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INITIATING REFERRAL IN MILD COGNITIVE IMPAIRMENT: WHO RINGS THE BELL?

The Heimlich maneuver can be effectively used in relieving upper airway obstruction from foreign bodies. Complications associated with this procedure can involve intrathoracic or intra-abdominal organs, but they are infrequent. Few case reports of acute abdominal aortic thrombosis after the Heimlich maneuver have been reported in the literature. Of these, a patient with no history of abdominal aortic aneurysm survived. In our case, application of the Heimlich maneuver might have caused rupture of atherosclerotic plaques in the abdominal aortic arch with resulting formation of the arterial thrombus. The pathogenesis of the thrombosis can be from the rupture of an atherosclerotic plaque with the Heimlich maneuver, the shift in the posture of the patient during the event, or direct trauma to the aneurysm. Despite the patient being maintained on chronic warfarin therapy for his previously diagnosed deep venous thrombosis, a continued hypercoagulable state cannot be excluded as a contributing factor, and the presence of pulmonary embolism and history of deep venous thrombosis would support this. Additionally, because our patient was slender, the location of the arterial thrombus in the infrarenal region of the aorta could be related to direct transmission of pressure from inadvertent malposition of the hands during the maneuver.