hello my name is dr. ed Norton Thoreau or dr. ent I'm in Otolaryngology had a neck surgeon
today I will be reviewing five different scenes from film and TV depicting airway
obstruction necessitating an emergency correctly Teradata me a term often used interchangeably
with tracheostomy but technically is different let's check out the first clip from the hit TV
show Grey's Anatomy I didn't do what he did GI Joe tripped him at the field so
apparently the patient suffered an airway obstruction after a car accident most likely
due to some type of head and/or neck trauma assuming mouth-to-mouth respiration was not
possible for whatever reason a bystander soldier performed an emergency correct with our anatomy
in the field using a pen for airway not a trach as stated by the EMT this scene
perfectly depicts what it may look like after a successful crack with our adata me why is he
blowing into the pen mainly because a pen with its small diameter does not allow for
easy respiration for the patient imagine breathing through a drinking straw it's hard so the soldier
assists the patient's breathing with forced air very nicely done overall and what's that
deadly boy sentence in this scene from the movie anaconda airway obstruction
has occurred from Airways swelling from getting stung by a wasp don't ask me how the wasp got
into the mouth in the first place it's still not pretty what are we gonna do that's all
I got whiskey in my class
before jumping to an emergency crack with our Dada me the bystander still should have tried
mouth-to-mouth respiration first whiskey which would contain alcohol is better than nothing
to sterilize the skin but honestly not sure how much that really helps the stab puncture location
itself with a knife appears to be correct but typically an initial vertical incision is
performed first rather than just a stab puncture there should also be quite a bit more bleeding
unfortunately one can I just stick a straw into the airway after a crack
with our adata me first the straw would have buckled trying to get it into the airway the
cartilage and soft tissues would have to be manually separated in order to get the
straw and easily next the straw on its own is not strong enough to hold the airway open and
will be squeezed shut by the cartilage and soft tissues finally the straw diameter is too small
and one of the bystanders should be blowing into the straw to help the person breathe
in this scene from the TV show house all the steps so far have been performed correctly except for a
few minor details first I would expect it to be even more bleeding next one can see a trick to
being inserted but the type of tube being used has a hole in it which typically would not be
used in this situation rather the correct treat to used would not be fenestrated and would also have
a balloon at the tip as shown here please note the doctor used a spreader correctly in order
to open up the soft tissues and cartilage in order to get the tube into the airway
good call even with a medical-grade large diameter tube bag ventilation
is still performed to help the patient breathe which reiterates the importance
of helping a person breathe especially when a drinking straw or pen is used over
all nicely depicted emergency airway guard like a hole so you can breathe
in this scene from a later episode of house a prisoner suffers a food-related and athletic
shock with airway obstruction from swelling dr. house only had a pen to perform an emergency
correctly paradata me but I questioned how easily he could have been sized the skin and enter the
airway using just the tip of a pen well in reality you can't there should also be a lot more bleeding
allergic reaction you can't breathe by on the ground hands behind you Alvarez look at
what I'm doing it's a tracheotomy come on man you know I'm a doctor what's wrong with him
given the location of the pen it really does look like a tracheostomy it was performed given how low
it is in the neck also the patient is audibly grunting which is not possible if he truly had
an airway obstruction rather noises from the air going in and out of the pen should only be heard
bits of blood would also fly out of the pen to be truly realistic there should be a lot more
bleeding present around the pen as well not like you always do check his mouth check his mouth in
this scene from the movie heat a restaurant patron starts to choke from a piece of food
the Heimlich maneuver is attempted correctly in the mouth examined though honestly without a
flashlight I'm not sure how well the mouth truly can be visualized the flame down sir just relax
everything will be just fine before jumping to an emergency crack with our data me the mouth should
be re-examined any finger sweep performed perform an emergency tracheotomy have an immediate glass
of vodka but it's a divvy offered sterilization hot water vodka due to its alcohol content would
be better than nothing to sterilize the skin but honestly not sure how well that would work also
do not pour hot water on the skin that would probably cause more damage from burns than any
help provided by skin sterilization also a crack lithotomy will be performed and not a trach know
what you're doing i ee technically no but I've been I've been doing some research and I feel
fairly confident I know how he's still choking you know sir wait a minute turns I'm gonna find your
God he's open she's just touching because I read membrane think I think it's crazy I'm gonna make a
small incisions like go my hands arrange let go my hands gonna make a small incision the reason I'm
doing this oh oh God note that Santa Bullock's character correctly stated trying to find the
cricothyroid membrane while feeling the neck with her fingers that's all correct when making the
incision a good amount of bleeding occurs which is also fairly realistic it's because you're choking
Wow okay this is deeper than I thought all good so far especially her statement about the incision
having to go much deeper than she imagined that's true even for health care professionals where I've
seen incisions made way too superficially I'm gonna insert my fingers in here because what's
happening and what your finger they don't put your finger it feels a lot different
the incision made appears to be horizontal rather than vertical but using the fingers to feel for
the crack without a membrane is not incorrect also note how far the fingers go into the neck
that looks about right the membrane okay jump put your fingers in there so what I'm gonna do is I'm
going to insert the straw in the hole and it's gonna allow the oxygen to get to your brain one
moment you're gonna feel the oxygen flow and your brain there we got oxygen as mentioned
before trying to insert a straw would not be possible as it would buckle trying to get it
into the airway the cartilage and soft tissues would have to be manually separated in order
to get the straw in easily indeed the straw is not in the airway which is why you see blood
coming up and out of the straw instead but the amount of bleeding shown overall appears to be
accurately portrayed or tchen Utley an aggressive abdominal thrust was performed by a sledgehammer
punch resulting in food getting caught out by the patient overall a failed emergency
cricothyroidotomy but ultimately successful Heimlich maneuver in conclusion rarely is an
emergency cricothyrotomy perfectly depicted in film and TV a straw will not work in real
life a pen can work given it is a rigid tubular structure but one must help the patient breathe
by blowing into the pen but when you are outside of a hospital you use the materials you have on
hand and on that regard the director and actors do an admirable job in spite of some factual lapses
but as is true with most Hollywood productions it is still fun to watch even if it's not realistic