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.

Percutaneous dilatational tracheostomy (PDT) is widely used for prolonged ventilation; however, dilatation-related complications may be underrecognized. We report a complication of tracheostomy malposition induced by tissue stretching during PDT, in which an excessively dilated tract fails to recoil adequately around the tube, compromising the cuff seal. A 57-year-old Korean man was admitted for recurrent seizures. PDT was performed under bronchoscopic guidance without immediate complications. Three days after the first PDT, partial tracheostomy tube dislodgment resulted in a 40%–60% ventilator leak. Sedation, tube reinsertion, and cuff reinflation were attempted; however, the leak worsened to 99%, necessitating rapid sequence intubation. Retrospective review of the bronchoscopic images demonstrated tracheal tissue stretching during initial insertion, suggesting excessive traction on the anterior tracheal wall. A size mismatch between the loading dilator and the tracheostomy tube likely created a gap that allowed tracheal tissue to be drawn into the tract and then recoil, contributing to malposition. Clinicians should recognize this potential complication, monitor for high ventilator leak rates, cuff-pressure abnormalities, and radiographic malalignment, and be prepared to perform repeat tracheostomy or endotracheal intubation if necessary.