Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Do a cricothyrotomy after a failed Heimlich. But it’s likely to fail.

Skeptical Scalpel, MD
Conditions
October 11, 2015
338 Shares
Share
Tweet
Share

At the end of an otherwise informative article about the nuances of performing a Heimlich maneuver, New York Times science reporter Jane E. Brody recommends that if all else fails, a cricothyrotomy should be attempted.

She goes on to briefly explain how the procedure is done. In the right hands, a cricothyrotomy is safer and easier to perform than a formal tracheostomy. However, for a layperson who has never seen either procedure done, does not know the relevant anatomy, and has never put a knife to anyone’s skin, it is highly unlikely to be successful.

Ms. Brody includes a link to website with some static drawings of the procedure. The site is called Aaron’s Tracheostomy Page and it bills itself as “The Internet’s leading tracheostomy resource since 1996.”

Here’s an excerpt from that description of the operation:

“Take the razor blade or knife and make a half-inch horizontal incision. The cut should be about half an inch deep. There should not be too much blood.”

Yes, there should not be too much blood, but sometimes there is.

Both the Times article and the reference repeat the medical urban legend that the barrel of a ballpoint pen can be used as a breathing tube.

A 2010 paper found that due to high resistance to airflow, most ballpoint pens are not adequate airways, and the two that were acceptable (the Baron retractable ballpoint and the BIC Soft Feel Jumbo) are unlikely to be on hand. An earlier paper also reported similar high airflow resistance with ballpoint pens.

A small study involving inexperienced junior doctors and medical students found that they were able to successfully perform cricothyrotomies in only 8 of 14 cadavers. Injuries to the thyroid and cricoid cartilages were common.

Remember these important points — cadavers don’t need an airway in a hurry, and they don’t bleed.

Evidence of successful cricothyrotomy by bystanders is lacking. A 2010 review of American soldiers killed in Iraq between 2003 and 2006 noted that five of those who died appeared to have had attempts at cricothyrotomy, all of which failed.

I once was asked to see a patient whose “cricothyrotomy” done in an ED by an experienced emergency physician and a resident turned out to be a laryngotomy. The tube was inserted directly into the larynx.

To the uninitiated, surgery looks easy. Last year I blogged about Malcolm Gladwell’s outrageous claim that just about any college graduate could become a cardiac surgeon.

I suppose one might say “What have you got to lose? The patient is dying. Try the cricothyrotomy.” I can’t stop you. But be certain it is necessary, and realize your chances of success are extremely low.

If you’re considering it, at least look at some of the many instructional videos available online.

Warning: graphic. There is some blood. Here’s one by an ED doc. In a non-hospital setting, you would not have all the help and equipment he had. Here’s another, this time by a surgeon — with lots of help and equipment. Both patients were relatively thin.

Now imagine doing it with a pocket knife and a ballpoint pen on an obese person. Still think it’s easy?

“Skeptical Scalpel” is a surgeon blogs at his self-titled site, Skeptical Scalpel.

Image credit: Shutterstock.com

Prev

A young woman with anemia. A colonoscopy reveals a surprise.

October 11, 2015 Kevin 0
…
Next

When was the last time you had a good laugh with your doctor?

October 11, 2015 Kevin 18
…

Tagged as: Surgery

Post navigation

< Previous Post
A young woman with anemia. A colonoscopy reveals a surprise.
Next Post >
When was the last time you had a good laugh with your doctor?

More by Skeptical Scalpel, MD

  • The hospital CEO who made a surgical incision. What happened?

    Skeptical Scalpel, MD
  • Medical error is not the third leading cause of death

    Skeptical Scalpel, MD
  • Should speed-eating contests be banned?

    Skeptical Scalpel, MD

Related Posts

  • 3 ways we’ve failed woman who breastfeed

    Joanna Buscemi, PhD
  • USMLE Step 1 pass/fail winners and losers

    Aamir Hussain, MD
  • Why did it feel like I failed my patient?

    Aatqa Memon
  • Can the Maternal CARE Act fail moms? 

    Sonal Patel, MD
  • Pass-fail in medical school. But the stress remains.

    Orly Farber
  • The most far-reaching effects of our failed leadership

    Matthew Hahn, MD

More in Conditions

  • Are we doing enough to help chronic pain sufferers?

    Adam Strohl, MD
  • Lessons taught by Bell’s palsy

    Alexander Rakowsky, MD
  • Unthinkable choices in childbirth emergencies

    Kim M. Puterbaugh, MD
  • The link between orofacial myofunctional disorders and dental health

    Stephanie Jeret
  • Motorcycle helmet laws: Balancing freedom and financial impact

    Stephen Cohn, MD
  • Crying to be heard: women in emotional pain

    Arthur Lazarus, MD, MBA
  • Most Popular

  • Past Week

    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Unveiling excessive medical billing and greed

      Amol Saxena, DPM, MPH | Policy
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Ethical considerations in medicine: unity and open discourse

      Andrew Zywiec, MD | Physician
    • Man’s search for meaning is spiritual, and relevant to medicine

      Arthur Lazarus, MD, MBA | Physician
    • The shifting landscape of gastroenterology manpower and compensation

      Brian Hudes, MD | Physician
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Navigating the broken medical system: challenges faced by foreign medical graduates

      Anonymous | Physician
    • The essence of medicine: genuine connections in practice

      Jennifer Tillman, MD | Physician
    • 1 in 4 attempt suicide: the persecution of autistic physicians

      Patricia Celan, MD | Physician
  • Recent Posts

    • The shifting landscape of gastroenterology manpower and compensation

      Brian Hudes, MD | Physician
    • I’m tired of being a distracted doctor

      Shiv Rao, MD | Tech
    • Diverse paths to financial freedom for doctors [PODCAST]

      The Podcast by KevinMD | Podcast
    • AI-driven diagnostics and beyond

      Michael Kirsch, MD | Tech
    • Applying the differential diagnosis method to investing

      Amarish Dave, DO | Finance
    • Pediatricians grapple with guns in America, from Band-Aids to bullets

      Tasia Isbell, MD, MPH | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • PA's Murder Trial; Doc's Manslaughter Charge; Cardiologist's Kickback Settlement
  • Suppressing Unwanted Thoughts; Choking on Cheese; Diet and Depression
  • FDA Advisors Grapple With Logistical, Ethical Issues of Artificial Womb Technology
  • Reassuring Registry Data on Going Into TAVR Sans Symptoms
  • Inhaled Glucocorticoid Flops for Speeding COVID Recovery in Outpatients

Meeting Coverage

  • Stopping Medical Misinformation Requires Early Detection
  • AI Has an Image Problem in Healthcare, Expert Says
  • Want Better Health Outcomes? Check Out What Other Countries Do
  • ERS Roundup: Cell Transplant Boosts Lung Function in COPD Patients
  • Benralizumab Allows Inhaled Corticosteroid Taper for Asthma Patients
  • Most Popular

  • Past Week

    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Unveiling excessive medical billing and greed

      Amol Saxena, DPM, MPH | Policy
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Ethical considerations in medicine: unity and open discourse

      Andrew Zywiec, MD | Physician
    • Man’s search for meaning is spiritual, and relevant to medicine

      Arthur Lazarus, MD, MBA | Physician
    • The shifting landscape of gastroenterology manpower and compensation

      Brian Hudes, MD | Physician
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Navigating the broken medical system: challenges faced by foreign medical graduates

      Anonymous | Physician
    • The essence of medicine: genuine connections in practice

      Jennifer Tillman, MD | Physician
    • 1 in 4 attempt suicide: the persecution of autistic physicians

      Patricia Celan, MD | Physician
  • Recent Posts

    • The shifting landscape of gastroenterology manpower and compensation

      Brian Hudes, MD | Physician
    • I’m tired of being a distracted doctor

      Shiv Rao, MD | Tech
    • Diverse paths to financial freedom for doctors [PODCAST]

      The Podcast by KevinMD | Podcast
    • AI-driven diagnostics and beyond

      Michael Kirsch, MD | Tech
    • Applying the differential diagnosis method to investing

      Amarish Dave, DO | Finance
    • Pediatricians grapple with guns in America, from Band-Aids to bullets

      Tasia Isbell, MD, MPH | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Do a cricothyrotomy after a failed Heimlich. But it’s likely to fail.
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...