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Instant Drama, Just Add Tracheotomy

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There seems to be a trend in Hollywood. If a scene is falling flat, add someone choking. But the Heimlich maneuver is boring and overplayed (and honestly just looks ridiculous). Wait, I know! He's not really choking, he's suffocating! And that means, instead of the boring, vaguely erotic reach-around of the Heimlich, our heroes get to slice someone open.

Sometimes this is used to establish that a character has medical training. Sometimes a note of drama is added because the character performing the techniques does not have the training, but usually he's being talked through it by someone who does. Like other Hollywood medical techniques, this often goes smoothly and without complications...even when performed by non-doctors.

On TV and in movies, this procedure commonly consists of stabbing someone in the throat using a ball-point pen with the ink tube removed. In real life, it would be quite difficult to use an empty pen to break through the skin and internal tissues all the way through to the airway, and you can't just jam it in anywhere. People were tested on their ability to do this, and only one out of ten participants was actually able to get the pen in the right spot and deep enough; it should be noted that this also took over five minutes, more than long enough for someone to suffocate. But if you know where to aim, and use a knife to make an incision first, a pen can indeed act as an improvised breathing tube.

Supposedly, this has led to idiots trying this on people who collapse for reasons that have nothing to do with breathing. This is obviously something you do not want to do without the kind of training that results in a medical doctorate degree. A procedure as drastic as a tracheotomy should only be used as a last resort, since it basically boils down to slitting someone's throat, which can obviously make things worse if performed incorrectly. If it's at all possible, you shouldn't do this until after you've called an ambulance and are sure that it's an appropriate measure to take.

It's worth noting that in most cases, what the characters perform is not actually a tracheotomy but a cricothyrotomy.

Not to be confused with an Impromptu Tracheotomy, which is stabbing someone's neck as an attack.


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    Anime & Manga 
  • Seen in JoJo's Bizarre Adventure: Golden Wind: After Narancia's tongue was bitten off by an enemy Stand, he begins to choke, and so Giorno quickly uses the tube of a pen to stab Narancia in his neck so that he can breathe, until Giorno finishes healing his tongue.

    Comic Books 
  • Batman, to the surprise of no one, can perform tracheotomies. He does this at one point in All-Star Batman and Robin to save Hal Jordan's life.
    • In a Detective Comics story arc during The Dark Age of Comic Books, The Riddler got his hands on a demon summoning ritual that had been performed by Gotham's founders, which called for the sacrifice of a "human bat," who was prepared for the sacrifice through a series of gruesome and bizarre ordeals, among them slitting the throat of a newborn baby. So he kidnapped a baby, shoved a ping pong ball in its mouth and left it for Batman to find as he made his escape.
  • In The Boys, Wee Hughie gets trained to do this by The Leader Butcher and ends up having to put it to use when Extreme Omnivore Black Hole suddenly suffers Power Incontinence and chokes on a plastic spoon.
  • In an issue of Deadpool (or possibly Agent X), Death Trap creator Arcade does this, much to everyone's surprise — not just that he knew how, but that he'd bother.
  • Played for more drama than usual in one Diabolik story, as doctor Flavio Todd had to practice one on his daughter when she started suffucating for an allergic reaction to a medicine given to her by another doctor to deal with the aftermath of an abortion... But they're on a car and he's so shaken by what's happening to her and discovering she just had an abortion that he crashes, with her dying and him forgetting everything except that he sliced his own daughter's throat, pushing the doctor to demand potentially dangerous cures so he could remember and properly pay for what he thinks is his daughter's murder. When he remembers (and the reader finds out why he had sliced his daughter's throat), however, he decides to track down the man who prescribed to his daughter a medicine without checking her for allergy so he can murder him.
  • In Knights of the Old Republic Slyssk needs to have one after being force choked. Justified, both since Slyssk is a Trandoshan with regenerative abilities that allowed him to survive, and the Mandalorian who performed the procedure is actually a doctor in disguise. Rohlan admits that he likely would have died if it wasn't for his Trandoshan toughness.
  • The Mighty Thor: Thor actually does this during Dan Jurgens' run, when he's masquerading as Jake Olson, showing that he retains the medical knowledge of Doctor Donald Blake.
  • Sensation Comics: Dr. Pat has to perform an emergency tracheotomy on a collapsed young mine worker who fell down a pit in the mine, which is where she got stuck starting his treatment.

    Film — Live Action 
  • In Anaconda, the team leader puts on some scuba gear and gets in the water to fix the motor, but is stung by a poisonous wasp which blocks his throat. He's quickly hoisted back on board and saved by Sarone, who performs an impromptu tracheotomy. It's later revealed that he staged the entire incident to manipulate the crew to follow him to the Anaconda's feeding grounds and serve as bait.
  • In Darkness, Anna Paquin is instructed to do this in order to save her father's life. Subverted because this is done in an attempt to make her unknowingly kill her father.
  • "Idiots trying this when they don't know what they're doing" is used for a fantastic subversion of Chekhov's Skill in The Heat. Just as Ashburn is getting chewed out by her partner for always thinking she knows better than everyone else, a guy next to them in the diner starts choking. Ashburn, who had half-watched a medical programme about tracheotomies earlier in the film, springs into action... succeeding only in nicking an artery and spraying the diner with blood by the time the ambulance arrives.
  • David performed one in Just Like Heaven despite having no medical training. Elizabeth's quasi-ghost talks him through it.
  • The Last Rites of Ransom Pride: When bandits break into the church where they are sleeping, Champ catches a brutal blow to the throat from a rifle butt. After the bandits are killed, Sergeant performs an emergency tracheotomy on Champ; explaining to Juliette that Champ's windpipe is filling with blood and if he doesn't relive the pressure, Champ will choke before they can get him to medical attention.
  • One character in The Legacy starts suddenly choking from a chicken bone during dinner. The Heimlich maneuver doesn't do anything, so the nurse of the house's owner proceeds to try to save his life with a tracheotomy operation.
  • In Mad Max: Fury Road, Max saves Furiosa from suffocation by puncturing one of her lungs in order to let air in.
  • In Nancy Drew, the titular character performs this on a classmate who had allergic reaction at a party (the classmate, according to a friend, was "insanely" allergic to peanuts and had made out with a boy who had eaten a peanut butter cookie), much to the horror of the other partygoers—Nancy also warns her guests beforehand to not try anything she was about to do on their own unless they've had advanced emergency medical training. The movie plays with the idea that Nancy is always Crazy-Prepared for emergencies—and thankfully, she does manage to save her classmate.
  • In Nurse Betty, Betty successfully performs a tracheotomy, knowing how to do so from obsessively watching a medical soap opera.
  • In the German film The Princess and the Warrior (2000), this is how the protagonists meet— Bodo, after inadvertently causing Sissi to be hit by a truck, performs an emergency tracheotomy note  on her and disappears before Sissi can learn his name. As a result, she becomes obsessed with tracking him down.
  • Saw V has Strahm get his head locked inside a box that starts filling up with water. He survives by giving himself a tracheotomy with a pen.
  • In The Sweet Hereafter, a character narrates in flashback how he was prepared to do this to his infant daughter as she went into anaphylactic shock after being bitten by a spider. Averted because in the end, he got her to the hospital before this was necessary, and subverted in the sense that it was clear this was to be a last resort and his chances of performing it successfully were minimal.
  • Lane performs one in Switchback to establish his character used to be in med school.
  • In Three Kings, Mark Wahlberg's character suffers from pneumothorax (a collapsed lung) so his comrades have to puncture his lung to give him tension release. Watch it here (gore alert).

  • This trope is Lampshaded in Choke by Chuck Palahniuk. The protagonist frequently runs a con where he deliberately chokes on food to get strangers to perform the Heimlich on him; he is terrified that one day he'll encounter an idiot thinking of this trope coming after him with a steak knife and a ballpoint pen tube.
  • In Codex Alera, this is performed on Ehren when his throat is crushed by an earthcrafter's chokehold. Ambassador Varg quickly makes an incision with one of his razor-sharp claws and sticks a hollow writing quill into the cut to breathe with. This is stated to be only a temporary measure and that without proper care and cleansing of the wound, Ehren would die anyway.
  • The Dark Hours: After realizing that her punch crushed Bonner's windpipe, Renee Ballard calls her friend Garrett the EMT in a blind panic and has him guide her through an emergency tracheotomy, which is done realistically, with Renee having to use a knife to make the incision. Then, after Bonner regains consciousness and realizes that it's all over for him, he rips the plastic tube she used out of his throat, and dies.
  • In Hawk, an assassin punches Vlad in the throat and collapses his windpipe, forcing him to perform this procedure on himself with the knife he'd just thrust into his attacker.
  • In Expendable, of The League of Peoples Verse, two explorers start asphyxiating in a strange atmosphere. One gets the idea of a tracheotomy in her spinning head and tries to perform it on her partner, untrained, with improvised tools, while blacking out herself. She wakes up next to the corpse and discovers that the effect is just a momentary symptom of acclimation.
  • In one Sweet Valley High book, a man uses this procedure to save the life of another person choking at a coffee shop. By doing so, he reveals that he is a doctor, and another patron of the coffee shop recognizes him as the doctor who had recently testified against a mob boss and been forced to go into witness protection. Naturally, the guy who recognized the doctor shouts out his identity to everyone in the coffee shop so that they can all acknowledge the hero by his proper name.
  • An emergency tracheotomy performed by a non-professional is a key plot event in Three Days to Never by Tim Powers. It's not a neat Hollywood tracheotomy, though, and has serious repercussions.
  • In Twig, Sylvester gets an amateur one from Candida after he has his throat crushed by the Baron Richmond, and is, bizarrely, able to speak in a whisper afterwards-he explains that he's regularly on the receiving end of an Impromptu Tracheotomy from any number of sources (guard dogs, knives, burrower worms...) and therefore his doctors surgically altered his throat so he could continue to try to talk his way out of it with a slit throat.
  • In Worm, Tattletale performs one on herself in Interlude 23 after Perdition crushes her windpipe.

    Live-Action TV 
  • American Idol had some tracheotomy-related drama, though not on-stage. Season 4 contestant Anthony Fedorov had had a tracheotomy when he was a child and had been told there was a chance he wouldn't even be able to speak again. And he not only spoke, he sang. Well enough to get 4th place.
  • In an episode of Beachcombers, Nick had to perform a tracheotomy on someone who had collapsed due to an allergic reaction to seafood, causing his throat to swell.
  • Call the Midwife: Dr. Turner has to perform an emergency tracheotomy at home for a pregnant woman who's suffocating from severe diphtheria. Justified in that this is a real treatment for extreme cases, but Played for Drama in that she doesn't speak English and he's still recovering his confidence after misdiagnosing a baby.
  • Seen in at least one episode of Casualty when one cast member found himself in the middle of nowhere with a wrecked car whose driver hadn't been wearing a seatbelt and broken her larynx on the steering wheel or something.
  • CSI:
    • In an episode, one part of an incredibly convoluted Rasputinian Death involved a guy whose throat had swollen shut effectively had an emergency tracheotomy by being shot in the throat with a crossbow.
    • In "Dead of the Class", the 'murder' turns out to be an emergency tracheotomy gone horribly wrong.
  • In an episode of CSI: Miami, the coroner had to do this to some random guy on the street.
  • Dr. Quinn, Medicine Woman: Dr. Mike and her daughter Colleen would perform quite a few of them.
  • Justified on Emergency!, which, like the ER example, had a trained doctor doing one in the emergency room on a guy whose trachea had collapsed. He had to have one to keep him alive until surgery could fix it.
  • In episode 3 of Emergency Couple, Chang-min and Jin Hee have to do this to a patient with esophageal cancer after they get stuck in an elevator.
  • ER:
    • Several dozen times at least. Justified, because they take place in a fully-equipped emergency room, on people who are in imminent danger of dying, by trained trauma specialists.
    • Subverted too. When Carol attempts a tracheotomy using a penknife, a juice straw, and duct tape on a gunshot victim in a convenience store (because she's being held hostage by a pair of robbers at the time), the patient doesn't make it.
  • Attempted in an episode of Fringe, due to a biological weapon that sealed bodily orifices. The skin then grew over the trache tube.
  • Also somewhat justified on Grey's Anatomy, as it's done by the certified Military Trauma Surgeon Owen Hunt, albeit done in an unconventional fashion with a ballpoint pen.
  • Seen about once every other episode on House.
  • Jake had to do this to a little girl in the first episode of Jericho (2006).
  • Judging Amy: Kyle does this in episode 5x05 after witnessing a bar fight.
  • Played for laughs on Leverage in "The Rashomon Job." Everyone except Hardison thinks he's having an allergic reaction and requires a tracheotomy, with the knife being handed to Eliot getting progressively larger each time the story is retold. Subverted in that Hardison does not actually want or need said tracheotomy, and has to con his way out of the procedure.
  • Parodied in the Lost pilot. Jack gives Rose CPR, and Boone suggests giving her a tracheotomy, and volunteers to ask passengers for pens. Jack agrees to get rid of him, then successfully revives Rose on her own. Later, Boone approaches him, hands full of pens, saying, "I wasn't sure which type works best."
  • Malcolm in the Middle parodied this by having a grade-school student who "saw this on TV" attempt to perform a tracheotomy on someone who quite clearly did not need it. With a ball-point pen.
  • M*A*S*H:
    • Once Father Mulcahy had to do this, with Hawkeye talking him through it via radio. For extra drama, Mulcahy is a priest, not a surgeon, they had to use an eye-dropper with the bulb snipped off for the tube, and Mulcahy was being shelled while it happened.
    • Hawkeye himself had to perform one on a North Korean soldier, after been captured to provide medical aid. In the field, without English-speaking assistants (enough yelling and gestures got the mobile soldier to hold his buddy down) or much equipment (first aid kit and a pen cap) and seemed to have been something of last resort/only thing he could try type situation. Realistically, it did not turn out well.
  • Monday Mornings: Young Dr. Michelle Robidaux performed one particularly difficult tracheotomy in the series finale. Her patient was practically dead and everybody gave up on him, but she managed to save him at the last moment. Her not asking for help earned her the spot of shame at the M&M meeting.
  • In an episode of Murdoch Mysteries, a hanging execution was sabotaged by shortening the rope to avoid breaking the neck and applying a tracheotomy under the condemned's clothes.
  • Parodied and subverted in My Name Is Earl, where Randy has trouble breathing due to some tape being put on his mouth. Joy gets out a pen and stabs…the tape, giving him a breathing tube.

  • In an episode of NCIS, a former Navy medical corpsman happens upon a recent car accident and attempts a tracheotomy on one of the victims. Despite being fully trained and capable, her patient dies and she is prosecuted for practicing medicine without a license. Much drama is wrung from the fact that she'd have a civilian EMT certification, providing legal protection in such a situation, had she been discharged from the Army or Air Force instead. In the end, Gibbs pulls some strings to cut a plea deal for community service.
  • New Amsterdam (2018): Georgia has to do this to Max when he passes out on a dock beside a lake. Sharpe tells her what to do over the phone.
  • In Night and Day, Ryan Harper has to perform one of these on Josh Alexander when a birthday cake triggers a nut allergy. As a result, Josh decides he owes Ryan his life and voluntarily becomes his slave.
  • Rizzoli & Isles: Maura performs an emergency tracheotomy on someone who is delivered to the morgue not quite dead in "This Is How A Heart Breaks".
  • Scrubs had Turk save someone's life this way. Dr. Cox tries to provoke him by taking the credit for it.
  • Wallander: The episode "The Man Who Smiled" of the BBC version has Kurt Wallander performing this with a kitchen knife and a pen.
  • A variant in WandaVision. The Harts are visiting over for dinner when suddenly Mr. Hart chokes on his food, which prompts Vision to use his intangibility powers to reach into his throat and get the food out.
  • The first episode of Wonderfalls involved this, after a character has an allergic reaction to peanuts. Since neither other person in the car actually knew how to do it properly, it led to the hilarious "We've got a stabbing victim!" line.
  • This happens in an episode of Xena: Warrior Princess. A bounty hunter after Xena gets a dagger through his neck, courtesy of another bounty hunter. Xena cuts him a new breathing hole out of mercy. He still dies, though (though because of Applied Phlebotinum, not anything Xena did)
  • The X-Files: In the episode "Agua Mala", Scully performs one on a police officer after he is attacked by the Monster of the Week.

  • Parodied in a Full Frontal Nerdity strip where the writer lists cliches he hates in movies and illustrates it by having the characters perform it on someone who has stubbed their toe.
  • An important character in The Meek Phe, Luca's wife is poisoned and a tracheotomy is used to attempt to save her life. It's not pretty. And then things go to hell.

    Western Animation 
  • Defied in Archer, where he tries to drunkenly perform one on Pam with a switchblade when she's going into anaphylactic shock. Even though she's dumb enough to gorge herself on soy-based fake seafood she knows she's violently allergic to, Pam is smart enough to know an unnecessary tracheotomy will just make things worse, so she fights off Archer's Unwanted Assistance long enough to grunt out the word "Epi-Pen," which is what she actually needed.
  • In G.I. Joe: Renegades, a tracheotomy is attempted twice in one episode. Scarlett has an allergic reaction to some poison, causing her throat to swell up, and Snake-Eyes prepares to puncture her throat before Tunnel Rat manages to scrounge up some antidote. Earlier, in Snake-Eyes' backstory, his Master is similarly poisoned, and Snake-Eyes tries to do the same with a sharpened bamboo shoot, but he's interrupted and simply makes the master's nephew Storm Shadow think Snake-Eyes was the murderer.

    Real Life 
  • Truth in Television: One of the reasons Formula One fans remember the 1995 Australian Grand Prix is what happened during practice: Mika Hakkinen crashed very badly, and the medics had to perform a cricothyrotomy on the side of the track just to keep him alive.
    • Also happened in 1994 at the San Marino Grand Prix to Ayrton Senna. The outcome was far less happy.
      • Conspiracy theories suggest FIA ordered paramedics to do it so he could be artificially "kept alive" so they could resume the race. In Italy, it's illegal to finish a race where a driver is killed.
  • Drama aside, Elizabeth Taylor needed a tracheotomy during a bout of pneumonia in 1960, and Catherine Zeta-Jones needed one as a child, resulting in her distinctive scar.
  • Stephen Hawking got pneumonia visiting CERN in 1985, and his wife Jane even asked about cutting life support, but instead a tracheotomy was employed to save him, at the cost of his voice. After one year using "choosing letters on a spelling card with his eyebrows" to communicate, Hawking got his famous Robo Speak machine.
  • This medical paper warns people not to attempt this at home with just any ball-point pen: only a few of them actually work.
  • One story from the Darwin Awards features a man who, in a bout of Alcohol-Induced Stupidity, stuck a rattlesnake into his mouth, with the obvious outcome. His tongue was so badly swollen that doctors had to perform a tracheotomy. (He survived.)