Emergency Tracheotomy

[TeslaCoil]

Recently had a discussion with a friend about performing emergency procedures in public, and came up with this conundrum: if a random person were to choke on their food in a restaurant, and the Heimlich fails, would it be prudent to perform an emergency tracheotomy?

I realize physicians are protected by the Good Samaritan Law, in so far as they are practicing within their "professional bounds", but what are those professional bounds? Does it vary by specialty? Would an anesthesiologist be professionally qualified to perform an emergency tracheotomy in public or anywhere for that matter? What are the legal implications?

Is there anybody out there who can clarify this?

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[btbam]

Good Samaritan laws aside, how many people would really feel comfortable A. doing a slash trach and B. with some ****ty kitchen knife at a restaurant. This all sounds really cool in theory, but I imagine the reality would be far from life-saving. This all assumes you are going distal to the food lodged in their trachea as well.

 

[Arch Guillotti]

I don't see why not. Father Mulcahy did one on MASH with only a little instruction from Hawkeye over the radio.

 

[Mad Jack]

We had a recent discussion where this came up. If you're not in ENT and doing emergent trachs, I would imagine that you'd open yourself up to legal liability if you used makeshift equipment and the patient died. Good Samaritan laws generally cover physicians acting within the scope of what they are competent of, and I don't think anyone would say they're competent at makeshift tracheotomies.

 

[TeslaCoil]

yea I figured as much...

 

[Infexious]

.

 

[TeslaCoil]

I def wouldnt wanna be on the defending side of the pulpit though haha. Nice avatar...

 

[deleted547339]

We had a recent discussion where this came up. If you're not in ENT and doing emergent trachs, I would imagine that you'd open yourself up to legal liability if you used makeshift equipment and the patient died. Good Samaritan laws generally cover physicians acting within the scope of what they are competent of, and I don't think anyone would say they're competent at makeshift tracheotomies.

Eh, I feel like if you were an ENT, general/trauma surgeon, EM physician, intensivist or anesthesiologist, I feel like you'd be practicing within your scope. Do all of these specialties do crics/trachs regularly? No. But they should be comfortable enough with the procedure to do it in a life or death situation. Mind you, the above situation is so contrived it is not likely going to impact any of us. But let's say your at an emergency situation, EMS is there and they get in a can't intubated can't oxygenate situation. In that case, I think any of the above physicians should prefer an error of commission than one of omission if a patient is in extremis.

 

[pulmoblast]

If ppl see you slashing a guy's throat and he dies...that looks bad...

Unless it is a friend/relative or you are MSF in Somalia...don't do that ****...wait for the EMS

The lay public is too dumb to understand...the fatso who choked on his steak now has a wife who can get rich because you decided to be a hero

 

[pgg]

I don't see why not. Father Mulcahy did one on MASH with only a little instruction from Hawkeye over the radio.

I saw George Clooney do a cricothyrotomy in the street with a ball point pen on ER.

 

[Moose A Moose]

Man, even if you're successful after the trach they're gonna be hurting.

Ouchhhh.

 

[Mman]

2 anesthesiologists on a plane with a choking man

 

[Mad Jack]

http://m.huffpost.com/us/entry/3989207

 

[VisionaryTics]

2 anesthesiologists on a plane with a choking man

Those are some top quality 90s anesthesiologist mustaches.

 

[Infexious]

.

 

[Mman]

The plastic knife would be as good as you get now days.

Not so sure about that. Every study of TSA screening suggests they miss almost everything so there is probably somebody on the plane with a knife they could lend you in an emergency.

 

[ZzzPlz]

http://www.forbes.com/pictures/ehlk45gmdd/which-knives-are-allowed/

 

[fakin' the funk]

Eh, I feel like if you were an ENT, general/trauma surgeon, EM physician, intensivist or anesthesiologist, I feel like you'd be practicing within your scope.

I personally don't feel that my scope of practice includes something I've never done.

 

[deleted547339]

I personally don't feel that my scope of practice includes something I've never done.

Never? Not even in a sim lab?

 

[Mman]

I personally don't feel that my scope of practice includes something I've never done.

If the choice was let somebody die or take a stab at it (pun intended), I'd go for it as inexperienced as I may be.

 

[Random Anesthesiologist]

Those are some top quality 90s anesthesiologist mustaches.

Don't kid yourself. It's really just an adult film.

 

[Random Anesthesiologist]

If the choice was let somebody die or take a stab at it (pun intended), I'd go for it as inexperienced as I may be.

Another reason to do a Ccm fellowship.

Lol

 

[KLPM]

Don't kid yourself. It's really just an adult film.

Now you mentioned it, they did come on behind the guy, perform mouth-to-mouth and took his shirt off.

 

[Ronin786]

That was quite the good recreation. The guy actually looked ashen and they seem to have gotten the original people to reprise their roles.