Charles A. Bertrand, M.D., FACP, DIM-CD (Ret.)
Associate Clinical Professor of Medicine at New York Medical College
and at the Medical University of South Carolina


DO IT YOURSELF HEIMLICH (re-visited)

In my early years in practice. I wrote a "letter to the editor" and it was published in the New York State Journal of Medicine. Dr. Henry Heimlich originated this maneuver about 40 years ago. My wife and I were attending a medical meeting in Niagara Falls where a chest surgeon had an exhibit explaining the procedure. He used a mannequin and it had a small rubber ball in the larynx with a string attached to it. To learn the technique, it was necessary to perform the maneuver with the hands closed in a fist and pressure was then exerted above the navel. The force was directed inward and upward thus increasing the pressure within the chest and forcing the ball to fly out a short distance. I tried it several times and was unsuccessful. I complained about the mannequin and implied that it was of poor quality. A doctor testily implied that it was not the fault of the mannequin but rather was due to my poor performance (at that time I did not know that he was the exhibitor). After a while I learned the technique and thanked him.

About two or three months later we were attending a reception for the Cardinal, and he was about an hour late. Meanwhile the guests had decided to take the hors d'oeuvres and we did too. Eventually we reached the front of the reception line and my wife squeezed my arm very tightly and pointed to her throat and then I realized that something was stuck in a larynx -- as she could not talk or breathe. So I performed the procedure then and a small piece of meat came flying out and landed next to the Cardinal's shoe. I then began to appreciate the value of this technique. Again this happened in a restaurant several years later -- we both stood up and I performed the technique-- the entire procedure took less then a minute. Later I had a problem with the very obese woman and was difficult to get my arms around her chest and she also fought against my positioning. In time she became practically became purple and then passed out and her body slumped towards the ground and I was able finally to perform a suitable maneuver and she recovered.

Over the years I had occasion to view the kitchens of a number of restaurants and would often see signs and posters explaining the technique. In time the personnel in restaurants referred to it as the "Café coronary" as the clinical picture bears some resemblance to a "coronary" or heart attack.

What stimulated my letter to the editor was an event that occurred on a Saturday morning when a doctor (an ENT specialist) was at home and a piece of lettuce stuck in his larynx. Unfortunately, his wife did not understand the situation and he almost passed out -- just then he saw a chair and pressed his body against it in a suitable location -- it worked well, the lettuce flew out and he could breathe. Later he explained that he knew nothing of the Heimlich maneuver, so I decided quiz other physicians. I did so in the next couple of days and not one out of 25 had ever heard that an individual could perform this maneuver on himself.

It was then that I wrote my first letter, and it was published in about 1990. Whereupon, I called Dr. Heimlich and asked him a few questions -- how many have been recorded -- he said about 20,000. But for each one reported he suspected that 8 or 10 were not reported. He estimated that about 3% were done by the individual with the problem. He also added that in children a sour ball, a piece of a hotdog or a piece of fruit or vegetable usually was incriminated.

Why am I writing this letter at this point? Well, one of our nurses -- Karen-- suggested it would reach more people through the internet, and I think that she is right. Furthermore a day or two later my wife had another experience while having lunch, and she did her own procedure while sitting at the table (I think it is better standing). Most of all, it is better to be decisive and start immediately (do not wait for help which probably is not there anyway). If the first thrust does not work - keep trying and use even more force. I would rather have a live patient with a fractured rib than the alternative.



The advice provided on this website is intended to be general in nature and should not be relied upon for specific treatment. If you need personal medical attention please contact your physician.


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