The Heimlich maneuver is a useful technique for rescuing patients with airway obstruction, but improper application can cause serious complications. We report a case of a 70-year-old man who underwent the Heimlich maneuver after a food bolus became lodged in his throat while he was eating. Because inappropriate sternal compressions were performed, the obstructing foreign body was not removed at the scene; instead, it was extracted during endotracheal intubation in the emergency department. The patient also developed flail chest as a result of the chest compressions and required conservative management with hospitalization for more than 60 days. This case highlights that caregivers may know of the Heimlich maneuver but may not clearly understand the proper technique. Proper education and training in this lifesaving procedure are therefore essential.

Purpose
Although several studies of preperitoneal pelvic packing (PPP) have reported a hemostatic effect in patients with pelvic fractures, the presence of packed surgical tapes may provoke inflammation or infection. In Korean institutions, the delta neutrophil index (DNI) is currently used as a clinical biomarker for identifying sepsis and predicting prognosis. Therefore, this study aimed to evaluate the usefulness of DNI in pelvic fracture patients who underwent PPP.
Methods
We retrospectively reviewed 36 hemodynamically unstable patients who underwent PPP between May 2014 and December 2018 at Wonju Severance Christian Hospital. To evaluate differences in postoperative DNI patterns between survivors and nonsurvivors, repeated-measures analysis of variance was performed.
Results
Eight patients died, and 16 patients developed PPP-related complications. Packed surgical tapes were maintained for a mean of 46.3 hours. Compared with survivors, nonsurvivors had significantly higher DNI values on postoperative day (POD) 2 (5.3% [range, 0%–40.2%] vs. 36.0% [range, 5.4%–70.2%], P<0.001) and POD 3 (2.6% [range, 0%–16.3%] vs. 29.9% [range, 1.2%–64.2%], P<0.001). The overall pattern of DNI change over time differed significantly between survivors and nonsurvivors (P=0.001). In addition, patients with PPP-related complications exhibited a significantly smaller decrease in DNI between POD 1 and POD 2 compared with those without complications (–1.6% [range, −7.8% to 58.9%] vs. –4.5% [−46.8% to 31.6%], P=0.048).
Conclusion
Postoperative DNI may serve as a clinical indicator for predicting mortality and complications in pelvic fracture patients who have undergone PPP.

Purpose
Pelvis fractures are associated with bladder and urethral injury (BUI). The purpose of this study was to identify risk factors associated with BUI in patients with pelvic fracture.
Methods
Patients (> 18 years) with pelvic injury (N = 314) at our hospital between January 2015 and June 2020 were retrospectively analyzed for age, sex, cause of injury, initial vital signs, urine red blood cell (RBC) count, Glasgow Coma Scale and Abbreviated Injury Scale score, Injury Severity Score, preperitoneal pelvic packing, and femur, lumbar spine, and pelvic fractures.
Results
Compared with the BUI-absent group, the BUI-present group had a greater percentage of patients who were male (79.2% vs. 55.9%; p = 0.026), had a urine RBC count/high power field (HPF) ≥ 30 (94.4% vs. 38.8%; p < 0.001), underwent preperitoneal pelvic packing (37.5% vs. 18.6%; p = 0.035), had symphysis pubis diastasis (33.3% vs. 11.7%; p = 0.008), and had sacroiliac joint dislocation (54.2% vs. 23.4%; p = 0.001). Independent risk factors associated with BUI were symphysis pubis diastasis [odds ratio (OR) was 3.958 (95% confidence interval: 1.191–13.154); p = 0.025] and a urine RBC count/HPF ≥ 30 [OR = 25.415 (95% confidence interval: 3.252–198.637); p = 0.006]. Of those with BUI, 15 patients were diagnosed at the trauma bay, and 9 had a delayed diagnosis.
Conclusion
Patients with pelvic injury who display symphysis pubis diastasis or have a urine RBC count/ HPF ≥ 30 are at higher risk of BUI, therefore, further BUI investigations should be considered.

Citations

• Hematuria as a Screening Tool for Bladder and Urethral Injuries in Pelvic Trauma: A Sensitivity and Specificity Analysis
  Md Habibur Rahman, Muktadir Tamim, Goutom Mukharzi
  TAJ: Journal of Teachers Association.2024; 37(2): 802.     CrossRef