The perils of vinegar and the Heimlich maneuver.

As I’ve gotten older, I don’t like to think on weekends. I like to get away from work. I don’t like to do much, either, but I’d rather do than think. So the other night we were having a relaxing Sunday dinner. My wife, her mother, and her 2 brothers had just returned from a several-day trip to a family wedding. I’d been home doing for my 3 sons. Before they left, my mother-in-law had told me I needed to make some cucumbers in vinegar. She had brought the cucumbers with her from home and did not want them to rot. While they were gone, I had neglected the cucumbers, only semipurposefully. I realized this particular Sunday afternoon that I’d better get the cucumbers fixed before they returned that afternoon. It’s pretty easy to do. You just cut them up, add some onion slices, put them in a container, and pour vinegar generously over the whole lot. My mother-in-law had instructed me to put a layer of ice on top and put them in the refrigerator. We were going to have some cucumbers at Sunday dinner, and I was going to look good. A double winner guaranteed to score me some points. Not long after we had begun dinner, one of my brothersin-law took a cucumber into his mouth and shortly thereafter began to cough. We all stopped eating and stared at him. Then there was a crescendo of coughing; he turned beet red and slumped unconscious in his chair. I thought to myself, ‘‘I’d better do something. After all, I’m the professional here.’’ Of course the Heimlich maneuver leapt to mind given the circumstances. I’d never actually done one before. Before I go further, let me say that this brother-in-law is big. Not tall, but big: big chest and big belly. He was heavy enough that I could not pull his chair away from the table by myself. My son had the presence of mind to help me get him away from the table so I could get my arms around him. Next, I discovered that in big people slumped in a chair unconscious, it’s very difficult to tell where the sternum ends and the belly begins. It’s also hard to get your arms around the chair and the big belly, to get into position unless you have long arms. Mine just made it. You have to squat uncomfortably to do this as well, and all of this makes it hard to generate much force during the maneuver. But, in mere seconds, I was Heimliching away as vigorously as I could in what I could only hope was the right place. Again, before I go further, let me say that when you position yourself behind someone in a chair to do the Heimlich, your head is immediately behind theirs. Every time you perform the maneuver, their head pops backwards. His head was whacking mine just beside my right eye. He has a big head too. It hurt and dazed me a little. Anyway after 5 or 6 attempts, nothing came up. He began to have some seizure-like activity. Everyone was just staring at me. My wife, who generally has a low opinion of my physician skills, jumped up to dial 911. At this moment, I realized that (1) my brother-in law was probably going to die, (2) I might have to get a steak knife out and cut open his throat in front of his mother; (3) as a physician, it was going to be beyond embarrassing to have him die in my house in front of his family; and (4) I was not scoring points here with the cucumbers. It doesn’t get much worse than this. Suddenly, as my son and I prepared to pull him out of the chair to the floor, he awakened and asked calmly, ‘‘What’s going on?’’ I was saved. No religious experience could have been more satisfying. I’m pretty sure that what happened was that he aspirated a small amount of vinegar, which precipitated laryngospasm and then vasovagal syncope. The whole Heimlich catastrophe had done nothing but give me a headache. His cords had probably opened when he passed out. Everyone naturally thought I was a hero. I let them think this because I felt I deserved something out of the affair because I was too anxious to eat. So why do I tell you this story? Since the event, almost everyone to whom I have told this story has said they had an episode of laryngospasm related to vinegar; none of them as severe as this episode but scary to them nonetheless. I think people should be aware of how dangerous vinegar is. I did a literature search of ‘‘vinegar and laryngospasm’’ and found nothing. I also couldn’t find a lot about how difficult it is to actually do a Heimlich maneuver on big people, particularly when they are seated, but it was the weekend and I didn’t try very hard. In any event, this doesn’t seem like an unlikely scenario, a big person choking in a chair. No doubt abdominal thrusts with him supine would have been easier, but then there’s the risk of aspiration. He had gotten quite a bit of dinner down before that cucumber. Finally, be aware that when you do the Heimlich, one complication is trauma to your own head. I could not find that in the literature I reviewed.