Ansela Jonla (ansela_jonla) wrote in little_details,
Ansela Jonla
ansela_jonla
little_details

Emergency tracheotomy

Setting: modern day Japan, a fictional suburb of Tokyo. My main character, KI, has on his hands a person with a blocked trachea. An ambulance has been called, but there's heavy traffic, and the lead up to the situation (a gas explosion in a cafe) has caused snarl ups in all the surrounding streets. KI is injured as well, but he's still capable of helping other people, is ignoring how hurt he is and is rather stubborn and resistant/used to physical pain.

Some of these questions I couldn't think of how to search for.


1) Is it possible for KI to perform an emergency tracheotomy? He's seen his dad, a doctor, do it before in the family clinic and he has his dad on speaker phone to guide him through it. He has a recently sharpened pair of scissors for cutting cloth (he was taking them to a friend's house as a favour) and a ball point pen. M*A*S*H and Casualty tell me yes, an untrained person can do this with guidance, but I'm not going to rely on them if I can help it.

2) I've found step-by-step techniques for a tracheotomy on Wikipedia, but they're a) written in medicalese (probably a good thing) and b) seem to be for planned procedures, not emergency ones. Which one would be more suitable for an emergency situation and what modifications would need to be made? And could someone please translate the more appropriate one into layman's terms please?

i)Tracheotomy procedure

1. Curvilinear skin incision along relaxed skin tension lines (RSTL) between sternal notch and cricoid cartilage.
2. Midline vertical incision dividing strap muscles.
3. Division of thyroid isthmus between ligatures.
4. Elevation of cricoid with cricoid hook.
5. Placement of tracheal incision. An inferior based flap, or Björk flap, (through second and third tracheal rings) is commonly used. The flap is then sutured to the inferior skin margin. Alternatives include a vertical tracheal incision (pediatric) or excision of an ellipse of anterior tracheal wall.
6. Insert tracheostomy tube (with concomitant withdrawal of endotracheal tube), inflate cuff, secure with tape around neck or stay sutures.
7. Connect ventilator tubing.

It is also possible to make a simple vertical incision between tracheal rings (typically 2nd and 3rd) for the incision. Rear end flaps may produce more intratracheal granulation tissue at the site of the incisions, making it less favorable to some surgeons.

ii) Percutaneous tracheotomy procedure

1. Curvilinear skin incision along relaxed skin tension lines between sternal notch and cricoid cartilage.
2. Midline blunt dissection down to the trachea (optional depending on technique).
3. Insertion of 14-gauge plastic cannula and needle with fluid filled syringe attached into trachea. Aspiration of air confirms correct placement of the tip in the trachea.
4. Removal of needle leaving cannula in place.
5. Insertion of soft tipped guide wire into trachea through cannula.
6. Removal of cannula leaving guide wire in place.
7. Tracheal dilatation is now undertaken - different techniques do this in different ways.
-1. Ciaglia - the sequential insertion and removal of a series (usually 4-5) of increasing larger dilators over the wire into the trachea.
-2. Griggs - insertion of a specially designed pair of guide-wire forceps along the wire into the trachea and then are opened to complete the dilation in one step.
-3. Rhino - insertion of a single large tapered dilator over a plastic guidewire reinforcement.
-4. Frova Percutwist - insertion of a specially designed screw of increasing diameter which rotates to create the dilatation.
8. Insert tracheostomy tube (with concomitant withdrawal of endotracheal tube), inflate cuff, secure with tape around neck or stay sutures.
9. Connect ventilator tubing.


3) Does Japan use air ambulances? If so, what sort of room is needed for them to land? Would they be able to land on a typical shopping street?

4) The police might want to talk to KI later on. Would they take his details at the scene of the explosion, or at the hospital? And would they ask for his home address, or which school he attends, or both?

5) If KI asked at the hospital how the guy he performed the tracheotomy was doing, what sort of information would he get? A plain 'none of your business' or something along the lines of 'he's alive and expected to stay that way' possibly with a 'thanks to you' added onto the end?

That's all I can think of for now.

Search terms: 'tracheotomy' 'Japan air ambulance'
Tags: japan (misc), japan: government: law enforcement, ~medicine (misc), ~medicine: emts/paramedics
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