It’s a dramatic plot twist in movies, medical dramas, and even the occasional sitcom: A character is choking or in respiratory distress and standard interventions like the Heimlich maneuver just aren’t cutting it. So a heroic bystander takes things into their own hands and jams a pen into the victim’s throat, much to everyone’s horror. But then, to everyone’s shock and relief, doing so clears the airway, allowing the survivor to breathe until help arrives. But can you really do this?
In theory, yes. When all other methods fail and there is no other option, a makeshift cricothyrotomy may be the only choice. The trouble is that research shows that it usually doesn’t work, and may severely injure or even kill the patient.
Can You Clear the Airway with a Ballpoint Pen?
On the big screen, jamming a pen into the airway creates a makeshift tracheotomy, allowing a patient to breathe when there is an upper airway obstruction. A study of attempts to clear the airways of cadavers with pens demonstrated that, in the real world, this strategy is rarely effective. 
Ten volunteers were tasked with performing a makeshift tracheotomy on cadavers with a pen. Just one was successfully able to penetrate the trachea, and that was after multiple attempts that spanned five minutes—far too long to save most living patients. The trachea was just too thick, and a ballpoint pen didn’t provide for enough force to penetrate it.
The study did find that the tube of a disassembled pen could function as a breathing tube, but that still leaves open the question of how to penetrate the throat.
In the real world, living human beings are even harder to treat than cadavers. They may be scared and uncooperative, and a well-meaning bystander may be reluctant to use sufficient force to poke through the trachea. This means that a ballpoint pen may do little more than damage the respiratory tract and increase everyone’s stress and pain.
Better Tools, Better Care
When a person cannot breathe, the first step is to call 911 while administering emergency care such as CPR or the Heimlich maneuver. Untrained civilians should ask the 911 operator for guidance as they await help from trained EMS professionals. Do not try to use a ballpoint pen to treat the injury. You could severely injure or kill someone who is already struggling to breathe. And even if you are successful, you may introduce dangerous bacteria into the airway, or fail to properly ventilate the patient once the ballpoint pen has been inserted.
What If a Patient Survives a Ballpoint Pen Cricothyrotomy?
First responders may be called upon to respond to patients whose well-meaning friend or family member jams a ballpoint pen into their throat in a desperate attempt to save them. If the attempt fails, the patient may suffer bleeding, bruising, a collapsing trachea, and other serious injuries. Even if the attempt succeeds, the patient may be at risk of infection and traumatic injuries because ballpoint pens tend not to be sterile.
A prompt response is key. Assess the patient, treat the injuries, and transport them for further care. In some cases, you may need to perform an emergency cricothyrotomy beneath the site of the pen penetration.
Preparing for the Worst
Portable emergency suction can help you tend to a wide range of airway emergencies, including those that involve ballpoint pens that have been jammed into fragile throats. Proper suctioning with a machine that delivers consistent, reliable suction saves lives. Moreover, having access to a portable machine ensures that you don’t have to move fragile patients or delay treatment.
For help finding the right machine for your agency, download our free e-book, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.
Editor's Note: This blog was originally posted Feb 2020. It recently has been updated.
