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Perform a Tracheotomy

If someone is choking and the Heimlich Maneuver doesn't work after 3 successive attempts then a tracheotomy (also called a cricothyroidotomy) may need to performed, by trained medical professionals.


  1. Get someone to look at a clock/watch and call out the minutes (e.g 60 seconds have passed so they shout "1 minute"). Don't forget the rule of 3: 3 minutes without oxygen means brain death!
  2. File:Trachsideview 338.jpg
    A diagram of the throat
    Find the cricothyroid membrane (soft spot on the throat), cut it open in a up/down motion. To find this, find the Adams apple, or larynx. Below this is a second, smaller bump. The valley between the two is the spot to cut.
  3. Spread the tissue (skin etc) apart horizontally
  4. File:Trachfrontview 448.jpg
    Front view of the trachea
    Avoiding blood vessels and glandular tissue puncture the cricothyroid membrane with a knife (very carefully and never transversely) (or you could use a sharp pencil or ball point pen), to enter the trachea. The depth of the puncture should be just sufficient to gain access to the airway. No more than a half-inch or about 1.25 cm.
  5. To maintain the opening to facilitate breathing, a soda straw or tube was placed in the opening. A ball point pen casing is also a good tube. (Elapsed time - three minutes)
  6. Get the victim to hospital immediately where further treatment can be provided.


  • Have someone call emergency services whilst abdominal thrusts and backslaps are being administered. Advise them that the airway is not clearing, and an emergency procedure may be necessary.
  • Reassure the casualty, panicking may make the choking worse.


  • This is an extremely dangerous procedure, that carries a high risk of death to the casualty.
  • Trained medical professionals only should attempt this procedure.
  • Whatever you use for a breathing tube, make sure it is clean! Otherwise, contamination could kill the patient.

Things You'll Need

  • A sharp knife
  • A soda straw or ball point pen

Related Tips and Steps

Sources and Citations