A woman brought her six-year-old child into the ED at eight in the morning. The child had vomit all over himself, and was crying profusely and complaining that his chest hurt. He’d swallowed the toothpaste instead of spitting it out while brushing his teeth before school, and his mother had shoved her fingers down to make him puke (she said “about a dozen times”) and then had proceeded to give him the Heimlich hard enough to crack two of his ribs.