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.
“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.
|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.”—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?”
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"?
UCI WC mechanic
Soccer mom with the good snacks
Craft beer enthusiast w/yeti cooler full of beer post ride
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.
...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.
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.
Dude Bro with the Taco for shuttling
Surprisingly not hard to get 3 out of those 4 pretty regularly living on the North shore, haha
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?"
And that's how you do a non offensive blewit joke btw, if anyone wants to take note. You know who you are.
More seriously, I agree completely with the sentiment - excellent work Dr. Coenen.
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.
I supposed there's the possibility that the first aid instructor was just wrong, or didn't fully explain.
This is how you improvise a tourniquet.
My ER doc former college roommate had the Army pay for it, so he had minimal loans. Not the best path for everyone tho
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:
(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
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.
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.
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