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Monday, 5 September 2011

Man Chokes to Death During Air Flight... Preventable?

Posted on 14:40 by Unknown
Image courtesy of digitalart / FreeDigitalPhotos.net
News media reported on Sept 5, 2011 about Robert Rippingale who choked to death during a flight from Singapore to New Zealand. He was with his girlfriend who noted he was shaking and turning blue after eating an in-flight meal. A doctor and two nurses attempted to save him though unsuccessfully.

The article reports that CPR was performed to try and save the man, but the obvious question is whether a Heimlich maneuver was done. Obviously, as long as an obstruction is present, doing CPR is bound to fail.

Assuming a Heimlich maneuver was performed and failed to remove the airway obstruction... what could have been done to save this man's life?

Let's assume best case scenario of having an experienced ENT surgeon was on board.

The surgeon could try to relieve the obstruction manually by looking down the throat using a laryngoscope and using instruments to remove the food obstruction from the airway.

If that fails, an emergency cricothyroidotomy would have saved this man's life. This emergency life-saving procedure is in essence making a hole in the neck directly into the airway. It is slightly different from a tracheostomy in terms of where anatomically this hole is made, but the end-result is the same.

Question is, EVEN if you had an experienced ENT on board, would an airplane even have a laryngoscope as well as instruments to remove a food impaction? Would an emergency cricothyroidotomy even be possible due to prohibition of sharp objects in airplanes? After all, you still need a knife of some sort to make the incision and to dissect down to the airway. Without a sharp instrument, this step would be impossible even if you have someone who knows what to do.

According to Appendix A to Part 121 of Title 14 of the Code of Federal Regulations (14 CFR 121), the specific requirements for US carriers regarding first aid and emergency aid kits are as follows:

For 0-50 seats, one kit is required; 51-150 seats, two kits are required; 151-250 seats require three; and more than 250 seats require 4 kits.

These kits must include, at a minimum:
  • 16 Adhesive bandage compresses, 1-inch
  • 20 Antiseptic swabs
  • 10 Ammonia inhalants
  • 8 Bandage compresses, 4-inch
  • 5 Triangular bandage compresses, 40-inch
  • 1 Arm splint, noninflatable
  • 1 Leg splint, noninflatable
  • 4 Roller bandage, 4-inch
  • 2 Adhesive tape, 1-inch standard roll
  • 1 Bandage scissors
Also, at least one approved medical kit must be on board that includes at a minimum:
  • 1 Sphygmonanometer
  • 1 Stethoscope
  • 3 Airways, oropharyngeal (3 sizes): 1 pediatric, 1 small adult, 1 large adult or equivalent.
  • Self-inflating manual resuscitation device with 3 masks (1 pediatric, 1 small adult, 1 large adult or equivalent).
  • CPR mask (3 sizes), 1 pediatric, 1 small adult, 1 large adult, or equivalent.
  • 1 IV Admin Set: Tubing w/ 2 Y connectors
  • 2 Alcohol sponges
  • 1 Adhesive tape, 1-inch standard roll adhesive.
  • 1 pair Tape scissors
  • 1 Tourniquet
  • 1 Saline solution, 500 cc
  • 1 pair Protective nonpermeable gloves or equivalent
  • 6 Needles (2-18 ga., 2-20 ga., 2-22 ga., or sizes necessary to administer required medications).
  • 4 Syringes (1-5 cc, 2-10 cc, or sizes necessary to administer required medications).
  • 4 Analgesic, non-narcotic, tablets, 325 mg
  • 4 Antihistamine tablets, 25 mg
  • 2 Antihistamine injectable, 50 mg, (single dose ampule or equivalent).
  • 2 Atropine, 0.5 mg, 5 cc (single dose ampule or equivalent).
  • 4 Aspirin tablets, 325 mg
  • 1 Bronchodilator, inhaled (metered dose inhaler or equivalent).
  • 1 Dextrose, 50%/50 cc injectable, (single dose ampule or equivalent).
  • 2 Epinephrine 1:1000, 1 cc, injectable, (single dose ampule or equivalent).
  • 2 Epinephrine 1:10,000, 2 cc, injectable, (single dose ampule or equivalent).
  • 2 Lidocaine, 5 cc, 20 mg/ml, injectable (single dose ampule or equivalent).
  • 10 Nitroglycerin tablets, 0.4 mg
  • 1 Basic instructions for use of the drugs in the kit.
It seems that there are airways of different sizes available, but no laryngoscope or other instruments to remove airway foreign objects.

Nowhere is a scalpel or knife listed either. You have needles and syringes which theoretically can be used to "poke" into the airway. However, though an 18 gauge needle might work for a chipmunk's airway, it is not sufficient for a full-grown man. It would be like breathing through a straw, but 50 times smaller and even more difficult to breath thru.

So it appears that in the event of an airway obstruction during an air-flight for which Heimlich fails, you can have the world's best surgeon present, and the man still would have died.

Some surgeons would argue a strong, stiff ball-point pen could have been used to perform the cricothyroidotomy, but as someone who has performed a dozen emergency cricothyroidotomies and tracheotomies in the past, even under the best of circumstances with a knife and being on a hospital floor with help around, it is hard. Furthermore, skin and the windpipe is made of tough "fabric" and trying to punch a ball-point pen through is laughable. Try doing it yourself on a chicken with the skin on.

Read the news article here.
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  • oyster
  • oz
  • pa
  • pacemaker
  • packing
  • pageant
  • pain
  • painful
  • paint
  • palate
  • pandas
  • paper
  • papilloma
  • parachute
  • paradoxical vocal cord
  • paralysis
  • paralyzed
  • parathyroid
  • parents
  • participating
  • past
  • patch
  • pathologist
  • pathology
  • patient
  • pattern
  • patulous
  • pbm
  • pediatric
  • pediatrician
  • pellet
  • pen
  • peptide
  • perennial
  • perfect
  • perforation
  • perfume
  • peri
  • perichondrium
  • period
  • peritonsillar
  • permanent
  • permission
  • persistent
  • personal
  • pet
  • ph
  • ph probe
  • pharmacist
  • pharmacy
  • pharyngeal
  • pharyngitis treatment
  • pharyngocele
  • pharynx
  • phd
  • phegm
  • phelgm
  • phelgmy throat
  • phlegm
  • phlegmy
  • phlegmy throat
  • phone
  • Physician
  • pick
  • picking
  • picture
  • pictures
  • piercing
  • piezoelectric
  • pillar
  • pipe
  • pitch
  • PKCzeta
  • placebo
  • plan
  • planet
  • planetree
  • plastic surgery
  • plastics
  • plugs
  • pocket
  • police
  • policy
  • pollen
  • polly hunsberger
  • polonium
  • polyp
  • pons
  • poor
  • popping
  • popular
  • popularity
  • portable
  • portman
  • positive
  • post
  • post-nasal
  • post-nasal drainage
  • posterior
  • pouch
  • power
  • ppo
  • practice
  • predicting
  • prediction
  • prednisone
  • pregnancy
  • pregnant
  • premarin
  • prenatal
  • prescribing
  • prescription
  • prescriptions
  • pressure
  • prick
  • prilosec
  • primer
  • problem
  • problems
  • procedure
  • process
  • professional
  • propel
  • protein kinase
  • provider
  • public
  • publication
  • puck
  • pulsatile
  • pumpkin
  • punishment
  • purchase
  • purulent
  • pus
  • puzzle
  • pylori
  • quickly
  • quickmark
  • r. kelly
  • radiation
  • radio
  • radioactive
  • radioactivity
  • radiological
  • radiology
  • raft
  • ragweed
  • random
  • rapid
  • raspy
  • RAST
  • reaction
  • reader
  • real-time
  • rebound
  • reckitt
  • record
  • recording
  • records
  • recurrent
  • red eyes
  • reduction
  • referral
  • reflux
  • regurgitation
  • rehm
  • removal
  • renovation
  • renovations
  • repair
  • repellant
  • replacement
  • reporter
  • research
  • residency
  • resident
  • resistance
  • response
  • resurface
  • resurfacing
  • review
  • rhinitis
  • rhinoplasty
  • richmond
  • right
  • ringing
  • rinse
  • risk
  • robert
  • robot
  • robotic
  • rock
  • roger
  • roof
  • room
  • rotating
  • routine
  • rubber
  • runny nose
  • rupture
  • ryan
  • safe
  • sale
  • saline
  • saliva
  • salivary stone
  • saltwater
  • santa claus
  • scan
  • scans
  • scar
  • scheduling
  • science
  • scientist
  • SCIT
  • scopolamine
  • scramble
  • scratch
  • screening
  • SD
  • seafood
  • search
  • seasonal
  • seaweed
  • secondhand
  • secure
  • security
  • sedated
  • sedation
  • self-pay
  • sensory
  • sepsis
  • septal
  • septo
  • septoplasty
  • septum
  • sermo
  • service
  • set
  • severe
  • sex
  • shampoo
  • shape
  • shark
  • shenandoah university
  • shop
  • shortness of breath
  • shot
  • shots
  • show
  • shrimp
  • sialadenitis
  • sialendoscopy
  • sialoadenitis
  • sickness
  • side
  • side effect
  • silent
  • silver nitrate
  • singer
  • singing
  • singing cat
  • singulair
  • singultus
  • sinuneb
  • sinuplasty
  • sinus
  • sinus fracture
  • sinus infection
  • sinus lift
  • sinus surgery
  • sinusitis
  • skating
  • skin
  • skin cancer
  • skull
  • sleep
  • sleep disorder
  • SLIT
  • sluder
  • small
  • smartphone
  • smell
  • smoke
  • smoking
  • sms
  • sneeze
  • sneezing
  • snore
  • snoring
  • snot
  • snotty nose
  • social
  • social media
  • social networking
  • soda
  • sodium
  • soft
  • song
  • sore
  • sore throat
  • sour
  • spa
  • spam
  • spanish
  • spasmodic
  • spasmodic dypshonia
  • spasmodic dysphonia
  • spasms
  • special
  • specialist
  • speech
  • speech therapy
  • spinal
  • spinning
  • spit
  • splints
  • split tube
  • spray
  • spur
  • ssnhl
  • staph
  • starvation
  • stat
  • station
  • stem
  • stereoisomer
  • sterile
  • steroid
  • steroids
  • sticky
  • stink
  • stone
  • stones
  • stops
  • storybooks
  • strange
  • strep
  • strep throat
  • stridor
  • strobe
  • stroboscopy
  • stroke
  • stuck
  • stud
  • student
  • study
  • stuffed animals
  • stuttering
  • sublingual
  • submandibular
  • submaxillary
  • sudden
  • sudden hearing loss
  • sun
  • sunblock
  • sunscreen
  • sunshine
  • superbill
  • superbowl
  • superbug
  • support
  • surgeon
  • surgery
  • surgical
  • survey
  • suture
  • swallow
  • swallowing
  • swelling
  • sword
  • symbicort
  • symphony
  • symptom
  • symptoms
  • syndrome
  • T-tube
  • tablet
  • talk
  • talking
  • tall
  • target
  • taste
  • tea
  • teacher
  • technology
  • teen
  • teenager
  • teeth
  • television
  • temperature
  • terrorism
  • terrorist
  • test
  • testing
  • tests
  • text messaging
  • the doctors
  • the onion
  • theory
  • therapy
  • thick
  • throat
  • throat cancer
  • throat clearing
  • throat-clearing
  • thrombosis
  • thrombus
  • throwing
  • thyroid
  • thyroidectomy
  • tia
  • tic
  • tic cough
  • tick
  • tilt
  • time
  • times
  • tinnitus
  • tiny
  • Tionne
  • TLC
  • TMJ
  • tobacco
  • TOCPM
  • today
  • tongue
  • tonsil
  • tonsil stones
  • tonsillectomy
  • tonsilliits
  • tonsillitis
  • tonsilloliths
  • tonsillotomy
  • tonsilolith
  • tonsiloliths
  • tony
  • tooth
  • tooth pain
  • top
  • topical
  • TORD
  • torres
  • tors
  • torticollis
  • tour
  • toxin
  • toyota
  • trach
  • tracheostomy
  • training
  • trans
  • translation
  • transmedics
  • transmission
  • transplant
  • transplantation
  • transportation
  • trauma
  • treating
  • treatment
  • tremor
  • trend
  • triangle
  • trombone
  • trouble
  • tube
  • tubes
  • tucci
  • tumor
  • turbinate coblation
  • turbinate hypertrophy
  • turbinate reduction
  • turning
  • tutorial
  • TV
  • tween
  • tweet
  • twitching
  • twitter
  • two
  • tylenol
  • tympanic
  • type
  • ulcer
  • ulpa
  • ulrich
  • ultrasound
  • unable
  • unclog
  • under
  • uninsured
  • united kingdom
  • university
  • Update
  • upper
  • upper respiratory infection
  • uppp
  • urgent
  • URI
  • urine
  • urticaria
  • usa
  • USA today
  • uva
  • uvula
  • uvulectomy
  • uvulopalatopharyngoplasty
  • vaccination
  • vaccine
  • vagal neuropathy
  • vascular
  • vasomotor
  • vasomotor rhinnitis
  • vcd
  • ventilation
  • versus
  • vertigo
  • ves
  • vessel
  • viagra
  • vibration
  • video
  • viral
  • virginia
  • virus
  • viruses
  • vit d
  • vitamin
  • vitamin A
  • vitamin d
  • vivosonic
  • vlog
  • vocal
  • vocal cord
  • vocal cord dysfunction
  • vocal cord paralysis
  • vocal cord paresis
  • vocal cords
  • vocal process
  • voice
  • voice therapy
  • voicebox
  • voicelift
  • volume
  • vomit
  • vs
  • wait
  • waiting
  • wall
  • wall street journal
  • warm
  • warrenton
  • washes
  • washington
  • washington dc
  • washington post
  • water
  • watkins
  • wax
  • wearable
  • web
  • web 2.0
  • webapp
  • Website
  • Website Update
  • wedge
  • weight gain
  • whale
  • what to do
  • wheezing
  • where
  • whisperer
  • whispering
  • white
  • who
  • whooping
  • wierd
  • wifi
  • will.i.am
  • wind
  • windows 7
  • winter
  • wire
  • wireless
  • withdrawal
  • without
  • woman
  • word
  • world
  • world voice day
  • world's
  • worlds
  • wound center
  • wp
  • wrestling
  • wrong
  • wsj
  • x-ray
  • xeomin
  • xray
  • xylitol
  • xyzal
  • youtube
  • zenker's
  • zenkers
  • zeta
  • zicam
  • zinc
  • zyrtec

Blog Archive

  • ▼  2011 (190)
    • ▼  September (26)
      • Cat with Two Faces (Literally)
      • Cigarettes Contain Radioactive Polonium
      • Not All Spinning Motions Cause Dizziness
      • HIPAA Allows for Regular Email Communication Betwe...
      • MRI Scans CAN Cause Vertigo
      • Oral Exam Using a Finger
      • United Kingdom Ends $17 Billion Electronic Medical...
      • New Webpage on Vocal Cord Granuloma
      • Singer John Mayer Diagnosed with Vocal Cord Granuloma
      • Tongue Acrobatics
      • World's Longest Human Tongue
      • Another Rock Singer With Injured Voice
      • World Record Large Ears
      • Keychain Emergency Airway Device (Video)
      • Smoker's Kids Have More Ear Infections
      • 100 Years of Style and Dance
      • Carbon Dioxide Helps with Nasal Allergies
      • Intranasal Treatment for Clogged Ears
      • Best Ballpoint Pen for Emergency Cricothyroidotomy?
      • Beating Heart in a Box
      • The Healthcare Dilemma Simplified
      • Man Chokes to Death During Air Flight... Preventable?
      • Best Medication for Dizziness
      • Surgery Without Wires
      • Movie Sets are Dangerous to Ears!
      • Hearing Loss Can Can Accelerate Brain Volume Loss
    • ►  August (22)
    • ►  July (20)
    • ►  June (15)
    • ►  May (10)
    • ►  April (18)
    • ►  March (12)
    • ►  February (33)
    • ►  January (34)
  • ►  2010 (267)
    • ►  December (23)
    • ►  November (18)
    • ►  October (32)
    • ►  September (30)
    • ►  August (35)
    • ►  July (16)
    • ►  June (27)
    • ►  May (22)
    • ►  April (27)
    • ►  March (11)
    • ►  February (13)
    • ►  January (13)
  • ►  2009 (43)
    • ►  December (11)
    • ►  November (13)
    • ►  October (19)
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