title: Food Particle Aspiration Associated with Hemorrhagic Shock: A Diagnostic Dilemma.
abstract: The hemodynamic compromise caused by a large aspirated food particle in the airway can become the focus of medical attention and a distraction from rare but fatal Heimlich maneuver related injuries after an incident of food aspiration. We herein present a case of an 84-year-old man who was brought to the emergency department after an episode of choking at a restaurant followed by several failed Heimlich maneuver attempts. Despite relieving the airway obstruction by extracting a large piece of steak from the airway, the patient remained hypotensive and required continued hemodynamic support. Repeated laboratory tests within 24 hrs of aspiration showed a significant decline in the hemoglobin level. A computed tomography (CT) scan of the abdomen and pelvis showed a lacerated liver with a large subcapsular hematoma draining into the pelvis. Conclusion. Hepatic rupture is a rare complication of Heimlich maneuver; this paper represents the second case report in the literature. It emphasizes the necessity of early identification and surveillance of fatal Heimlich maneuver complications in a high risk population.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: Basheer
authors.identifier: 0000-0001-8816-3725
authors.initials: B
authors.lastname: Tashtoush
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Schroeder
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: Roya
authors.initials: R
authors.lastname: Memarpour
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Oliveira
authors.affiliation: Department of Otolaryngology, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Medina
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: Anas
authors.identifier: 0000-0001-9459-162X
authors.initials: A
authors.lastname: Hadeh
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: Jose
authors.identifier: 0000-0002-5941-3382
authors.initials: J
authors.lastname: Ramirez
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: Laurence
authors.initials: L
authors.lastname: Smolley