Knife Stories: Emergency Tracheotomy Saves Choking Diner



When someone is choking on food and turning blue, bystanders have to act quickly. The Heimlich maneuver has saved countless lives, but sometimes it just doesn’t work. The choice becomes either tracheotomy or death. Right effing now. And you can’t do a trach without a knife.

When Pauline Larwood started choking during a conference dinner in Bakersfield, CA on September 25th, she picked a good place to do it. She was surrounded by doctors and public health officials at The Mark restaurant, during a conference addressing fungal respiratory infections.

The Heimlich maneuver failed to dislodge the obstruction in her airway, and as she turned blue Dr. Royce Johnson called for a knife. Another doctor handed Johnson his EDC pocketknife, and Johnson quickly performed an emergency tracheotomy on the rapidly-fading Larwood.

Paramedics arrived quickly and took her to the hospital, where she is expected to make a full recovery. Even when surrounded by doctors, it’s a good thing she didn’t choke in New York or New Jersey: by the time someone retrieved a halfway-clean knife from the kitchen she could easily have died or suffered brain damage.

More details at ABC News.


  1. Duncan Idaho says:

    Boy, that’d be a hairy thing to have to do.

  2. Matt in FL says:

    We’ve all seen it in the movies enough times. Would you do it if you had no other choice? If the alternative was pretty much guaranteed death for the person choking?

  3. Mark N. says:

    Actually, it is a fairly easy procedure to do. My father told me how it’s done (he was a surgeon). All you need are a sharp knife and a tube of some sort that is tough enough not to collapse, e.g., a pen casing. You start with a 1 to 1 1/2 inch vertical cut on the central part of the throat. You stretch this cut open to reveal the cartilaginous airway immediately below the skin. The airway is segmented, like a stack of rings, and you make a horizontal incision between two segments large enough to insert the tube–just a poke with the tip of the knife will do the trick, no cutting and hacking. Insert the tube, pointing it down towards the lungs, and release the skin. The skin closes up and you’re done. You can tape the tube in place to secure it.

    1. Rick says:

      Like Father Mulcahey did in a MASH episode.

  4. Mark is completely right, as an EMT-P, I never had to do one. The pen trick is good idea, a drinking straw can collapse, just be sure to make the incision horizontal between the tracheal cartilage three fingers below the adam’s apple. A sharp knife is essential, helps if it’s one-handed opening. Heimlich maneuver, properly done, works most of the time, but after the third try, the patient is out of air, so…

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Knife Stories: Emergency Tracheotomy Saves Choking Diner

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