. RESULTS: Analysis of 1,947 cases yielded a 46.6% success rate for abdominal thrusts in removing obstructions. The age distribution was bimodal, with peaks during infancy and old age. June had the highest incidence of FBAO. Incidents were most frequent during lunch and dinner times, and most cases occurred in private residences. The first-time success rate was 41.5%, and a lower level of impaired consciousness was associated with lower success rates. A lower incidence of cardiac arrest was noted in successful cases. The success rate was high (60.2%) for children (age ≤15 years), with differences in demographic characteristics and a lower rate of impaired consciousness and cardiac arrests, as compared with unsuccessful interventions in the same age group. CONCLUSIONS: Our study showed a 46.6% success rate for abdominal thrusts in patients with FBAO. The success group had a lower proportion of impaired consciousness and cardiopulmonary arrest than the failure group. Future studies should attempt to identify the most effective maneuvers for clearing airway obstruction.

Knowledge and misconceptions of choking and first-aid procedures among Syrian adults: A cross-sectional study.

Background: Choking is a critical emergency that occurs when foreign objects obstruct the airways. It commonly affects young children, older people, individuals with developmental disabilities, those with acquired or lifelong disability, and those with mental health conditions. Symptoms can vary, ranging from coughing to cyanosis. Aim: Our study aims to evaluate Syrian adults' knowledge of choking and their understanding of first-aid procedures. Specifically, we will assess the prevalence of misconceptions in order to train community members and increase their level of knowledge about first aid for choking. Ultimately, our goal is to reduce deaths resulting from this critical condition. Methods: This cross-sectional study aims to assess the knowledge and attitudes regarding choking among adults in Syria. The targeted population consists of Syrians aged between 18 and 45 years who reside in Syria. Data were collected through an online survey, disseminated via social media platforms from March to July 2022. Scores were computed to quantify levels of knowledge, with participants achieving a score of 16 or higher classified as having a high level of knowledge. The collected data were analyzed using descriptive statistics, Pearson's correlation coefficient, and chi-square tests. Results: A total of 406 responded to the survey, with 246 (60.6%) scoring less than 16 points, indicating a low level of knowledge. Gender and place of residency were not correlated with knowledge level p = 0.249, p = 0.913, respectively). Participants employed in the medical field, those who had received training in first aid, and individuals with higher levels of education exhibited higher levels of knowledge. However, the level of knowledge was below expectations for these groups. Conclusion: There should be an increase in the availability of first-aid courses to the public and improvements in hands-on training for physicians and medical trainees.

Assessment of Knowledge, Attitude, and Practice of First Aid Management of Choking Among Primary School Teachers in Riyadh, Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: Understanding first aid is crucial for immediate intervention during health emergencies, with choking representing a significant danger, particularly for young children. Obstructed airways commonly lead to choking incidents, carrying substantial risks if not swiftly dealt with. This research endeavors to evaluate the comprehension, perspectives, and implementation of first aid measures for choking incidents among primary school teachers in Riyadh, Saudi Arabia, an area of paramount importance with minimal existing research within this particular demographic. METHODOLOGY: This was a cross-sectional study conducted from the beginning of July till the end of October 2023, among 447 primary school teachers in Riyadh, Saudi Arabia. Data collection was carried out by administering a questionnaire through an online platform. The questionnaire included demographic information, knowledge about signs and symptoms of choking, the attitude of participants, participant's practice, and the relationship between the knowledge level about choking and practice. The data collected were reviewed, coded, and then fed into IBM SPSS Statistics for Windows, Version 29 (Released 2023; IBM Corp., Armonk, New York, United States).  Results: Our study on first aid management of choking among primary school teachers highlighted significant findings. Participants demonstrated high awareness of choking signs with 386 (86.3%) recognizing universal signs and 330 (73.8%) claiming proficiency in first aid. Attitudes favored the importance of immediate treatment in 394 participants (88.1%) and the necessity of first aid knowledge for teachers (92.2%). One-hundred and fifty-one participants (33.8%) reported performing choking first aid with 328 (73.4%) opting for the Heimlich maneuver for a six-year-old. Significantly, higher knowledge correlated with increased first aid performance (p < 0.001) and support for mandatory training (p < 0.001). CONCLUSION: Our study indicates a higher knowledge level in primary school teachers with positive attitudes and practices regarding choking first aid management. It underscores the importance of enhancing first aid training among primary school teachers, emphasizing its positive impact on choking management and the necessity of immediate intervention in such cases.

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.

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)

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.

Incarcerated diaphragmatic hernia following Heimlich maneuver.

The Heimlich maneuver or abdominal thrust is a recognized effective therapy for foreign-body airway obstruction. Serious complications, however, have been described. We present a case of an incarcerated diaphragmatic hernia secondary to Heimlich maneuver.

Exploration of teaching practice of foreign body airway obstruction first aid / 中华医学教育探索杂志

In order to optimize the teaching process, improve the teaching quality and cultivate of emergency nursing talents with comprehensive quality, we systematically designed the teaching process of foreign body airway obstruction first aid. From the design ideas and curriculum innovation, we focused on the use of a variety of teaching methods, and we combined it with modern information technology, which demonstrated the practicability and operability of first aid skill. This teaching practice has proved that the systematically teaching reform design is helpful to improve the learning efficiency of nursing students and cultivate the comprehensive quality of students' emergency response ability.

Influence of body position during Heimlich maneuver to relieve supralaryngeal obstruction: a manikin study.

To study the most effective body position for Heimlich maneuver. Methods: A choking simulation manikin was connected to a laryngeal model of a child or an adult, and a differential pressure transducer recorded the airway pressure and waveform during the maneuver. A konjac jelly was placed on the larynx to mimic complete supralaryngeal obstruction. The maneuver (five successive compressions) was carried out six times each in standing, prone, and supine positions. For cases of children, we added a supine position with a pillow under the back. Results: In the adult model, airway obstruction was more frequently relieved in the supine and prone positions than in the standing position (P < 0.001). In the child model, airway obstruction was more frequently relieved in the supine position, with a pillow, and in the prone position, than in the standing position (P < 0.001). Without relief, successive Heimlich maneuvers made the airway pressure increasingly negative (adult, from -21.9 ± 6.5 cmH2O to -31.5 ± 9.1 cmH2O in the standing position [P < 0.001]; child, from -15.0 ± 9.5 cmH2O to -30.0 ± 9.2 cmH2O in the standing position [P < 0.001] and from -35.0 ± 17.4 cmH2O to -47.3 ± 25.1 cmH2O in the supine position without a pillow [P = 0.002]). Conclusions: The Heimlich maneuver was more effective in the supine and prone positions. In children, the prone position may be most effective. Successive Heimlich maneuvers may be harmful when the airway is not relieved after the first compression.

Cuerpo extraño en la vía aérea en pediatría / Foreign-body aspiration in children

It is a frequent pediatric event and a common cause of morbidity and mortality in children, requiring accurate diagnosis and proper treatment. Diagnosis is usually based on clinical manifestations such as cough, dyspnea. stridor, respiratory distress and asymmetric decreased air entry or unilateral wheeze. Choking crisis may be absent or minimized. Chest X-ray may have no abnormalities or show signs such as asymmetrical hyperinflation, massive, fixed or changing atelectasis. Occasionally, hyperinflation or obstructive emphysema with atelectasis can be present in the same hemithorax. Inspiratory and expiratory chest X-rays show ipsilateral mediastinum movements. Most foreign bodies are not visible to chest X-ray exploration. Acute suffocation must be treated with Heimlich procedure. In later stages, diagnosis and treatment require rigid bronchoscopy. Prognosis is fairly positive with an early and complete foreign-body extraction.

La aspiración de un cuerpo extraño (CE) a la vía aérea en pediatría es un accidente frecuente, presenta importante morbimortalidad, por lo que requiere un diagnóstico y tratamiento oportuno. El diagnóstico usualmente se establece mediante hallazgos clínicos, siendo los más frecuentes tos, síndrome de penetración, y con menor frecuencia dificultad respiratoria, estridor, sibilancias unilaterales. La radiografía de tórax puede ser normal o alterada, mostrando hiperinsuflación unilateral, atelectasia u otros signos. La mayoría de los CE son radiotransparentes. Durante la fase aguda debe practicarse la maniobra de Heimlich, en cambio en la fase crónica el diagnóstico y tratamiento definitivo se hace mediante broncoscopía. La prevención es fundamental evitando que niños menores manipulen objetos pequeños, advertir el riesgo de asfixia por aspiración en los envases de alimentos riesgosos y de juguetes de pequeño tamaño. El pronóstico es bueno si la extracción del cuerpo extraño es precoz y completa.

Purging using the Heimlich maneuver among children and adolescents with eating disorders.

This case report describes five independent cases of children and adolescents assessed for eating disorders who disclosed using the Heimlich maneuver as a purging technique. The maneuver is meant to be used only in life or death situations, likely once or less in any person's lifetime. A child or adolescent with an eating disorder may be using it to self-induce vomiting on a daily basis, increasing the risk of complications, including potential damage to major organs of the body. Asking patients who purge to elaborate on the methods with which they purge can provide clinicians with fuller information, improving their ability to select appropriate medical tests and interventions. Thorough investigations of physical complaints during the patient assessment may be warranted, including examining patients for possible rib fractures, hemorrhages, perforations of the hollow viscous, and other forms of blunt abdominal traumas.

Postobstructive pulmonary edema in the setting of aspiration and air travel.

BACKGROUND: Postobstructive pulmonary edema (POPE)-also referred to as negative pressure pulmonary edema-occurs with deep inspiration against a closed glottis or obstructed airway. The result can be life threatening, however, most cases have a self-limited presentation and resolve with supportive care. OBJECTIVE: Our aim was to critically evaluate a previously unreported mechanism in the exacerbation of POPE. CASE REPORT: This is a report of a 50-year-old woman who experienced an acute episode of hypoxia and altered mental status aboard a transcontinental flight. Her presentation was suggestive of pulmonary embolus. However, a detailed history yielded an episode of preflight choking relieved by the Heimlich maneuver. After 2 days of supportive care she was discharged with a complete return to baseline. CONCLUSIONS: Subclinical cases of POPE can be exacerbated by the low atmospheric pressure experienced on commercial airlines. With early recognition and supportive treatment, the patient returned to baseline before her discharge 2 days later. Making the diagnoses of POPE is not always straightforward for the practitioner and necessitates a broad differential. Initial supportive care focusing on maximizing respiratory support is critical.

Heimlich's maneuver-assisted bronchoscopic removal of airway foreign body.

Aspiration of foreign bodies (FBs) by children can lead to serious illness and sometimes even death. Bronchoscopic removal of the FB is necessary to prevent from any catastrophic event. Sometimes bronchoscopic removal is not possible due to the larger size of the FB, sharp FB, or long duration FB. Tracheostomy is normally used for the removal of such FBs. The aim of this case report is to highlight the use of Heimlich maneuver for the removal of such FBs before opting invasive procedures. In the present case, a 5-year-old child was presented with history of FB aspiration 5 h back. After multiple failed bronchoscopic attempts to remove the FB it was decided to use Heimlich maneuver in the supine position. A single attempt of Heimlich maneuver expelled the FB into the oral cavity, which was removed by Magill's forceps. On repeated bronchoscope check, there was no remnant of FB. Child's further course of stay in hospital was uneventful. In conclusion, Heimlich maneuver may be useful in patient with failed bronchoscope removal of airway FBs before proceeding for tracheotomy or other invasive procedures.