Emergency cricothyrotomy... legal/ethical question

[cdmOMR]

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So here is the scenario. Your at a restaurant lets say and someone starts choking. By the time you get to the guy, Heimlich maneuver has already been tried and you cant reestablish the airway. Ambulance isnt close and persons getting cyanotic and will be dead without immediate action. You know your head and neck anatomy well, you know where you should cut for a cricothyrotomy, you're in a restaurant with sharp knives around.

Question 1: Do you do it?

Question 2: Would you do it if the person was friends or family?

Question 3: What are the legal implications?

** I found this in the IL state law good Samaritan act, but the language is hardly fool proof

(745 ILCS 49/15)
Sec. 15. Dentists; exemption from civil liability for emergency care. Any dentist or any person licensed as a dentist in any other state or territory of the United States who in good faith provides emergency care without fee to a victim of an accident at the scene of an accident shall not, as a result of his or her acts or omissions, except willful or wanton misconduct on the part of the person, in providing the care, be liable for civil damages.
(Source: P.A. 89‑607, eff. 1‑1‑97.)

 

[Saddleshoes]

Do the tracheotomy. Get the mope breathing good. Then slip quietly into the crowd and disappear.

I had something close to this happen at a car crash scene once. That was how I handled it.

 

[aphistis]

Yes; yes; insignificant next to the personal implications of knowing I purposefully chose to let someone die when it was within my ability to save their life.

 

[cdmOMR]

Yes; yes; insignificant next to the personal implications of knowing I purposefully chose to let someone die when it was within my ability to save their life.

That was my feeling... this came up in a conversation between some dental student friends of mine and one said he wouldn't do it on a stranger for fear of being sued.

 

[tkim]

Are you guys trained to do it? If you are, then go for it.

 

[mike3kgt]

So you think you are trained because you took a course in gross anatomy as a dental student? I think NOT. I wouldn't do anything beyond CPR. I'd try my hardest within the realms of my training (BLS), however, if you were an oral surgeon or anesthesiologist and ACLS certified... and feel comfortable doing it, sure, go for it.

Good Samaritan laws will protect you in the case of Heimlich or CPR... but I'd bet that an attorney could make the case that the average dentist is way below qualified perform tracheotomy on somebody.

If you do it and save the guy, you are a hero. If you do it and miss and kill the person when CPR probably could have saved him/her... you're screwed.

 

[nealofgrafton]

The law says you can't act beyond the scope of your training. So the best protection is a fake name and disappearing after the person starts breathing.

 

[armorshell]

Since people in this thread seem to have trouble differentiating between a cricothyrotomy and a tracheotomy, I would say it's a bad idea. 😀

But also, any dentist (some OMFS aside) are no more trained than anyone else in performing either procedure. Yes, you know where the cricothyroid membrane is. Now what? I know where the appendix is. Does that mean I can perform an emergency appendectomy? I mean, if it's an emergency, right?

[YOUTUBE]http://www.youtube.com/watch?v=vYRAVw8Op8Q[/YOUTUBE]

 

[cdmOMR]

Im in no way say a dentist is trained or even has a good chance at performing it correctly... but Id say a dentist would have a much better stab at it than any random person (no pun intended). Im talking life or death... if you dont do it, the guy/girl is dead. What if its one of your friends or family?

Ps I think someone not breathing is slightly more emergent than a ruptured appendix... unless it does actually blow up, we didnt learn part in school yet

 

[Rapunzel]

If dentists can perform emergency surgery to save someone's life, what about others who also know the relevant anatomy? I was in an Introduction to Communicative Disorders 101 class, and the Speech Pathologist teaching the class explained how to do this emergency procedure in such a situation as described by the original poster (except it was a fellow passenger on an airplane and all you have are plastic airline knives). Speech Pathologists also study this anatomy, but I find the suggestion concerning. What about medical students? veterinarians? undergraduate students who have taken an anatomy class? Where do you draw the line at who should try what in order to attempt to save a life?

 

[aphistis]

If dentists can perform emergency surgery to save someone's life, what about others who also know the relevant anatomy? I was in an Introduction to Communicative Disorders 101 class, and the Speech Pathologist teaching the class explained how to do this emergency procedure in such a situation as described by the original poster (except it was a fellow passenger on an airplane and all you have are plastic airline knives). Speech Pathologists also study this anatomy, but I find the suggestion concerning. What about medical students? veterinarians? undergraduate students who have taken an anatomy class? Where do you draw the line at who should try what in order to attempt to save a life?

I still haven't heard anyone give a compelling reason not to do it if you know where the cricothyroid membrane is. In that scenario, there's no mistake you can make that will make the patient's prognosis worse than if you did nothing.

To quote one of my anesthesia attendings: "When the only alternative is guaranteed death within minutes, there are NO contraindications to attempting a surgical airway."

 

[K Niner]

What if you were a physician who specialized in family practice, neurology, or some other non surgical/emergent specialty. Would you be liable if you did perform the cric? (I'm assuming that in a family practice residency you don't receive training in this, I don't know)

 

[AbbyNormal]

I am a bit confused. Somebody wants emergent tracheotomy, somebody else wants emergent cricothyrotomy. If the patient has food lodged in the trachea proximal to the cricothyroid membrane do you really think you are going to ventilate with cricothyrotomy? Explain to me how you think this will help.

What I would do is continue to attempt ventilation and continue attempts to clear the airway. As a patient becomes unconscious from hypoxia they relax which may help you to clear the airway. Just my two cents as a paramedic/RN...

 

[K Niner]

I am a bit confused. Somebody wants emergent tracheotomy, somebody else wants emergent cricothyrotomy. If the patient has food lodged in the trachea proximal to the cricothyroid membrane do you really think you are going to ventilate with cricothyrotomy? Explain to me how you think this will help.

What I would do is continue to attempt ventilation and continue attempts to clear the airway. As a patient becomes unconscious from hypoxia they relax which may help you to clear the airway. Just my two cents as a paramedic/RN...

Do paramedics do cricothyrotomies or tracheotomies?

what about family practice physicians and similar?

 

[AbbyNormal]

Do paramedics do cricothyrotomies or tracheotomies?

what about family practice physicians and similar?

I can't speak for all paramedic programs but when I trained in the early 1980's we were taught how to perform emergent cricothyrotomies. My basic nursing training did not cover that. My nursing classes did not cover lots of things I learned as a paramedic like inserting IVs, basic EKG interpretation, cardiac arrest management and intubation. After graduation the hospital taught us all that though.

I would hate to be put in the situation of having to make the decision for a cric.

Somebody quoted Good Samaritan law covers their actions as a health care professional in their state. I am not familiar with that state so they may vary but years ago I was taught that the Good Samaritan law in my state (WV) is intended to cover non health care folks. We were taught that if we did what a reasonable prudent person with similar training would do then we would probably be found not guilty in court. But we are still held to the standards of care for our profession whether dentist, paramedic, RN, MD, et cetera. If our action do not meet the standard of care then we are liable even if we are not financially compensated and had good intent.

I am not an attorney so I don't know how much of that is valid. It is an interesting dilemma.

 

[jay47]

http://www.tracheostomy.com/resources/surgery/emergency.htm

My question is, what are the potential problems with even attempting this emergency procedure? I was seriously just thinking about this yesterday, studying for my gross exam, and it doesn't seem like any major arteries or veins would be cut- the cricothyroid membrane is very easy to find if you know where to look. Of course, a tracheotomy is a different story.

Honestly, if there was no emergency personnel around or emergency services around, I wouldn't be able to live with myself if I didn't try.

 

[tkim]

http://www.tracheostomy.com/resources/surgery/emergency.htm

My question is, what are the potential problems with even attempting this emergency procedure? I was seriously just thinking about this yesterday, studying for my gross exam, and it doesn't seem like any major arteries or veins would be cut- the cricothyroid membrane is very easy to find if you know where to look. Of course, a tracheotomy is a different story.

Honestly, if there was no emergency personnel around or emergency services around, I wouldn't be able to live with myself if I didn't try.

I've done a couple - twice in cadaver skills lab and once on a trauma arrest. The cadavers were easy, the trauma arrest, not easy. Lots of blood. Even doing it on a non-bloody obstructed airway, you'd better be sure that the person you are about to do it to is either unconscious or restrained. Hypoxic people will fight you.

If you've never been trained to do it, I wouldn't.

 

[jay47]

I've done a couple - twice in cadaver skills lab and once on a trauma arrest. The cadavers were easy, the trauma arrest, not easy. Lots of blood. Even doing it on a non-bloody obstructed airway, you'd better be sure that the person you are about to do it to is either unconscious or restrained. Hypoxic people will fight you.

If you've never been trained to do it, I wouldn't.

Good to know. I would only ever save it as an absolute last resort. Of course, I would assume they would be unconscious by the time I attempted the move, so hopefully restraint would not be too much of an issue. The superior thyroid artery is probably what might cause the most bleeding.

 

[tkim]

Good to know. I would only ever save it as an absolute last resort. Of course, I would assume they would be unconscious by the time I attempted the move, so hopefully restraint would not be too much of an issue. The superior thyroid artery is probably what might cause the most bleeding.

http://www.sciencedirect.com/scienc...serid=10&md5=6d75ba7bde6dcfffa8a692501359cfe1

 

[AbbyNormal]

I was a paramedic with two patients in a MVA in the early 80's with just me and my partner, no backup and there was no hospital in our county. The woman's face was gone. It looked like she had gone face versus guardrail. Facial features were not distinct and she was in cardiac arrest. The driver was critically injured but alive. I had to triage and treat him, not her. If she had been the only patient I would have considered a cric and trying to save her because I didn't see severe trauma except to her face/head but I don't know if she would have had a better outcome. I have never seen a successful save from traumatic arrest in the field but I have in the hospital. Very scary.

 

[diplo123]

So you think you are trained because you took a course in gross anatomy as a dental student? I think NOT. I wouldn't do anything beyond CPR. I'd try my hardest within the realms of my training (BLS), however, if you were an oral surgeon or anesthesiologist and ACLS certified... and feel comfortable doing it, sure, go for it.

Good Samaritan laws will protect you in the case of Heimlich or CPR... but I'd bet that an attorney could make the case that the average dentist is way below qualified perform tracheotomy on somebody.

If you do it and save the guy, you are a hero. If you do it and miss and kill the person when CPR probably could have saved him/her... you're screwed.

You act as if a cricothyrotomy is a complex procedure. Dental students receive far superior and thorough training of head & neck anatomy than any med student. As long as you can palpate the cricothyroid membrane and create a small puncture, you can do the procedure and save someone's life. Be careful not to touch the cricoid cartilage, as it doesn't heal properly. Finally, this is NOT A THYROIDECTOMY lol.

 

[dentstd]

(745 ILCS 49/15)
Sec. 15. Dentists; exemption from civil liability for emergency care. Any dentist or any person licensed as a dentist in any other state or territory of the United States who in good faith provides emergency care without fee to a victim of an accident at the scene of an accident shall not, as a result of his or her acts or omissions, except willful or wanton misconduct on the part of the person, in providing the care, be liable for civil damages.
(Source: P.A. 89‑607, eff. 1‑1‑97.)

Here are two points where you'll get in trouble. Performing surgery on a choking patient is arguably "willful or wanton misconduct." All the sudden, this piece of legislation doesn't apply to you, and you'll have civil liability.

While you may not have civil liability, civil liability is not the only type of liability. Specifically, you have criminal liability. Performing surgery in this scenario is battery, otherwise known as criminal assault. ("battery" in tort law, "assault" in criminal law). If you decide to use a knife (a weapon), it's assault with a deadly weapon. (One of the aggravated crimes)This is a felony. If he dies, you'll also likely face charges of murder.

You have to know how to read legal documents. "Emergency care" in this case likely refers to emergency care pertaining to dentistry, not emergency care generally. I'd have to confirm with case law.

If the Heimlich hasn't worked, it doesn't mean it won't work eventually. If you're a reasonable person, you persist in performing the Heimlich, not perform surgery of any sort.

To all those people who said you'd perform the surgery and meant it, stop being a *******. Learn to use your head.

 

[dentstd]

One more thing. If he dies, you go to jail. If he lives, you go to jail.

If he dies, during your trial, the court will try to determine whether the victim died of choking or whether he died of the surgical procedure you performed. (You guys wanted to know the legal ramifications, right?)

 

[dentstd]

I am a bit confused. Somebody wants emergent tracheotomy, somebody else wants emergent cricothyrotomy. If the patient has food lodged in the trachea proximal to the cricothyroid membrane do you really think you are going to ventilate with cricothyrotomy? Explain to me how you think this will help.

What I would do is continue to attempt ventilation and continue attempts to clear the airway. As a patient becomes unconscious from hypoxia they relax which may help you to clear the airway. Just my two cents as a paramedic/RN...

This is dentistry. We have lots of people to pretend they know medicine. (Afterall, we're "doctors of the mouth".) The med schools teach you that one of the most common sites for food to lodge is the right bronchiole, because the angle of departure after the hilum is very straight, while the radius rapidly decreases. These quack doctors (more commonly known as "dentists") don't even know they're likely making a surgical incision at the wrong site.

 

[aphistis]

If I may, "doctor"...

If you have an awake, otherwise healthy patient who manages to get a foreign body past the vocal cords and into the right mainstem BRONCHUS (not bronchiole, as a glance as any anatomy text will reveal), the odds are very low that the patient will experience any emergent distress. Yes, the occluded portion of the airway tree will be temporarily blocked from gas exchange, leading to a transient V-Q mismatch and the possibility of atelectasis if allowed to persist for too long, but a patient with healthy cardiopulmonary function has ample ventilatory reserve to tolerate a single, relatively brief episode of one-lung ventilation without detriment. Now, I'm happy to continue discussing the merits of this argument from a medical perspective, but it'd save us both time if you just surrender the question to me.

Furthermore, what the med schools apparently didn't teach you is that when you perform a cricothyrotomy, you're not doing it for surgical access to remove the foreign body. You're doing it to bypass the upper airway and whatever obstructions lie therein to reestablish effective ventilation and gas exchange.

Considering the amount of Ivy League tuition you spent on all the misinformation I just had to correct, it might behoove you to consider being just a little less openly contemptuous of the "quack doctors" who spent less on their educations than you. Some of us know a few things you don't, and others of us know a lot of things you don't.

 

[DrReo]

You beat me to it, aphistis. At least Dr. Ivy is utilizing his self proclaimed "quack dentist" by his ability to recall elementary anatomy.

 

[dentstd]

If I may, "doctor"...

If you have an awake, otherwise healthy patient who manages to get a foreign body past the vocal cords and into the right mainstem BRONCHUS (not bronchiole, as a glance as any anatomy text will reveal), the odds are very low that the patient will experience any emergent distress. Yes, the occluded portion of the airway tree will be temporarily blocked from gas exchange, leading to a transient V-Q mismatch and the possibility of atelectasis if allowed to persist for too long, but a patient with healthy cardiopulmonary function has ample ventilatory reserve to tolerate a single, relatively brief episode of one-lung ventilation without detriment. Now, I'm happy to continue discussing the merits of this argument from a medical perspective, but it'd save us both time if you just surrender the question to me.



Considering the amount of Ivy League tuition you spent on all the misinformation I just had to correct, it might behoove you to consider being just a little less openly contemptuous of the "quack doctors" who spent less on their educations than you. Some of us know a few things you don't, and others of us know a lot of things you don't.

I made a mistake in calling it bronchiole and not a bronchus, but by how I defined the site, you could tell what I was referring to. That's my mistake, and I should've double checked the histo book. The rest of it's mostly you spitting back words from a physio book to show off how many scientific terms you could fit into a series of sentences. You havn't, however, used it in a meaningful way to demonstrate or even faintly justify your decision to proceed with the procedure in this situation.

Furthermore, what the med schools apparently didn't teach you is that when you perform a cricothyrotomy, you're not doing it for surgical access to remove the foreign body. You're doing it to bypass the upper airway and whatever obstructions lie therein to reestablish effective ventilation and gas exchange.

And why would you make any surgical incision at all when you can't definitively locate the point of obstruction? Specifically, why would you relieve the upper airway, when there's a high chance of a lower airway obstruction (ie, bronchus)? That makes me wonder if you've even thought about this, or whether you're just trying to find a comeback. Do you know where the obstruction is when a restaurant customer starts to choke? You don't have access to medical equipment.

And it doesn't take full obstruction for a patient to become cyanotic, fyi. I'm going to disregard your assessment on the "temporary"-ness of the situation not causing these problems. I think you're making it up. These symptoms have occured in lesser situations.

The EMT's the only person who've demonstrated knowledge. The dentists, however, are showing off their vocabulary.

Now let me defer this to legal arguments. You've already stated above that you'd perform aggravated assault with a deadly weapon on this victim. Of course, you weren't thinking. That's the problem permeating this thread. You'll gladly commit a felony to support your shaky scientific knowledge.

 

[dentstd]

You beat me to it, aphistis. At least Dr. Ivy is utilizing his self proclaimed "quack dentist" by his ability to recall elementary anatomy.

You're right, I recalled the wrong vocab word (even thou I indicated the precise location I meant to say). And you say your bullcrap like my error supercedes the wrongful decision to commit a felony. Look at all these idiots willing to slit someone's throat just because they've read Netter's Anatomy.

 

[DrReo]

You're right, I recalled the wrong vocab word (even thou I indicated the precise location I meant to say). And you say your bullcrap like my error supercedes the wrongful decision to commit a felony. Look at all these idiots willing to slit someone's throat just because they've read Netter's Anatomy.

Who knows, maybe next time it will be a wrong drug because you failed to recall So and So's Pharmacology.

 

[aphistis]

I made a mistake in calling it bronchiole and not a bronchus, but by how I defined the site, you could tell what I was referring to. That's my mistake, and I should've double checked the histo book. The rest of it's mostly you spitting back words from a physio book to show off how many scientific terms you could fit into a series of sentences. You havn't, however, used it in a meaningful way to demonstrate or even faintly justify your decision to proceed with the procedure in this situation.



And why would you make any surgical incision at all when you can't definitively locate the point of obstruction? Specifically, why would you relieve the upper airway, when there's a high chance of a lower airway obstruction (ie, bronchus)? That makes me wonder if you've even thought about this, or whether you're just trying to find a comeback. Do you know where the obstruction is when a restaurant customer starts to choke? You don't have access to medical equipment.

And it doesn't take full obstruction for a patient to become cyanotic, fyi. I'm going to disregard your assessment on the "temporary"-ness of the situation not causing these problems. I think you're making it up. These symptoms have occured in lesser situations.

The EMT's the only person who've demonstrated knowledge. The dentists, however, are showing off their vocabulary.

Now let me defer this to legal arguments. You've already stated above that you'd perform aggravated assault with a deadly weapon on this victim. Of course, you weren't thinking. That's the problem permeating this thread. You'll gladly commit a felony to support your shaky scientific knowledge.

Dude, you can disregard all you want. I've completed an anesthesia fellowship at a level 1 trauma center, and I've managed hundreds of airways. On this topic you are completely FOS; however, as a matter of (flatly undeserved) professional courtesy, I'm giving you one final opportunity to let the matter drop before I dismantle your arguments a line at a time in the name of educating the other dental board readers. The decision is yours; don't say I didn't warn you.

 

[libratl]

From reading this thread, one can certainly tell that a GP can have the knowledge to perform a cricothyrotomy or a tracheotomy.

To Aphistis: Regarding the OP's questions, is it your opinion that a GP who has not gone through fellowship/anesthesia rotation/residency should attempt this procedure? Or are you rebutting dentstd specifically because he made a blanket statement about dentists being quacks?

And if you may, please share more on what's is right and what is misinformation for everybody's education.

 

[dentstd]

Who knows, maybe next time it will be a wrong drug because you failed to recall So and So's Pharmacology.

Analogy isn't remotely close.

This is dentistry. Worst case scenario I accidently prescribe tylenol instead of ibuprofen.

 

[dentstd]

Dude, you can disregard all you want. I've completed an anesthesia fellowship at a level 1 trauma center, and I've managed hundreds of airways. On this topic you are completely FOS; however, as a matter of (flatly undeserved) professional courtesy, I'm giving you one final opportunity to let the matter drop before I dismantle your arguments a line at a time in the name of educating the other dental board readers. The decision is yours; don't say I didn't warn you.

Dismantle what you want. I honestly don't care. I wish you would dismantle more things, because you read into an argument I didn't make. I read that first, long-ass argument and noticed a couple assumptions you made that I certainly didn't make. I just don't have the strength to teach you punks how to not put your own preconceptions into the author's writing anymore.

Dismantle all the you want. From the very beginning of this thread, you've established yourself as the dentist who would willingly assault a stranger. A dentist who would willingly commit the felony of aggravated assault. You've demonstrated one of the most gross lapse of judgement a health professional can make. And what happens afterwards? ...only the most firm, persistent stance that you're somehow right in all this.

I think it goes without saying more that when a person's choking at a restaurant, you do not slit his throat open. I find it most humorous that you ridicule an Ivy League education, because this Ivy League education taught us that the best way to handle this situation's to persist in administering the Heimlick. To reduce the effects of gravity by reclining him forward, tap his back to loosen the object, and attempt to thrust the object out. Your superior Indiana Dental education apparently taught you to take a knife to a man's throat. Or did your anesthesiology rotation teach you that? (Or could be be what we all suspect. You're twisting the medical knowledge you learned to somehow support your felonious thinking.)

Imagine the situation from the victim's perspective: he's just having dinner and accidently laughed or whatever and food entered the wrong pipe. He's in panic, trying desperately to dislodge the food. People come and help him by administering the heimlick. All the sudden, some ******* dentist comes at him with a knife and appears to be trying to slit his throat. Poor guy. It's just not his day today.

Again...this is a display of a dental professional's gross lapse of good judgement. Criticize me away. You've lost credibility when you said you'd commit [aggravated] assault with a deadly weapon.

 

[dentstd]

To Aphistis: Regarding the OP's questions, is it your opinion that a GP who has not gone through fellowship/anesthesia rotation/residency should attempt this procedure? Or are you rebutting dentstd specifically because he made a blanket statement about dentists being quacks?.

Read through the arguments these dental students and dentists are making with regards to dentists knowing what it takes to handle this situation. Judge for yourself whether they're demonstrating knowledge of a trained professional...or knowledge of a quack.

FYI, he said he completed anesthesiology training at a trauma center. For obvious reasons, I think his training is in anesthesiology, not general surgery. Seeing surgeons do their work does not make one a surgeon. It's like dental assistants diagnosing TMJ problems. They've seen dentists do it, so they know all there is to know. (Although I'm curious to see a dentist showcase his general surgery knowledge after doing anesthesiology training.)

I won't pretend to know "cricothyrotomy," as my training doesn't touch that level. I won't recommend or advise against the procedure. That's not my place. I DO know, however, to stay the F away from that procedure when someone's choking.

 

[jay47]

Dismantle what you want. I honestly don't care. I wish you would dismantle more things, because you read into an argument I didn't make. I read that first, long-ass argument and noticed a couple assumptions you made that I certainly didn't make. I just don't have the strength to teach you punks how to not put your own preconceptions into the author's writing anymore.

Dismantle all the you want. From the very beginning of this thread, you've established yourself as the dentist who would willingly assault a stranger. A dentist who would willingly commit the felony of aggravated assault. You've demonstrated one of the most gross lapse of judgement a health professional can make. And what happens afterwards? ...only the most firm, persistent stance that you're somehow right in all this.

I think it goes without saying more that when a person's choking at a restaurant, you do not slit his throat open. I find it most humorous that you ridicule an Ivy League education, because this Ivy League education taught us that the best way to handle this situation's to persist in administering the Heimlick. To reduce the effects of gravity by reclining him forward, tap his back to loosen the object, and attempt to thrust the object out. Your superior Indiana Dental education apparently taught you to take a knife to a man's throat. Or did your anesthesiology rotation teach you that? (Or could be be what we all suspect. You're twisting the medical knowledge you learned to somehow support your felonious thinking.)

Imagine the situation from the victim's perspective: he's just having dinner and accidently laughed or whatever and food entered the wrong pipe. He's in panic, trying desperately to dislodge the food. People come and help him by administering the heimlick. All the sudden, some ******* dentist comes at him with a knife and appears to be trying to slit his throat. Poor guy. It's just not his day today.

Again...this is a display of a dental professional's gross lapse of good judgement. Criticize me away. You've lost credibility when you said you'd commit [aggravated] assault with a deadly weapon.

Give me a break man... this guy obviously knows that repeated attempts at the chest thrust procedure would be the first thing to do. It would always be wise to try and perform the procedure yourself in case the previous person was not doing it correctly. The original basis of the question was meant along the lines of this being a last resort. You have 6 minutes under standard conditions before permanent brain damage begins to occur, so no matter what happens after a certain period of time, the person is going to die or suffer severe consequences.

Secondly, if a person has somehow lodged a piece of food into a BRONCHUS, then your Ivy league education would have taught you that there were TWO bronchi. The patient would still have limited, but still functional use of one lung and at least some air would be able to pass. You seem to be the one throwing facts around without knowledge. However, if something was lodged superior to the trachea, or cricothyroid ligament, as in the inlet to the larynx (which could easily occur), a cric would surely work.

Thirdly, this isn't a question of law, or right or wrong. When someone is going to die because they are not getting oxygen, they are GOING TO DIE. Yes, it is understood that if paramedics are coming, and on their way SOON you should not perform something you are not specifically trained to do. But, when you posses the knowledge and skills that an average person does not have, it doesn't become a matter of law, it becomes a matter of character. What happens if the person does not get help, let's say within 30 minutes, as in a rural area? They die. You really only have 3 options in this scenario: 1. Do nothing, which has only one outcome if there are not other emergency personnel that can come within say 15 minutes- death. 2. Do a cric. Then one of two things can happen- The person dies (same as one) The person is saved.
I can agree that an emergency tracheotomy would be a much different story- there are many more blood vessels and the thryoid gland very close by, so I don't think I would ever attempt that, especially without a trach tube or the other proper tools.

Fourth, don't go around forums calling people dumba**es. It is one thing to fundamentally disagree, as we obviously do, but your name-calling is truly uncalled for. It is very immature, especially well respected members like Aphistis.

 

[jay47]

You're right, I recalled the wrong vocab word (even thou I indicated the precise location I meant to say). And you say your bullcrap like my error supercedes the wrongful decision to commit a felony. Look at all these idiots willing to slit someone's throat just because they've read Netter's Anatomy.

Maybe you haven't read Netter's. Slitting someone's throat implies they have no knowledge of blood vessels and arteries in the area. The only artery or vein immediately close to the cricothyroid ligament is the superior thryoid (http://www.netterimages.com/image/9018.htm). Perhaps you would cut it, which would cause significant bleeding. However, should the patient live, there is still the inferior thyroid artery to supply the thryoid.

They cricothyroid ligament is very easy to palpate. Try it on yourself.

Again, should the person die, they don't need any arteries.

 

[TJNova2011]

Reread the original post. Heimlick has already been attempted and not successful

Dismantle what you want. I honestly don't care. I wish you would dismantle more things, because you read into an argument I didn't make. I read that first, long-ass argument and noticed a couple assumptions you made that I certainly didn't make. I just don't have the strength to teach you punks how to not put your own preconceptions into the author's writing anymore.

Dismantle all the you want. From the very beginning of this thread, you've established yourself as the dentist who would willingly assault a stranger. A dentist who would willingly commit the felony of aggravated assault. You've demonstrated one of the most gross lapse of judgement a health professional can make. And what happens afterwards? ...only the most firm, persistent stance that you're somehow right in all this.

I think it goes without saying more that when a person's choking at a restaurant, you do not slit his throat open. I find it most humorous that you ridicule an Ivy League education, because this Ivy League education taught us that the best way to handle this situation's to persist in administering the Heimlick. To reduce the effects of gravity by reclining him forward, tap his back to loosen the object, and attempt to thrust the object out. Your superior Indiana Dental education apparently taught you to take a knife to a man's throat. Or did your anesthesiology rotation teach you that? (Or could be be what we all suspect. You're twisting the medical knowledge you learned to somehow support your felonious thinking.)

Imagine the situation from the victim's perspective: he's just having dinner and accidently laughed or whatever and food entered the wrong pipe. He's in panic, trying desperately to dislodge the food. People come and help him by administering the heimlick. All the sudden, some ******* dentist comes at him with a knife and appears to be trying to slit his throat. Poor guy. It's just not his day today.

Again...this is a display of a dental professional's gross lapse of good judgement. Criticize me away. You've lost credibility when you said you'd commit [aggravated] assault with a deadly weapon.

 

[Palmetto914]

All, after reading through this thread, I had to re-read the title to make sure it didn't say "SDN D!CK-measuring contest of anatomy and physiology". The question is asking whether or not you'd do whatever you could to save someone's life...dentstd, you've made it quite clear you wouldn't break the law to do so. Calling some people that would dumb@a's is ironic, as I'm sure there are plenty of people that would call someone that would stand there and do nothing much worse than that.

 

[mike3kgt]

What happens if the person does not get help, let's say within 30 minutes, as in a rural area? They die. You really only have 3 options in this scenario: 1. Do nothing, which has only one outcome if there are not other emergency personnel that can come within say 15 minutes- death. 2. Do a cric. Then one of two things can happen- The person dies (same as one) The person is saved.

Best reasoning so far for when a dentist may actually be indicated for this type of procedure other than the Netter's comments... I loved that.

Still, in a rural area, I wouldn't do it. Only place I'd consider it is if I were on my sailboat, in the middle of international waters or middle of the jungle in a foreign country and the person has an obstructed upper airway when after repeated attempts could not dislodge the object AND there was nobody around MORE qualified than I to perform this procedure.

Then again, I have seen sailors who are at sea for months at a time with dental "fillings" out of boat epoxy that they did themselves and these restorations were better than some dentists. You have to remember that the AVERAGE NON-ACLS trained general dentist shouldn't be going anywhere near the trachea.

 

[cdmOMR]

It seems I started a bit of war, but I figured it would be an interesting topic to discuss. Theres a lot to comment on, but I dont feel like typing it all out right now.
I do have one question to Dentstd, though... if the person was your mother, would your answer be the same?

 

[dentstd]

Reread the original post. Heimlick has already been attempted and not successful

Reread the claim. You persist in the heimlick, eventhou it hasn't worked before.

 

[dentstd]

Give me a break man... this guy obviously knows that repeated attempts at the chest thrust procedure would be the first thing to do. It would always be wise to try and perform the procedure yourself in case the previous person was not doing it correctly. The original basis of the question was meant along the lines of this being a last resort. You have 6 minutes under standard conditions before permanent brain damage begins to occur, so no matter what happens after a certain period of time, the person is going to die or suffer severe consequences.

Secondly, if a person has somehow lodged a piece of food into a BRONCHUS, then your Ivy league education would have taught you that there were TWO bronchi. The patient would still have limited, but still functional use of one lung and at least some air would be able to pass. You seem to be the one throwing facts around without knowledge. However, if something was lodged superior to the trachea, or cricothyroid ligament, as in the inlet to the larynx (which could easily occur), a cric would surely work.

Thirdly, this isn't a question of law, or right or wrong. When someone is going to die because they are not getting oxygen, they are GOING TO DIE. Yes, it is understood that if paramedics are coming, and on their way SOON you should not perform something you are not specifically trained to do. But, when you posses the knowledge and skills that an average person does not have, it doesn't become a matter of law, it becomes a matter of character. What happens if the person does not get help, let's say within 30 minutes, as in a rural area? They die. You really only have 3 options in this scenario: 1. Do nothing, which has only one outcome if there are not other emergency personnel that can come within say 15 minutes- death. 2. Do a cric. Then one of two things can happen- The person dies (same as one) The person is saved.
I can agree that an emergency tracheotomy would be a much different story- there are many more blood vessels and the thryoid gland very close by, so I don't think I would ever attempt that, especially without a trach tube or the other proper tools.

Fourth, don't go around forums calling people dumba**es. It is one thing to fundamentally disagree, as we obviously do, but your name-calling is truly uncalled for. It is very immature, especially well respected members like Aphistis.

This same guy who obviously knows to do the heimlick also obviously thinks he's a surgeon for doing dental anesthesiology residency at a trauma center. He did, afterall, stuff tubes down many peoples' throats. (his words too) I just want to ask him one question: have you EVER in your life performed a single surgery?

Because I think that a person can exhibit those symptoms with one lung obstructed. Add to it that he's in dire panic, those symptoms are entirely possible. (I've already thought about your scenario. I just happen to not agree.)

When you perform surgery on the larynx, you're not only cutting into the larynx. All those structures you're cutting thru, those structures are gonna bleed like hell. (again, I've already thought about this). Compound the problem with the possibility that you hit the vocal cord. What do you do then? Or what if crap starts to move down the fascia layers?

And yes, this is a matter of law. How is it that I'm sure? Because my law professor taught me the law when I went to law school. We specifically addressed the good samaritan law. It's not absolute. It can be overcome. Only some states of that law, and it can be toppled given that certain criteria are met (I've already highlighted those criteria within the law above). This case falls within that criteria quite nicely. Child, don't even go into this when you know zero about the legal system and at least fundamentals of the law. And if the person dies, you'll be the one on trial for murder/man slaughter. How is this? Because we don't know whether he died from choking or from your surgery.

What's uncalled for is your juvenile sense of right and wrong. What mother taught you is wrong. I'm gonna call you a ******* when you persist in thinking like a *******.

 

[dentstd]

I do have one question to Dentstd, though... if the person was your mother, would your answer be the same?

If this were my mother, father, brother, or sister, I would place them in a relatively supine position and do the heimlick. I would tell them to try to relax to open the airways and increase the chances of the object dislodging. Even when I know none of them would press charges against me, I'm not a surgeon. I know the exact anatomy of that region, but I've never performed a single surgery in my life.

Even surgical residents aren't allowed to perform surgeries on their own without supervision. Let me rephrase, even some people who've studied the surgical procedures ahead of time, know the various methods to minimize damage in the event of errors, and have extensive practice with surgeries...are not allow to do these procedures by themselves. I certainly do not think dentists who are proud about their purported knowledge (and with no prior experience other than having seen others at a trauma center do it) are capable of such procedures.

 

[jay47]

Best reasoning so far for when a dentist may actually be indicated for this type of procedure other than the Netter's comments... I loved that.

Still, in a rural area, I wouldn't do it. Only place I'd consider it is if I were on my sailboat, in the middle of international waters or middle of the jungle in a foreign country and the person has an obstructed upper airway when after repeated attempts could not dislodge the object AND there was nobody around MORE qualified than I to perform this procedure.

Then again, I have seen sailors who are at sea for months at a time with dental "fillings" out of boat epoxy that they did themselves and these restorations were better than some dentists. You have to remember that the AVERAGE NON-ACLS trained general dentist shouldn't be going anywhere near the trachea.

Again, the time limit here is key. I used to live 30 minutes away from the nearest town. There is NO possible was for them to get there under 25 minutes even with clear traffic and going 100 mpg. If someone in my family was choking there is no one else around I would attempt the following.

1. Call 911 immediately (or perform chest thrust 1st if I saw them begin the choke)
2. Attempt the chest thrust immediately, multiple times from multiple angles. Hit on back, etc...
3. If after the person lost consciousness after 4 minutes and I still could not do anything else, I would attempt to palpate where the food was in the throat. If I could feel it below the cric, I don't know that I would do anything. Perhaps I would put the person in my vehicle and try to meet the paramedics half way to speed up the time. If I could feel it above the cric or at least not feel it below I would probably attempt the cric. I know that I couldn't live with myself if I didn't try something to save their life.

 

[dentstd]

What happens if the person does not get help, let's say within 30 minutes, as in a rural area? They die. You really only have 3 options in this scenario: 1. Do nothing, which has only one outcome if there are not other emergency personnel that can come within say 15 minutes- death. 2. Do a cric. Then one of two things can happen- The person dies (same as one) The person is saved..

Or 3) continue doing the heimlick until it works.

When you do the surgery and the person dies, that's when all hell breaks loose. When the victim's family gets word that their dear Bob died, and some stranger cut open his throat, how do you think the family'll react? If they were to contact any lawyer what-so-ever, they'll find out they have at least 2 legal options. If they want your money, they'll sue in tort. If they want you in jail, they claim murder.

 

[dentstd]

Again, the time limit here is key. I used to live 30 minutes away from the nearest town. There is NO possible was for them to get there under 25 minutes even with clear traffic and going 100 mpg. If someone in my family was choking there is no one else around I would attempt the following.

1. Call 911 immediately (or perform chest thrust 1st if I saw them begin the choke)
2. Attempt the chest thrust immediately, multiple times from multiple angles. Hit on back, etc...
3. If after the person lost consciousness after 4 minutes and I still could not do anything else, I would attempt to palpate where the food was in the throat. If I could feel it below the cric, I don't know that I would do anything. Perhaps I would put the person in my vehicle and try to meet the paramedics half way to speed up the time. If I could feel it above the cric or at least not feel it below I would probably attempt the cric. I know that I couldn't live with myself if I didn't try something to save their life.

Okay, just shut up right now. Just shut tha hell up. There's a thick ass layer of cartilage in the way, you think you can feel food? He's not eating rocks.

Zip your mouth right now and we'll forget you even spoke.

 

[jay47]

This same guy who obviously knows to do the heimlick also obviously thinks he's a surgeon for doing dental anesthesiology residency at a trauma center. He did, afterall, stuff tubes down many peoples' throats. (his words too) I just want to ask him one question: have you EVER in your life performed a single surgery?

Because I think that a person can exhibit those symptoms with one lung obstructed. Add to it that he's in dire panic, those symptoms are entirely possible. (I've already thought about your scenario. I just happen to not agree.)

When you perform surgery on the larynx, you're not only cutting into the larynx. All those structures you're cutting thru, those structures are gonna bleed like hell. (again, I've already thought about this). Compound the problem with the possibility that you hit the vocal cord. What do you do then? Or what if crap starts to move down the fascia layers?

And yes, this is a matter of law. How is it that I'm sure? Because my law professor taught me the law when I went to law school. We specifically addressed the good samaritan law. It's not absolute. It can be overcome. Only some states of that law, and it can be toppled given that certain criteria are met (I've already highlighted those criteria within the law above). This case falls within that criteria quite nicely. Child, don't even go into this when you know zero about the legal system and at least fundamentals of the law. And if the person dies, you'll be the one on trial for murder/man slaughter. How is this? Because we don't know whether he died from choking or from your surgery.

What's uncalled for is your juvenile sense of right and wrong. What mother taught you is wrong. I'm gonna call you a ******* when you persist in thinking like a *******.

Basically, I don't give a **** about the law when someone is going to die. I really don't care if there is a chance I can go to jail if there is also a chance I could save someone's life. Period.

"what if I cut the vocal cords" ...scoff.... The vocal cords are located well above the cricothyroid ligament attached to the thyroid cartilage.(http://www.homebusinessandfamilylife.com/larynx.html) take a look at Netter's cross section. Or perhaps you would like to look at Rohen's (http://www.esg.montana.edu/esg/kla/ta/respiratory.html). The only reason I cite these URL's is because you are so full of crap it's coming out the other end.

Did you even dissect a cadaver? Did you do a cric in lab? The only way I'm going to cut the vocal cords is if I spear the damn knife up superiorly.

"what if crap starts to move down the fascial layers" Sure, infection could spread from the fascia, and no I won't name them all, because it doesn't matter if the PERSON IS DEAD. And if your response was to blood flowing into the trachea then the answer is simple, turn the person the other direction so that blood flows out of the throat. Yeah it's going to bleed like hell, but at least it could be oxygenated blood and not deoxygenated blood now.

A friend of mine put it quite well when he said that you can replace a heart, you can replace a kidney, lung, liver, pancreas, you can sew up cuts, wounds and treat burns, but you can't replace a brain. Without oxygen in a reasonable amount of time (the entire basis of me attempting this procedure) the brain will die.

I think you keep thinking that we are just going to go cut up any person of the street. NO. This is only when this is a last resort and death is the only other option. I suppose that I'm deviating from the originally asked question when he states that the paramedics aren't close- my attempt is under that assumption that they will knowingly be unable to get there in time before death occurs.

Finally: don't call me a child, and you can call me a *******, but you are the pompous type of lawyer whom I want nothing to do with. I've read lots of other posts by you on SDN in the past and your arrogance is unrelenting. I'm done with this thread.

 

[jay47]

Okay, just shut up right now. Just shut tha hell up. There's a thick ass layer of cartilage in the way, you think you can feel food? He's not eating rocks.

Zip your mouth right now and we'll forget you even spoke.

Notice the word ATTEMPT jacka**.

 

[dentstd]

Basically, I don't give a **** about the law when someone is going to die. I really don't care if there is a chance I can go to jail if there is also a chance I could save someone's life. Period.

...and this is where you lost credibility. Game over. It matters when they die from your doing. The victim still had a chance to live if you'd stick to the proper ways of handling this. Exceed your capability and you may make matters worse. They may die because of you!

Stick to drill and fill. That's your area of expertise. Not surgery.

 

[dentstd]

Notice the word ATTEMPT jacka**.

And if you press just rostral to the food, the food'll go even deeper where the airway circumference is smaller. Let's just kill this man, why don't cha? He may be choking before you, but he'll certainly have no chance with your medicine.



OMFG, you're a total idiot.