Mountain Biker's Life Saved After Passing Doctor Performs Trailside Tracheotomy

Oct 1, 2021
by James Smurthwaite  
Photo: Van Guilder

A mountain biker in Minnesota was given life-saving surgery on the side of the trail by a passing ER surgeon, the Washington Post reports.

Todd Van Guilder was riding on the Cuyuna Lakes Trails on September 12 when he crashed and fell on his stomach and chest. When he sat up he was struggling to see and starting to have difficulty breathing. His riding buddy called 911 and before long 6 emergency service workers were on the scene.

After assessing his condition, paramedics decided he would need oxygen and a police officer volunteered to jog three-quarters of a mile back down the trail to the parking lot to grab a tank. Thankfully, on the way down, the officer passed 38-year-old Jesse Coenen, an emergency room doctor from Wisconsin, who was visiting the trails.

Coenen uses mountain biking to wind down from 13 hour shifts in the ER, but sprung into action when he heard what had happened. He and his riding friend rode down to the parking lot to fetch the oxygen and then rode it back to where Van Guilder was lying unconscious.

The Cuyuna Lakes trails where the accident took place

“I quickly realized this was a serious situation,” said Coenen, “They told me that the guy had fallen off his bike and that a helicopter had been dispatched. They were helping him to breathe, but it was necessary to make sure that his breathing was adequate.”

The first option for Coenen and the medics was to try intubating Van Guilder. Intubating is a process where a tube is passed down through the throat so they could help him breathe with a manual resuscitator. Coenen made several attempts to insert the tube but was unable to as he couldn't see the windpipe, leaving him with just one option, a tracheotomy.

bigquotesI figured he might have anywhere between 10 and 20 minutes before he died. That’s when I decided to enter the windpipe through the neck.”Jesse Coenen

The tracheotomy is usually done under general anaesthetic and bypasses the throat to allow a tube to enter directly into the windpipe via incisions in the neck. Coenen said, "His oxygen level had started to drop, and I was getting concerned, I figured he might have anywhere between 10 and 20 minutes before he died. That’s when I decided to enter the windpipe through the neck.”

Thankfully the paramedics had a scalpel and gloves but Coenen now had to carry out the surgery on a live human for the first time. "Cutting somebody’s neck like this is a rare procedure, even for a doctor,” he said. “I’d done it before on mannequins and a pig cadaver, and I knew by heart how to do it. I’d just hoped I would never have to." Coenen's first incision wasn't wide enough to insert the tube so he had to cut it again at which point the tube was inserted allowing a paramedic to manually deliver oxygen, saving Van Guilder's life.

Even despite the surgery, Coenen said that he wasn't sure Van Guilder would survive but soon his oxygen levels were rising and he could be transported down the trail then taken to hospital in a helicopter. Van Guilder was treated for a traumatic brain injury but escaped with no broken bones. After 10 days of being monitored by doctors, he was released from hospital with minor injuries and on a soft food diet. He told the Washington Post, "I talked to him [Coenen] on a Zoom call and told him how grateful I am that he happened to be there that day at that precise moment. I’m obviously extremely fortunate. What are the odds?”

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174 Comments

  • 318 1
 Impressively done, and super glad that it worked out.

Also, I now feel the sudden need to diversify the careers of my riding buddies. Any ER doctors want to start riding with a group of intermediate dadbod riders whose idea of fun includes "making sure we do all the features on a blue skill park trail"?
  • 15 0
 I had this once happen to me when I broke a bone on the trail. he was a really nice guy and I never even got his name.
  • 19 0
 For a while I was riding with two ER DR students and a General Med student. I never felt safer while in rides and hitting big Whistler stuff for the first time. Haha
  • 345 1
 MTB fantastic four:

ER doctor
UCI WC mechanic
Soccer mom with the good snacks
Craft beer enthusiast w/yeti cooler full of beer post ride
  • 35 2
 @conoat: and the friend who is a bbq pit master and brings that grill in the truck anywhere he goes
  • 54 2
 @conoat: don't forget a lawyer for when you really case a jump
  • 81 0
 @conoat:
That is the dream.

Instead this is what I've got.

Software Engineer whose tagline is "Its ok, you can do another lap without me"
Construction Manager that promises he'll show up, but never does
Automotive Marketing guy who's still too broke from getting his MBA to have a decent bike (especially now), so rides everything on a 8 year old XC hardtail with one functioning brake.
  • 6 0
 @conoat: Accountant to get you a tax credit / refund that offsets the cost of a new bike.
  • 10 0
 I ride with a paramedic buddy of mine a lot. Wanna take a guess which of us has needed medical attention more? LOL.
  • 30 0
 @conoat: i actually met my dentist through strava as he was following my boyfriend. when i was first learning to ride i took a good scorpion in a full face and still ended up with a broken tooth. he came in on his day off and opened his office to get my front tooth fixed before i had to go back to work on monday. still friends to this day, also still his patient. we mostly chat about biking when i come in for a cleaning LOL. also, he gets new bikes all the time but right now his "dentist bike" is the new norco range
  • 28 0
 My riding group regularly contains an anesthesiologist, cardiologist, and/or gastroenterologist. I guess I can consider myself in good company. I work in state government, so I provide no benefit to the group...except my ability to say inappropriate things at the drop of a hat.
  • 10 0
 Ride with a military medic.
  • 1 0
 @Connerv6: well at least they can walk you through what needs to be done
  • 2 0
 @Offrhodes: I live in close proximity to a pretty well known medical school, in a mid-size city, so when I used to ride road a lot there tended to be oodles of various types of medical professionals in the peloton. With the exception of a PT buddy I used to ride with though, none of them rode dirt. In fact, as a former SAR guy with a lapsed WFR cert. *I'm* probably the most qualified in the few group rides I do to to provide emergency treatment of any kind. Treatment which falls faaaaarrrr short of slicing open someone's throat.
  • 12 2
 @ocnlogan: Since we're sharing, here's MY Squad:

...
...
...
...Friend who talks shit about my old bike every outing but refuses to join me on anything harder than a flat gravel path, with a Giant Trance she got 50% off through flirting.
  • 7 0
 @conoat: Soccer mom? No one beats a firefighter when it comes to food. Pretty sure it's a vocation prerequisite.
  • 6 0
 @ocnlogan: Salesman who whines about how he needs to get in shape but never has time to go ride.
  • 21 0
 I'm a hospice nurse. If that would help.
  • 10 0
 @ridesmoothbro: Only for really bad crashes
  • 6 0
 @ridesmoothbro: You are a saint my man... Perhaps bring some morphine.
  • 22 0
 @ocnlogan: You guys have riding buddies?
  • 6 0
 @atrokz: I misjudged a drop once (I've misjudged many a drop in my time, but...) and ended up with a AC tear. A USMC medic was riding just behind me. He offered to "re-set" my separated shoulder that he assumed was dislocated. I asked him how he knew it was dislocated, he said "I don't, but I can try to set it anyway" I politely declined his offer to re-set my torn shoulder. Thinking back, I can't imagine how badly it would have hurt if I had allowed him yank aggressively on my perfectly located but badly torn shoulder. That being said, if my crash had resulted in a sucking chest wound, I think I would have been in excellent hands.
  • 2 0
 @crys-vb: Broken tooth with a full face? That crash must have been something special!
  • 2 0
 @dirtmcleod:

Kind of.

More like I started mountain biking, loved it, and then coerced/convinced/tricked my existing friends into trying out riding and buying bikes.

And somehow, its "stuck" as a hobby/interest for all of them so far.
  • 6 0
 @conoat: noted, and I'd add:

Dude Bro with the Taco for shuttling
  • 2 0
 @ridesmoothbro: "Gee Atherton entered the chat"
  • 1 0
 @conoat: you just described my riding group.
  • 1 0
 @conoat:
Surprisingly not hard to get 3 out of those 4 pretty regularly living on the North shore, haha
  • 2 0
 Comment of the day!
  • 2 0
 @Connerv6: I am this guy
  • 5 0
 Anyone can get Wilderness and Remote First Aid training so you can help your fellow riders or give instructions to the wide-eyed people looking down at you saying "you're not alright bro" .
  • 3 0
 I’ll admit it, on those rare occasions my sister visits and we ride, I am a bit more reckless. I figure since she has been an ER doctor for more than 20 years, she can probably handle anything I hurt.
  • 1 0
 @conoat: nailed it
  • 3 0
 @conoat: my riding group used to contain a bunch of ER nurses and a few ER doctors.

Crashed and broke my kneecap. Result "Hey lets take the long way back that includes a 45 minute climb and super technical descent even though we could exit right now and be back at the car in 5 minutes"

Other hits include "I know you just shattered your collarbone, but we are going to stop at the gift shop and grab some t shirts before we drop you off at the airport curb so we can keep riding for the rest of the week"

And "I know you just separated your shoulder, but can you drive me to the top so I can do the 45 minute descent while you wait in the car and then drive home?"
  • 2 0
 ICU nurse here, also have a truck for shuttling.
  • 3 0
 At least in my group they could build the helicopter to get me out. I doubt they could fly it though Frown
  • 1 0
 My usual company at the moment is a guy who almost matches my speed after 1.5 years of riding, I've been on a bike for almost 10 years now...the same guy got himself a concussion and broken cheek bone. A few minutes later a nurse came by walking in the woods and got him a ride to hospital. I guess he's one lucky bastard.
  • 1 1
 @conoat: *good snacks/curves
  • 4 0
 @ocnlogan: I laughed so hard reading this I almost choked on my cheerios this morning! Priceless. You’re not alone, we all have a few. This past Thursday, guy I work with came up in convo and wanted to go for a Ride with me. Ok sure. Figured I would take him to a sort of popular not too insane spot for an 8 mile loop… shows up in jeans and hiking boots, 1988 Cannondale delta hard tail with seat angled up at about 30 degrees…15psi In Tires, stuck in smallest cog in back, drivetrain was clearly coated in 10w30…etc.. I fixed his seat, tires etc in the lot.. he manned up and did the ride. Not flying but made it. Oddly wasn’t at work yesterday.
  • 1 0
 @ridesmoothbro: Go to the light….
  • 1 0
 @conoat: you forgot pothead friend with weed drinks and gummies
  • 1 0
 @joshtuzyk: wait, you don’t carry weed with you everywhere you go?
  • 1 0
 @salespunk: These people don’t sound like friends.
  • 2 0
 @rrolly: Sleep 'til you're hungry, eat 'til you're tired.
  • 2 0
 @ocnlogan: You only need one brake
  • 1 0
 @BikesBoatsNJeeps: they are more trained than paramedics for this very procedure which here is now banned for paramedics. So there's that too.
  • 90 8
 Breathtaking story!
  • 10 2
 I want to reply with a pun, I really do. Yours was so on point, and yet, the nature of the topic.........I just can't. It's amazing how people can be awesome.
  • 9 1
 @truenorthsimon: err, you blew it?

And that's how you do a non offensive blewit joke btw, if anyone wants to take note. You know who you are.
  • 8 1
 Glad he was riding the surgeons bike of choice, cannondale scalpel
  • 1 0
 Trach and ride
  • 52 0
 See, this right here is why we, as a community, make fun of dentists who ride nice bike rather than make fun of doctors who ride equally nice bikes. Well done Coenen! Best of luck with the recovery Van Guilder.
  • 4 0
 I was just thinking this lmao
  • 19 0
 And of course he rides a Yeti:

www.washingtonpost.com/wp-apps/imrs.php?src=arc-anglerfish-washpost-prod-washpost.s3.amazonaws.com/public/37SWB3I4P5C7BIXFSEHRODGONU.jpg&w=916

More seriously, I agree completely with the sentiment - excellent work Dr. Coenen.
  • 54 0
 You wont be laughing when you need an abscessed tooth and some guy on a Yeti turq with axs pulls your tooth with his quick link pliers
  • 3 0
 @actonca: Forget his choice in bikes - look at his choice of helmet technology! Looks like Bontrager Rally WaveCel.
  • 52 0
 First thing the nurse in the hospital said to him when he came to: “you good?”
  • 3 0
 Out of all these great comments here this actually cracked me up.
  • 29 0
 F**K, my heart as racing just reading this. We are lucky so many doctors love this sport (insert joke about dentist bikes).

Wife crashed a few years back while riding solo and tore open her arm pretty good...she had no supplies with her and didn't know the quickest direction out. First rider to pass was an emergency room doctor who had a full med kit in his camelbak. He was able to stop the bleeding, wrap the arm and assist her to the closest trail entrance where I was able to pull up in the car and take her to the emergency room.
  • 4 0
 It seems by some miracle there's always a first responder lurking nearby to save the day. The only time I've found myself in the midst of a medical emergency, a first aid instructor happened upon the scene within a minute or so on a side-by-side. In this case it was a vehicle rollover at an autocross race, an exceedingly rare occurrence at these types of events, caused by a few compounding factors. The driver's arm came out of the car as it rolled 1.5 times and was crushed pretty badly, causing road rash to the bone on one side of the arm and the forearm to peel away from the other. After we extracting the driver from the upside down car I was looking at the biggest pool of blood I've ever seen instinctively whipped off my belt and used it as a tourniquet. A minute later the first aid instructor took charge and explained to me tourniquets aren't used anymore. Fortunately the driver made a full recovery and regained full use of the arm.
  • 1 0
 @maxxx: I'm curious, what do they do instead of a tourniquet now if someone is possibly bleeding out?
  • 1 0
 @sino428: I'm just as curious as you! Google says prolonged tourniquet use can cause further damage, but faced with the same scenario, I would still do the same and prioritize limiting the bleeding until paramedics arrive.

I supposed there's the possibility that the first aid instructor was just wrong, or didn't fully explain.
  • 1 0
 @maxxx: huh, weird, I just took a weekend long outdoor first aid course and we were definitely taught to use a tourniquet. Apparently neck braces aren't used any more though!
  • 1 0
 @maxxx: Yea I know that they should be used only as a last resort and using one can cause further damage if not done correctly. Maybe that is what he meant.
  • 2 0
 @sino428: First aid instructor was behind the current level of care. Tourniquets are fine if direct pressure doesn't work.
  • 3 0
 @sino428: like some others have said tourniquets are definitely recommended in major bleeding. Guidelines have changed recently and now they are actually the first choice for controlling some types of major bleeding. It's possible what the instructor was talking about is improvised tourniquets made from your belt, those are not recommended. Check out www.stopthebleed.org/resources-poster-booklet

This is how you improvise a tourniquet.
www.crisis-medicine.com/not-tourniquet-without-windlass
  • 1 0
 @sino428: tourniquet is backup if direct pressure doesn’t do the trick. Bleeding out doesn’t end well.
  • 1 0
 Tourniquets are most definitely still in use. It could be that the placement of the belt tourniquet wasn’t good, or that this was not an injury that required one, and perhaps he was trying to be polite? @maxxx:
  • 22 0
 "Seen on the Trail"....Stan's portable tracheotomy kit. And tomorrow there will be a big release. Pinkbike, we know how you work.
  • 14 0
 Can tire plug bacon strips be used to stop arterial hemorrhage? Anyone know?
  • 5 0
 @kcy4130: not sure, the sealant in my bloodstream's been holding up well so far.
  • 5 0
 I try to keep my BAC up so that you can just hit a cut with a flint spark and it will auto-cauterize.
  • 28 6
 They hatched a great plan: "The first option for Coenen and the medics was to try incubating Van Guilder."
  • 21 1
 How else are they gonna keep the eggs warm?
  • 3 0
 LOL
  • 19 1
 @James Smurthwaite. Swap in that incubating on paragraph 6 sentence one for intubating and you are golden.
  • 23 1
 Thanks, good job I'm a writer not a doctor!
  • 4 0
 @jamessmurthwaite: If I was a doctor, there would be a whole lotta surgeries started, not a lot finished.
  • 2 0
 @jamessmurthwaite: “Dammit Jim, I’m a doctor not a bricklayer!”
  • 14 0
 I was riding my dirt bike in the middle of the desert in California, and had a really bad crash that broke my arm and my pelvis. We were hours away from help, with no one else around. Thankfully, an off duty paramedic was out riding too, and just happened to cross paths with my group. He happened to have GPS, and called Flight for Life with our coordinates. He was able to get me stabilized, and helped manage my needs as I went into shock while we waited for the helicopter. I dont know if he saved my life, but he saved me potentially hours of agony in the middle of the desert. I have no idea who he was, but I am very thankful he was out there..
  • 3 0
 Wow - awesome
  • 17 1
 God bless passing surgeons on their Yetis!
  • 23 0
 Doctors on Yetis, but true surgeons ride Scalpels.
  • 15 0
 @chaoscacca: A passing Druid might have some Pagan herbal Remedy
  • 11 0
 I don't know about misplaced emphasis "treated for TBI, but escaped with no broken bones". Break my bones any day, save the brain!
  • 9 0
 I had a crash in December that could have ended my life. I went head first in to a tree after a gap jump gone wrong. It was immediate lights out, and to this day I remember nothing about the crash. I sustained a TBI, had two brain bleeds, and a myriad of other issues. Lucky for me I was riding with a retired Army Nurse, as well as a currently practicing nurse that morning. I think they played a major role in saving my life. God Bless our health care workers.
  • 10 0
 Well done, Doc! I just realized my riding buddy is a tissue and organ recovery physician, yikes, hope he doesn't decide to harvest me instead of rescue me lol.
  • 6 0
 See, and here I expected 1/2 the comments to be about how YOU could have intubated him without the scalpel. There's still hope for the comment section.....still hope. Well done Doc, I'm no doctor, but if I was I would have been terrified for such a procedure never having done it on a human, especially in such a random scenario on the trail. People get jealous of doctors and their homes, cars, boats, etc. but there's a reason they make that $$.
  • 1 0
 I carry an extra valve stem just in case I need to trach someone. If you have to use a scalpel you’re doing it wrong
  • 8 0
 This would have been a cricothyrotomy not a trach but good stuff
  • 7 0
 Not all heros wear capes.
  • 1 1
 No of them do…
  • 1 0
 None of them do
  • 6 0
 holy smokes that sounds gnarly
  • 4 0
 Well, this will make me slow down on tomorrow morning's ride... until I feel it and then stupidity will resume.
  • 5 0
 This deserves a bike from some manufacturer with a huge thank you
  • 3 0
 while a cool sentiment, an ER doc probably doesn't need a free bike (one would hope anyways)
  • 8 0
 @hamncheez: a 38 year old ER might need it. Med school loans are no joke
  • 2 0
 @ndwight: good point.

My ER doc former college roommate had the Army pay for it, so he had minimal loans. Not the best path for everyone tho
  • 3 0
 Stories like this make me so happy. In my eyes, Medical Professionals are really super heroes, quietly going about their daily routines, and then act when called upon.
  • 2 0
 The Washington Post article is paywalled. Does anyone know if the crash resulted in a blockage of the esophagus, or was the tracheotomy just to facilitate getting oxygen to his lungs in a pinch?
  • 5 0
 "Hows does the Doctor sit down with balls that big?!?"......
  • 2 0
 My two best riding buddies were an ER doc and an IT guy. The ER doc moved on to another sport, but if I ever run into a router or IP address issue, my other guy has me covered. Smile
  • 1 0
 A friend of mine rides with 2 doctors and a paramedic. They were mountain biking on a local trail near Leicester (UK) and he went over the handle bars head first into the ground. His riding friends saw the accident and heard the crack. They quickly stabilised him and called for an ambulance. One of the doctors called his friend who is a spinal surgeon on a day off and he rushed back to work and made sure there was an operating theatre available. The ambulance was redirected en-route from Leicester hospital to the large hospital in Nottingham. My friend went straight in surgery and had a metal plate put on his upper spine. Today he still has the metal plate in his back and is biking again -all ok. Without those doctors and a swift surgical intervention he would probably be paralysed from the neck down. I think it would be excellent if Pinkbike had a first aid tab on its website for us all to learn from just in case we find ourselves in such a situation.
  • 3 0
 Amazing story. But what caused him to not be able to breath? Is that a side effect of the TBI?
  • 2 1
 They say intubation failed first so I'm guessing it was a crushed esophagus creating a physical blockage. .
  • 2 0
 Deviated Trachea
  • 2 0
 followed by a Pneumothorax
  • 5 0
 @Mcbellamy: I was once followed by a pneumothorax - I just unwrapped my Cliff bar, threw it behind me and rode away while it ate it.
  • 1 0
 @Mcbellamy: thanks, that's scary. I wonder whether a motocross-style chest protector could reduce the chance of this happening - or is trauma to the neck area the culprit?
  • 1 0
 I am SO glad the rider & everyone around him got through this.
I’m curious from an EMS provider perspective (these are excellent learning/discussion opportunities)…What kind of head/facial trauma was there, was pt. unconscious/no gag reflex? Would we not dart the pneumothorax to relieve the pressure that’s causing the deviated trachea, and continue to try to intubate? Performing an emergency tracheotomy (for us/in our scope) in the field like that is for a totally failed airway vs. difficult airway, do we know what other airway options were available, was performing the procedure not in the scope of EMS providers on scene? @Mcbellamy:
  • 1 0
 @HRAGAN: it sounds like they attempted to insert an oropharyngeal or nasopharyngeal airway tube but the swelling/deviation was preventing correct insertion.
  • 1 0
 Failing that we would attempt a Laryngeal Tube insertion (known as a fanny on a stick Smile ) A tracheotomy would be last resort.
  • 1 0
 @Mcbellamy:
(I realize there’s probably a lot of info. missing from the article, and I’m not trying to armchair quarterback here, but this article has been a teaching scenario all day today).

Neither an OPA or NPA would have been prevented by tracheal deviation. NPA’s not a good idea with facial trauma of course. Most EMS services carry a supraglottic BIAD of some kind (iGel, King, etc.). If you can’t get these in because of tracheal deviation from a tension pneumo. or hemp., then that’s the emergency to be addressed immediately. Absent or diminished lung sounds, low O2 sat. &/or capnography wave form can all show pneumo or hemothorax. MOI to begin with would be cause to check for these things.
O2 would be dropping without full lung capacity/gas exchange + pressure on the heart/heart not having room to function effectively. Needle decompression ASAP = relieving the tracheal and cardiac pressure, raising O2 sats & making assisted ventilations possible with a BVM. Performing a cricothyrotomy would not fix tracheal deviation; that would remain an emergency until someone could dart the pneumo/hemo.

I’m also curious about why none of the paramedics on scene would have attempted to relieve the pneumo. or try to intubate themselves. If they had an intubation kit on hand, presumably someone there had training/skills/experience. Why would you surrender your patient/scene to someone else? Did they maybe panic and defer to what seemed like a higher level of skills? Doing emergency interventions like these out in the field vs. in the very controlled and highly supported environment of an ED is very different. ER docs are awesome, but not every ER doc possesses the capacity to perform every emergency skill, much less the patient assessment/judgement about when to use certain skills.
BLS before ALS
  • 1 1
 This is truly an awesome story. What makes this absolutely impressive is performing an emergent trach, under the pressure of an actively desatting patient, without what sounds like an actual tracheostomy kit on the trailside. Bravo Dr. Coenen
  • 2 0
 Oh boy now we gonna have all the super medics carrying pens and tampons lol
  • 2 0
 Read this twice and maybe I missed it but why was he having a hard time breathing? Because of the TBI? Landing on his chest?
  • 1 0
 Crushed airway I believe.
  • 2 0
 Trauma to the chest can cause a Pneumothorax. Unequal pressure in the chest cavity can force the trachea to one side severely restricting the ability to inspire and expire.
  • 4 0
 It’s not super clear eh. Something was obstructing his airway though. He had a head injury and it sounds like he lost consciousness (although not immediately and no mention of brain bleed) so it could have just been from that as all the soft tissue in his mouth and throat relaxed and he wasn’t alert enough to protect his airway. But then the Washington Post article also mentions some direct trauma to his neck so maybe he had an expanding hematoma that started to occlude his windpipe? A tension pneumothorax wouldn’t have been fixed by a cricothyrotomy. Pretty cool story. Hopefully the guy’s head injury wasn’t too bad.

-medical resident
  • 1 0
 Might needle decompression have helped to avoid the surgical intervention? @Mcbellamy:
  • 1 0
 Needle decompression would likely have helped address the tracheal deviation & maybe avoid the cric.? @rorylepage:
  • 1 0
 @HRAGAN: Well it doesn’t sound like he had a pneumo let alone a tension pneumo resulting in tracheal deviation. There’s no mention of one. If the life-saving procedure was attempted intubation and then a cricothyrotomy that would mean the main issue was airway obstruction as opposed to an issue with the lungs/pleura/chest wall. So needle decompression wouldn’t have done anything for him. If he had a tension pneumo then ya he would’ve needed a needle decompression and/or chest tube.
  • 1 0
 @rorylepage: Hmmm…someone mentioned tracheal deviation elsewhere in the comments, and, given the MOI, that would likely be due to a pneumo or hemo, with resulting chest cavity pressure causing tracheal dev.
There’s also no mention of direct trauma to neck or throat that could cause obstruction.
It seems there’s likely a lot of information missing from the article; I know the main focus is on heroics, but I’m just curious about assessment/treatment from the medical provider perspective. ☺️I’m also curious about why the patient care was transferred to a layperson, despite his stated credentials.
  • 1 0
 @HRAGAN: This has been discussed heavily on the Minnesota focused MTB FB group. The incident is local to me also. There was a local CBS station interview with the persons involved that gave some more detail. The description was of OTB on the chest, shoulder and neck. The medical implications of that are beyond my knowledge. What I can say is that the results of that have been quite openly discussed by the persons involved on said FB group as well as local riders who where also on the scene and helped run equipment/guide people. Everyone seems to agree there wasn't time to get said individual out of the woods before he was in extreme distress. Also, this was at the worst part of the trail to get someone out, almost a mile hike to any removal locations.
  • 1 0
 @HRAGAN: Ya you're right about the neck trauma. I re-read the Washington Post article and looks like the incisions they refer to were just the surgical incisions from the cric. So ya I don't know what was going on with his airway. I mean he may have had a pneumo but a surgical airway doesn't fix that and if that was really the threat to his life you'd think they'd mention that or the needle decompression/chest tube that would have been the intervention that he ultimately needed? Missing some details for sure. But sounds like even after he was discharged from hospital they weren't exactly sure what happened.
  • 1 0
 “I was wearing a helmet, but when I took the fall on my bike, I landed really hard on my stomach and chest,” Van Guilder said. “I could hear where my buddy was, but I couldn’t see him. I told him, ‘I think I have a bit of a problem.’”. Sounds like the mechanism of injury was trauma to the chest.
  • 1 0
 @rorylepage: Patient was conscious and speaking immediately after the crash. His SPO2 diminished over a period of 30mins at which point he became unconscious and required intubation.
  • 1 0
 I love how many stories there are of people having accidents and a doctor of some kind just happens to be around to save the day
  • 1 0
 I guess the ones who didn't have a doctor nearby didn't live to tell their tale.
  • 3 0
 hopefully they used a presta valve.
  • 2 0
 I ride with a nurse. He said if we were riding together and I get to an accident he would call 911. lol
  • 1 0
 trailside intubation or tracheotomy? not much of a choice, but typically if you need one you're in no shape to make that decision.
  • 3 0
 Doctor. Doctor. Doctor? Doctor. DOCTOR. Doctor!
Doctor. Doctor.
  • 2 0
 Good to know about this in case I ever encounter it on the trail, seems easy enough.
  • 1 0
 Such sh1tty medical care here in the US. Paramedics on-site within minutes, helicopters called, trail side tracheotomies. Boy we suck!
  • 1 0
 You forgot to add: “$250,000 bill”.
  • 3 0
 this is so cool
  • 1 0
 Glad it turned out alright. Given the positive outcome, the next biggest question is what kind of bikes do ER surgeons ride?
  • 1 0
 I live near these trails and am shocked to see this story. How did it not make local news? Thankful it ended well!
  • 1 0
 I'm in Hudson, ride all the metro trails almost every day and get up to the northern trails regularly. Coverage of this fall has been pretty constant since it happened. I don't have cable so I have no idea what was aired on TV but the story was posted and updated a few times here: minnesota.cbslocal.com/2021/09/22/mountain-bike-crash-reunion

The guy's friend was also posting on the fb group MN Mountain Bike Enthusiasts after the incident then with updates as his buddy was able to recover enough that he was comfortable sharing details.
  • 1 0
 @rantlers: By local news I meant Brainerd newspaper. Don’t have FB or live tv, so I probably shouldn’t be completely shocked I didn’t hear about. Just surprised to see it hear first, normally in a small town news like this travels pretty fast.
  • 1 0
 I can't imagine the risk of infection. That doctor is a real life James bond
  • 1 0
 A couple splashes of Red Bull usually kills all the worst stuff
  • 3 0
 Sunday Saves for sure!
  • 2 0
 Kudos to Dr. Jesse Coenen! Well done!
  • 2 0
 not all heroes wear capes, but most wear spandex.
  • 1 0
 Real life super hero right there. They kinda deserve the big ego and fancy bikes Smile
  • 1 0
 Im hoping the 'he'd never done it on a live human' was a typo. I assume it was meant to be 'conscious' human?
  • 2 0
 nightmare
  • 4 3
 You can do this with a pocket knife and an the outside tube of a Bic pen.
  • 4 0
 Sounds so easy eh? Lol
  • 11 0
 saw it in a movie once
  • 2 0
 The patient would get a bigger hit of oxygen if you used your hydration-pack tube rather than a pen. Definitely a good reason to always carry a sharp knife. I knew I disliked water bottles for a reason. Sticking with my EVOC FR Lite Tracheotomy-pack....
  • 2 0
 @suspended-flesh: you mean you don’t carry pens around when mountain bike riding???
  • 2 0
 @SterlingArcher: Only Krink markers!
  • 2 0
 What a hero.
  • 1 0
 Said Tom Waits to Iggy Pop....
  • 1 0
 This is why I always carry a biro.
  • 2 0
 JFC, that's insane.
  • 1 0
 Dr. Baller......, paging Dr. Baller... Holy F, what a boss! Legend.
  • 1 0
 Hope he is doing well heel fast mate
  • 1 0
 This is anout the most metal thing ive heard all year. Respect doc
  • 1 1
 If only there was a dentist on his Yeti ebike, he or she could have done an emergency tooth extraction.
  • 2 1
 Thank God it wasn't a dentist!
  • 1 1
 Thats why you always keep a ballpoint pen around. I seen it in a movie. Pull the ink out and straight stab to the throat.
  • 1 0
 A true trail Angel! Reminds me to get on that wilderness first aid class
  • 1 1
 ….if only it were a Dentist.
  • 1 1
 Should that quote not be attributed to —Dr. Jesse Coenen
  • 1 0
 Thanks Doc.

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