Resuscitation, 24 (1992) 91 Elsevier Scientific Publishers Ireland Ltd.
91
Letter to the Editor
Chest compression - an alternative to the Heimlich Manoeuver ? (Accepted August 17th, 1992)
Dear Editor, I wish to report a case of foreign body in the trachea, removed by chest compression. In a psychiatric department a patient tried to swallow a sausage she had for dinner. A nurse came to the patient when she lay on the floor; she was pulseless and had no signs of breathing. The diagnosis of foreign body obstruction of the airway was easy, especially because the patient had a tendency to put too much food into her mouth, a habit well known to the nurses. The nurse immediately started the Heimlich manoeuver, applying three to four compressions to the epigastrium. Nothing happened and she repeated the maneuver without success whereupon she called for help and in her desperation started mouth to mouth ventilation. A doctor came and started heart compression. At the first pressure the sausage came out. Both the doctor and the nurse heard a noise in the abdomen when the first chest compression was executed, which was later diagnosed as a rupture of the stomach. The patient had a spontaneous pulse and started breathing immediately after the foreign body had been removed. The patient was transfered to a surgical department. A laparatomy confirmed the diagnosis of gastric rupture and the rupture was repaired. The patient was kept on a respirator for 2 days. She woke up and had the same mental status as before the event. The distended stomach might have helped to rise intrathoracic pressure. Most people now think that chest compression is effective because intrathoracic pressure is raised. To me it seems obvious that chest compression raises the thoracic pressure more than the Heimlich manoeuver. If it does not, we should perform the Heimlich manoeuver for artificial circulation! In some cases the patient has circulatory arrest when one starts to remove a foreign body and in these cases it could be as effective to start chest compression as to start the Heimlich manoeuver. Could this be an argument for doing CAB instead of ABC when coming to a pulseless patient? Andreas Skulberg Akuttetaten,
Correspondence
to: A. Skulberg, Akuttetaten,
0182 Oslo, Norway.
0182 Oslo, Norway.
91
Letter to the Editor
Chest compression - an alternative to the Heimlich Manoeuver ? (Accepted August 17th, 1992)
Dear Editor, I wish to report a case of foreign body in the trachea, removed by chest compression. In a psychiatric department a patient tried to swallow a sausage she had for dinner. A nurse came to the patient when she lay on the floor; she was pulseless and had no signs of breathing. The diagnosis of foreign body obstruction of the airway was easy, especially because the patient had a tendency to put too much food into her mouth, a habit well known to the nurses. The nurse immediately started the Heimlich manoeuver, applying three to four compressions to the epigastrium. Nothing happened and she repeated the maneuver without success whereupon she called for help and in her desperation started mouth to mouth ventilation. A doctor came and started heart compression. At the first pressure the sausage came out. Both the doctor and the nurse heard a noise in the abdomen when the first chest compression was executed, which was later diagnosed as a rupture of the stomach. The patient had a spontaneous pulse and started breathing immediately after the foreign body had been removed. The patient was transfered to a surgical department. A laparatomy confirmed the diagnosis of gastric rupture and the rupture was repaired. The patient was kept on a respirator for 2 days. She woke up and had the same mental status as before the event. The distended stomach might have helped to rise intrathoracic pressure. Most people now think that chest compression is effective because intrathoracic pressure is raised. To me it seems obvious that chest compression raises the thoracic pressure more than the Heimlich manoeuver. If it does not, we should perform the Heimlich manoeuver for artificial circulation! In some cases the patient has circulatory arrest when one starts to remove a foreign body and in these cases it could be as effective to start chest compression as to start the Heimlich manoeuver. Could this be an argument for doing CAB instead of ABC when coming to a pulseless patient? Andreas Skulberg Akuttetaten,
Correspondence
to: A. Skulberg, Akuttetaten,
0182 Oslo, Norway.
0182 Oslo, Norway.
