Life-Saving Emergency Trach Performed in Restaurant

On Sept 23, 2013, a physician performed a life-saving emergency tracheotomy in a restaurant on a patron who was choking on a piece of meat. [link]

While eating dinner at The Mark Restaurant in California, Dr. Royce Johnson, an infectious disease doctor affiliated with UCLA, performed this procedure on Pauline Larwood, a female supervisor and a community college trustee.

Dr. Johnson saved this woman's life using a pocket knife and the hollow cylinder of a pen after a Heimlich maneuver failed to work.

Interestingly, Dr. Thomas Frieden, director of the CDC, who was also present in the restaurant assisted in the care by monitoring Larwood’s pulse during the incident.

Also present in the restaurant witnessing the emergency procedure were:

• Francis Collins, MD (director of NIH)
• Farming and business moguls Lynda and Stewart Resnick
• Rep. Kevin McCarthy, R-Bakersfield
• Assemblywoman Shannon Grove, R-Bakersfield
• State senator Jean Fuller, R-Bakersfield

Although typically surgeons are the individuals trained to perform tracheotomies, bravo to Dr. Johnson who took the initiative in spite of the fact that he probably has never performed one.

I should also add that though media reports state that an emergency tracheostomy was performed, it is probably more likely that an emergency cricothyroidotomy was performed instead which is easier and less "bloody."

Source:
Dramatic dinner rescue involves knife, UCLA doctor and CDC chief. The Bakersfield Californian 9/24/13

CALIF. DOCTOR SAVES CHOKING DINER WITH KNIFE. The Associated Press 9/25/13

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Pitch Perfect's Vocal Cord Nodules

Becca (played by Anna Kendrick)

In the hilarious movie Pitch Perfect, Becca played by the lovely Anna Kendrick participates in an all-female a capella singing group.

During a critical juncture in the movie, one of the soloist Chloe (played by Brittany Snow) reveals she had been living (and singing) with vocal cord nodules.

The movie implies that Chloe's vocal cord nodules were surgically removed and that perhaps days later, she resumed singing, though not recovered to the degree that she's able to sing a solo. See video clip below.

Couple problems with this scenario which does not reflect reality.

Vocal cord nodules develop due to aggressive voice use, especially with poor talking or singing technique. As such, initial treatment is NOT surgical because if the underlying vocal behavior that led to vocal cord nodules is not corrected, they will just come back... and you can add some scarring as well due to the surgery itself (strict voice rest for a prolonged period of time after surgery is a must to minimize scarring complications).

Strict voice rest is also not the best course of action which will help initially, but again, if voice use resumes without the underlying bad vocal behavior being corrected, the nodules will just come back again.

So what is the correct course of action???

1) Aggressive voice therapy... Given Chloe is a singer, working with an experienced singing voice therapist would be of tremendous benefit. She can continue singing, but use of electronic amplification is a must to minimize increased compensatory volume (people tend to increase their voice in loud surroundings) and her singing should be limited to low impact vocalizations (think Silent Night rather than Ode to Joy).

2) Limit talking if at all possible and avoid being in conditions where there's a lot of noise. NEVER abuse the voice (no screaming, yelling, etc) which may be hard to do in a college setting with loud restaurants and bars.

3) If after a prolonged voice therapy and restricted voice use does not resolve the vocal cord nodules, only than would surgical intervention be considered. There are two flavors of surgical intervention: steroid injections to the nodules or excising the vocal cord nodules. Needless to say, there will be a mandatory prolonged period of strict voice rest after surgical intervention.

Read more about treatment here.

Finally, there's another scene where Chloe's voice was able to achieve an unusually low note. That does NOT happen with vocal cord nodules whether before or after surgery. Chloe's pitch range should remain the same. The only situation where her pitch would drop lower than normal would be if her vocal cords became diffusely swollen. Just like a violin string, the thicker the string or in this case vocal cord, the lower the pitch.

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How the Voice Anatomically Reverberates to Produce Speech

Came across this old school animation showing how sound produced in the voicebox reverberates in the upper airway, mouth, and nasal cavity to produce speech that everybody else hears.

To watch what it looks like from the inside, check this video out.

Source:

FFFFound! 5/23/11

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Food Allergy Reaction Video

So the other day, I was watching the movie Hitch starring Will Smith and Eva Mendes during which there is this one scene where Hitch suffers an allergic reaction from a food he ate during a dinner date. Watch video.

It's actually a pretty good depiction of a reaction due to a food allergy.

However, given the throat-clearing suggesting airway swelling which extends to his face, he really should have called 911 as this not uncommonly leads to death if the airway swelling is severe enough to obstruct his breathing. Along with facial and airway swelling, his blood pressure probably dropped and his heart rate increased to point he could have passed out due to insufficient blood flow to the brain. Of course, it was a movie and none of that happened, but don't think for a second that benadryl alone is adequate.

It is a little unusual for an adult to have a previously unknown food allergy with this severe a reaction in someone as old as Hitch, but not impossible.

Treatment was appropriately given with benadrylin the movie, but in reality Hitch additionally should have gone to the ER where epinephrine and steroids also would have been administered followed by several hours of observation.

After recovery, he should ALWAYS carry an epipen with him. He should also probably see an allergist to determine what it was he reacted to so that he can avoid it in the future.

On another note, in the movie, Hitch literally chugs down an entire bottle of liquid benadryl and acts drunk from it. That usually wouldn't have happened... rather, he would have gotten extremely drowsy and fallen asleep fairly quickly. However, in some individuals, it might occur.

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