(Medical question) Lets pretend someone's windpipe was blocked...

[Draconi Redfir]

Be it through choking hazard, allergy causing inflammation, swelling, or something else. For whatever reason, this hypothetical person can not breathe through the standard mouth + nose setup.

Some of you might have seen movies or the like where someone would fix this issue by puncturing the windpipe with the shell of a ballpoint pen (ink removed) to create an air passage. Pretty sure this isn't advised in real life due to being dangerous, but still.

What i want to know is what if the entire windpipe is a no-go? Could we say, find a spot between the ribs and stab them them directly into a lung to provide them with air? Or would this collapse their lung? Lets pretend we have more tools at our disposal then just a ball-point pen, a really sharp knife or the like.

I feel like blood pouring into the lung is the most likely outcome which would be bad, but I'm mainly wondering if it'd still be (hypothetically) feasible at all. Maybe one lung collapses / floods, but it provides air for the other lung, thus keeping the person alive?

[LibraryOgre]

If you are having a medical emergency, please call 911. :smallbiggrin:

However, I'm pretty sure that putting the tube into the lung would collapse the lung. A collapsed lung is when air gets into the chest cavity (https://medlineplus.gov/collapsedlung.html), and punching a hole between a couple ribs will do that. There are chest tubes (https://medlineplus.gov/ency/article/002947.htm) which can help mitigate that, but they require suction to ensure that air stays out of the pleural space. Plus, your "breathing tube" would have to stay with the lung while it expands and contracts, without slipping out of the hole. It would also bypass the valves in your trachea that help filter out dust and nastiness.

So, with some REALLY GOOD improvised tools and a lot of medical experience, yeah, maybe, you could manage it. But you're not going to be talking a priest through the procedure over the radio, so he can do it with a Tom Mix pocket knife and a pen.



The Mod Ogre: Joke at the top aside, I am treating this not as "medical advice", but as "how does this anatomy thing work." More in vein with "I am writing a book and want to see if this idea works", than "Hey, what if I want to try recreational surgery." Feel free to address my non-red text up there; if you want to talk about the mod text, PM me.

[Rockphed]

I suspect that if the entire windpipe is blocked the person in question is pretty much dead already. Just breathing I can feel my chest moving as I breath in and out, so I suspect that if you put a hole into a lung from the bottom it will stop working right.

That said, heart surgery is a thing for the last 50 years or so, so there is a way to have someone keep breathing while you have their chest opened up like a macabre mimic.

I'll have to ask my wife since she is the biology person in our relationship.

[Eldan]

Fun fact: every movie and TV series I've ever seen does tracheostomy (cutting into the windpipe) wrong. You do it considerably lower down than most people think. Between the thyroid and the sternum, just a finger or so above the clavicles. And when done in a medical context, you don't just cut a hole. You then push an air tube into the hole. Depending on what exactly the situation is, you can push that tube through a restriction in the windpipe, or even down into the lungs.

[Draconi Redfir]

Fun fact: every movie and TV series I've ever seen does tracheostomy (cutting into the windpipe) wrong. You do it considerably lower down than most people think. Between the thyroid and the sternum, just a finger or so above the clavicles. And when done in a medical context, you don't just cut a hole. You then push an air tube into the hole. Depending on what exactly the situation is, you can push that tube through a restriction in the windpipe, or even down into the lungs.

yeah, definitely a case of "rule of cool" hollywood flair there. Don't take medical advice from movies for sure :P

[Rockphed]

My wife says that the biggest risk in a tracheotomy is accidentally hitting the jugular vein (or the carotid artery that runs right next to it) in your quest to get to the trachea. She (albeit, not a surgeon) wouldn't want to do a tracheotomy unless the person was going to die without it.

She also says that if your trachea is completely shot you are pretty much dead anyway.

[Lord Torath]

Fun fact: every movie and TV series I've ever seen does tracheostomy (cutting into the windpipe) wrong. You do it considerably lower down than most people think. Between the thyroid and the sternum, just a finger or so above the clavicles. And when done in a medical context, you don't just cut a hole. You then push an air tube into the hole. Depending on what exactly the situation is, you can push that tube through a restriction in the windpipe, or even down into the lungs.Does this include the M*A*S*H episode? That's the first time I've ever seen it. If I remember right, they used a ball-point pen 'shell' for the air pipe.

[Draconi Redfir]

She also says that if your trachea is completely shot you are pretty much dead anyway.

Well dang, no direct-to-lung attempts eh? That sucks

[Tvtyrant]

Back when COVID was first happening I wanted to know why there weren't direct blood oxygenators to bypass destroyed lungs. I found out that there are, about 5 in the whole world. That's because they tend to cut up red blood cells, and destroy lungs can't really be healed so the person likely will die anyway.

Which is to say, if bypassing a sufficiently large portion of the body is necessary they probably won't recover.

[Melayl]

Well, speaking anatomically, *very* theoretically, you could put a tube directly into one of the mainstem bronchi or the lung itself and ventilate that way. Theoretically. It would be a surgical opening, and would likely not able to be done quickly enough to matter.

[Rockphed]

Does this include the M*A*S*H episode? That's the first time I've ever seen it. If I remember right, they used a ball-point pen 'shell' for the air pipe.

My wife thinks that one is well done. It might be the earliest example of a fictional tracheotomy, so they might have done it right because the truth is impressive enough. With MASH I always wonder how much of the medical chatter is stripped from actual MASH operations reports and how much they made up as technobabble. I don't remember my wife complaining about anything medical being completely stupid (except for the occasional "there is no way that person has that disease! His skin should be bright yellow!") when we watched it together, but she could just have been suspending disbelief to enjoy the humor and antics.

[Bohandas]

Back when COVID was first happening I wanted to know why there weren't direct blood oxygenators to bypass destroyed lungs. I found out that there are, about 5 in the whole world. That's because they tend to cut up red blood cells, and destroy lungs can't really be healed so the person likely will die anyway.

Why don't ECMO machines count? There's somewhere on the order of hundreds or thousands of those.

[Ionathus]

If you are having a medical emergency, please call 911. :smallbiggrin:

Reminds me of the classic r/s****yaskscience post:


Does the 5-second rule apply to soup? please hurry.

[Tyndmyr]

Could we say, find a spot between the ribs and stab them them directly into a lung to provide them with air? Or would this collapse their lung?

That creates a sucking chest wound. Humans really, really need their lungs to not be directly exposed to the outer world. Otherwise, every breath sucks air in around the lung, collapsing it. This sort of wound is immediately life threatening, and requires urgent trauma treatment, generally in the form of chest seal(s), followed by immediate transport to a hospital.

It doesn't really fix the airway issue because the air isn't getting into the lung and interchanging properly, it just creates a new urgent problem.

There are cases of people improving airway solutions in real life via the trachea, but...heck, I would not want to do that. I've had basic trauma training, but I am not any kind of a surgeon. I'd probably spend my time trying to clear the airway, including an attempt at the Heimlich maneuver, followed by immediate transport to a hospital. If that doesn't work out, welp. The one time it's come up, I was able to get the airway clear. Hopefully it isn't something that pops up again.

[Anymage]

I wonder, if the normal airway through the throat were to be swelled completely shut, how well a punctured lung could stay inflated. If there's only one hole it might be able to reach equilibrium. Or I might just be picturing things wrong.

Of course if someone were to puncture a lung in this case, the recipient would go from choking to death to drowning in their own blood. Not really an improvement.

[DavidSh]

I wonder, if the normal airway through the throat were to be swelled completely shut, how well a punctured lung could stay inflated. If there's only one hole it might be able to reach equilibrium. Or I might just be picturing things wrong.

Of course if someone were to puncture a lung in this case, the recipient would go from choking to death to drowning in their own blood. Not really an improvement.
The problem with puncturing a hole to the lungs, is that it ends up also puncturing a hole to the chest cavity. The chest cavity being air-tight is the only reason that expanding the rib cage or lowering the diaphragm would cause the lungs to expand. To inflate the lungs, you'd need a source of air above ambient pressure. I'm not a medical doctor, so maybe I'm missing something, but that's what the anatomy and physics suggest to me.

[SouthpawSoldier]

Former military. Sucking chest wounds (tension pneumothorax) is one of the things we were trained to treat in combat buddy aid. As others have said, an opening into the chest cavity sucks in more ways than one; causes ambient air to suck into chest cavity, preventing the lungs from expanding. Ironically, treatment is to add a vent hole into cavity, by way of a 16ga(IIRC) needle and catheter being inserted.

"2nd intercostal space, on mid-clavicular line" was the mantra, IIRC (been out for a decade). Side that's collapsing, we'd feel down and count ribs; in-line with nipple, insert in space above 3rd rib (staying as close to that rib as possible, clipping underside of 2nd rib causes more harm). Press needle in until you feel a "pop", then advance catheter and remove needle. We would practice with balloons under racks of ribs in class.

Very poorly represented in the Clooney movie "3 Kings".

Flight medic senior NCO I once had over me said she'd had a case so bad (catheter eventually plugs, so you have to do another) that she used over a dozen needles in flight with a patient. Patient was alive when they landed and handed them off to the CSH, and that's what matters.

I wasn't a medic; was aviation maintenance. Hung out with a lot of flight medics though, and am fascinated by trauma tech. IF you really want a mind bender, look up a Fast 1 IO on youtube. THere's videos of Marines and their Corpsman practicing with one.

Also cool are the new gauze injectors; when you have a deep penetrating bleed, it takes time and effort to pack the wound with gauze and getting it deep enough to stop the bleed. New tool we have is a large syringe-like device, packed with hemostatic gauze discs; insert into wound to the bleed, depress plunger and withdraw injector, and your wound is packed.

Apologies for tangent, but like I said, military trauma tech and techniques is fascinating to me. Going away present for me from a medic friend was a textbook on new surgical techniques developed from GWOT. Learned of all kinds of interesting stuff; like "dirt tattooing"; when one is too close to a blast, the dust is forcefully embedded into the skin, just like ink with a tattoo. Until the dermal tissue is eventually replaced, the skin will appear blotchy. NEver thought of that, but it's a real thing.

[SouthpawSoldier]

....so I suspect that if you put a hole into a lung from the bottom it will stop working right.


Very much so; current doctrine for quietly...neutralizing sentries is along these lines. Not sure how specific I can be, but the method is designed to do specifically this.