Improvised Tracheotomies: Sword, Steak Knife, Plastic Straw, Pen

Respiratory therapists don’t perform tracheotomies, cricothyroidotomies, or tracheostomies. However in emergency situations when it’s life or death knowing how to perform an emergency airway puncture can be invaluable.

Like so much of English medical terminology, the word “tracheotomy” is derived from ancient Greek. This may not be surprising, but you may be surprised – or horrified – that this procedure is just as old. Archaeologists have found an Egyptian artifact that appears to depict a tracheotomy being performed. A 2,000-year-old collection of Vedic Sanskrit hyms describes the procedure in detail. Alexander the Great is reported to have performed an emergency tracheostomy on a soldier in the field.

Even though modern medicine is far beyond where it was in the ancient days, emergency situations still call for improvisation.

Steak knife at a new year’s eve party – A popular local man was celebrating new year’s eve shortly before midnight when he started choking on a piece of meat. Five people at the party took turns performing the Heimlich Maneuver to no avail. Finally as a last resort a doctor at the party used his steak knife to perform an emergency tracheotomy. Soon afterward paramedics arrived and took the man to the hospital. 

Pocket knife and sports bottle straw – A study published in the US National Library of Medicine compared the effectiveness of an emergency roadside cricothyroidotomy using non-medical temporary tracheostomy tubes – in this case the plastic drinking straw from a sports bottle – versus standard medical airway devices. The results of the study show that the sports bottle’s straw was very similar to its standard medical airway device equivalents, however the use of the barrel from a ballpoint pen would not have been as effective.

Knife and a hollow pen – A Bakersfield, California woman could not have been more fortunate to be eating at the same restaurant as a group of medical specialists who had just attended a conference. Help was nearby when she started choking on her dinner. After the Heimlich Maneuver failed to dislodge the food that was stuck in the woman’s throat, a doctor at the restaurant used a knife to make an incision and then inserted a hollow pen that improvised as a breathing tube. Soon an ambulance arrived to take the woman to the hospital, where she recovered.


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