title: Airflow efficacy of ballpoint pen tubes: a consideration for use in bystander cricothyrotomy.
abstract: OBJECTIVE
  To examine the suitability of commonly available ballpoint pens as a substitute emergency tracheostomy tube.
  
  
  METHODS
  Commonly available ballpoint pens were examined and compared against two standard cricothyroidotomy sets. The pens were evaluated for dimensions, speed of construction of a temporary tracheostomy tube and airway resistance with differing flow rates.
  
  
  RESULTS
  Internal diameters of the pens varied considerably. Time taken to construct a temporary tube ranged from 3 to 170 s, and in the majority of pens the airway resistance increased dramatically as the airflow rate increased.
  
  
  CONCLUSIONS
  Contrary to popular belief, the majority of ballpoint pens appear unsuitable for use as a substitute tracheostomy tube. In this study only two pens fulfilled the criteria for use: the Baron retractable ballpoint and the BIC soft feel Jumbo.
authors.affiliation: Princess of Wales Hospital, Bridgend, Wales CF31 1RQ, UK.
authors.forename: David
authors.initials: D
authors.lastname: Owens
authors.forename: Ben
authors.initials: B
authors.lastname: Greenwood
authors.forename: Alistair
authors.initials: A
authors.lastname: Galley
authors.forename: Alun
authors.initials: A
authors.lastname: Tomkinson
authors.forename: Sarah
authors.initials: S
authors.lastname: Woolley
mesh_terms: D000402:Airway Obstruction / Q000517:prevention & control*; D000403:Airway Resistance; D004630:Emergencies; D004867:Equipment Design; D006801:Humans; D007821:Laryngeal Muscles / Q000293:injuries*; D013997:Time Factors; D014139:Tracheostomy / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome