- Welcome to the new studio space.
Really excited to film the first episode
of 9-1-1 Medical Scenes.
We've done this one before.
These are hyper unrealistic
but some good medical learnings to be had.
Let's get started.
- Your son seems to have his head on his shoulders.
Well now anyway.
- Are they playing golf in the rain?
It also feels like fake rain like from a sprinkler.
- You're some piece of work, Billy.
- So I've been told. (thunder rolls)
- When thunder roars, go indoors.
But lightning strikes do happen.
Two dozen deaths a year in the US about.
Actually one third of them happen indoors.
So the recommendation from the CDC to keep yourself safe
from lightning strikes is to like not do the dishes.
To stay away from plumbing, not to take showers
not to use electrical equipment
'cause it can travel through the electricity
in your home and through plumbing.
So just about like sitting, being peaceful and meditating.
And it goes without saying,
being outdoors in a thunderstorm is not generally safe.
Standing in near tall object is not generally safe.
Like trees. That's a really bad idea.
- Someone call 9-1-1!
- Okay that's actually the first thing you should do
after a lighting strike.
When it comes to first aid, call for help,
and then it's about trying to help the person
in their time of need.
Meaning if they're like vomiting,
you wanna turn them on their side.
If they're pulseless, you know what you do.
Chest compressions. Chest compressions. Chest compressions.
- I thought we could move on to... To...
- Is she withdrawing from heroin?
- So itchy.
- Or maybe just acute intoxication with a substance?
- I'm sorry I-
- He's wearing cross stripes on a shirt
that has plaid on it.
My man, pick one or the other.
- Okay. This is some kind of psychosis.
Psychosis-related excoriation
where they start scratching themselves
thinking that there's insects on them or something.
- I'm on the edge of my seat here.
- Bro. She's stabbing herself with a fork!
Can you show a little compassion?
- Right, we were going to (audio fades)
portfolio projections
and first quarter profits, which we hope will do.
Liza? What are you doing? Liza!
- These are officially the least caring people,
colleagues I've ever seen in my life.
She's scratching herself with a fork,
having some sort of medical situation occur
and they're just annoyed.
- To your knowledge, was Liza on any substances?
- No.
She was two years sober. She knew better than that.
- Just because someone says they're two years sober
doesn't mean that that's the case.
And also as a police officer, if someone says no,
move on, there's no point trying to push through
in a situation like this.
You test the blood and then you find out the answer.
- Several victims suffering seizures.
Two people stabbed themselves.
All symptoms came without warning.
(indistinct) Special response is on its way.
In the meantime we rounded up everybody still standing.
- I've never seen anything like this stab.
- We need to get these people transported.
- We're not going anywhere until
we know what we're dealing with.
- I mean I would get everyone out of the building instantly
because first of all you don't know
if this is an inhalation situation or an oral ingestion.
So something weird is happening here.
- What'd you have for lunch?
- Skipped it.
Big breakfast.
- Wait for it.
- I know who did this?
- What?
- Mercury.
- Did this police officer/paramedic,
I can't tell who this is speaking,
know that this is mercury poisoning
before he even opened up the sandwich.
No, never gonna happen.
And first of all, that type of mercury doesn't really get
absorbed well in the digestive tract,
only through respiratory
and then it can actually spread throughout the body.
Be neurotoxic and hurt the lungs, all that.
The danger of that mercury is if it gets aerosolized
like with a vacuum or something or a fan.
So the fact that they're all just
like breathing it in and chilling, that's like not ideal.
- I'm too scared.
It's bad.
- Oh come on now little man.
Lemme take a look at you.
Just a toy.
- Oh-kay.
- Told you it's bad, huh?
- We actually have tools for this
in the ER to pull things out of noses.
I just wouldn't do it on a roof 'cause let's say you do it
and it hurts the child and they move weird.
They could fall off the roof.
So get into a safe environment first.
Ideally an emergency room.
- Okay Harry, showtime.
On the count of three, I want you to blow your nose
like you have the biggest booger in the world in there,
okay? - Okay.
- Okay.
- I mean for small things that could work
but for larger things like that I wouldn't start doing it
'cause you're drastically increasing intracranial pressure.
So like if you can just pull it out
with tweezers like in in an emergency room setting, do that.
- Okay, don't worry.
Just means we're gonna have to go to plan B.
Where I use my special toy car removal device.
- Promise won't hurt though, right?
- Yup.
- Or you could just be honest with the child
and not lie and say it's gonna be very quick.
Move the subject along.
Say that it's gonna hurt less than leaving that thing
in there so you're creating an honest answer,
but still keeping the child calm.
- Okay, buddy.
- Why standing? Why in the forest?
If he starts having a major nose bleed,
what are you gonna do in the field?
- No. (child screams)
Got it.
- This is like a bunch of dudes came together
and said we're gonna be doctors
in the field and they started practicing medicine.
- How?
- After you left, I kept wondering how Harry
got it so far up there.
- So you figured it out.
Tweezers?
- No.
What the (indistinct)?
Why is there lava in the pool?
Was this house built on an erupting volcano?
- Chad.
- No. - Wait, wait, wait. Stop!
- Why is this turning into a rave?
They're putting rave music on while someone's dying.
- Chad. (indistinct)
Give your hand, give me your hand.
- Okay, so when you have burns that are this bad
you could actually start tearing skin off just
by applying the slightest amount of pressure.
In a situation like this, obviously the risk of doing that
is worth it because you wanna save their life
and one of the ways people lose their lives here
is from a lack of hydration.
When you have such severe burns, you actually release
a huge amount of different electrolytes into
your bloodstream, which can be toxic to certain cells
of your body, especially your cardiac cells.
So hydrating people that are going through really
bad burns is of utmost importance.
It's like the first step.
And then also knowing that when your skin is not
intact you actually lose a lot more fluids
throughout the day.
- Thank you, guys.
(shouts)
- He's like iron man but not.
- Oh my God. Is that the thing that's keeping you alive?
- It was. It is now an antique.
- We have to extract it. Here.
Yeah, that's impossible.
- We don't, it cooks his heart
- But if we take it out, he'll bleed to death.
- Not if the heat from the rock cauterized everything
around it.
- What if it didn't?
- We don't have a choice.
Look, damn thing's sinking into him. Clamp now.
- The confidence level these first responders have
to make medical decisions is impressive.
You know, as someone who's worked in a hospital a decade
I have no idea what to do in that situation.
I probably take it off but... (sighs)
- What are you doing?
No!
- Oh, is this an MRI?
Oh no.
Just for people to know.
There's few types of imaging that we get in the hospital.
Some are x-ray, CAT scans are basically x-rays
with many slices and then you have MRIs which is
magnetic resonance imaging where we actually use spinning
magnets in order to visualize the body in a way
that doesn't create radiation.
So there's no harm from their imaging.
There may be indirect harms from finding out the results
but the actual process itself is not harmful to humans.
With the exception of if they have some metallic parts
on their body or they walk into a room with metallic items.
- There should be a safety button in there that'll overheat
the magnet and kill it.
The problem is we can't access the button.
It's on the front of the machine.
- Which I'm assuming is somewhere behind that gurney.
Okay, tell your staff to step away please.
- What about the metal in our uniforms?
- I was just getting to that.
- Help me.
Help me.
- We're gonna get you down but I need you to-
- There are safety standards.
It's called OSHA
Occupational Safety and Health Administration.
I hope I said that right, where you don't need to go
in your frigging lingerie to go and rescue someone.
- Airways are clear, but I'm hearing a strider,
possible Pneumothorax.
- What is the use in talking about his lungs
like he's an inpatient in a hospital
when he's acutely jammed.
- (groans) (gasps)
- You guys can get dressed now.
- Bilateral test raise.
- What does that mean?
- It means your lungs didn't collapse.
- Why does it hurt so much?
- Because you cracked some ribs.
- Chest rise first of all
and that means he doesn't have flail chest
which means that his ribs aren't broken.
I would not go ahead
and venture to say that his lungs aren't injured.
I would like to hear bilateral breath sounds
in all lung fields
in order to say that there's no new pnuemothorax.
- When I left my ex Julian, he said that he would
ruin my life.
And ever since our divorce I've been feeling
I don't know, different.
(straining)
Liza are you all right?
- Is she pregnant?
- (sneezes) (screams)
- She has some kind of very aggressive parasite.
- Need you to hold still for me, okay?
And you should close your eyes for this part.
A little tug.
- I don't know if this is ideal for people to do
in the field given the fact that some of these worms can
actually attach to the intestines through like
hooks and such.
And then as a result,
by ripping them out you can actually cause trauma.
- [Liza] What is that?
- Round worm?
By the looks of it.
- There's different types of round worms.
Almost all of them are treatable by medications called like
Albendazole or Mebendazole.
These are just anti-parasitic,
anti worming, deworming agents.
Could be a hookworm, could be a pin worm.
Hookworms are usually a little bit bigger
and they can actually enter your body through skin going
through feces ridden soil in underdeveloped nations.
It can actually end up in your intestines
as gross as that sounds.
Sometimes the pinworms can lay eggs surrounding the anus
and then like a young child can scratch that area
and pass it on to others.
That's why daycare centers oftentimes have outbreaks
and there's a test we do, it's called the scotch tape test
where overnight we actually put a piece
of scotch tape on the anus and then take it off
bring it in, look at microscope, see if there's eggs on it.
- Liza, are you okay?
- (gasping) Can't breathe.
- She must have aspirated some of the material.
TK, track her O2 levels.
- So that can happen sometimes if you vomit from
a laying down position, you can get some of the vomit into
your lungs and that can be quite problematic 'cause,
in vomit, there's acid.
Acid going to the lungs can create a pneumonitis
and over time can even create a pneumonia.
- She's satting a 90 cup.
- If you're satting low, that means that you're not
oxygenating your blood.
She also looks like she's unconscious and not breathing
and if you just check her and she doesn't have a pulse,
you should start chest compressions.
- Nancy, start compressions.
- Well, thank you.
- (speaking Spanish)
- Those are the worst chest compressions.
She's pushing on her freaking throat.
This is a 9-1-1 show, they don't have a medical specialist
on board say stop pushing on their throat?
- By your great power, heal this woman.
- (gasping)
- We've got her back.
- Oh well I'm just gonna have that lady be
with all my patients and saying nice things.
Inhaler. By the way,
for those who have asthma that's triggered by colds,
it usually happens as a result of overreaction
to the cold air and sometimes even to the cold dry air
and it causes a type of bronchoconstriction.
There are some people that, especially
before exercise in what we call EIB,
which is exercise induced bronchospasm from cold weather
like this can actually get relief by using
an asthma inhaler before the sport
and then they actually don't need it afterwards.
There's a huge amount of worry in parents
in children who have exercised induced bronchospasm
to the point where they're like, oh,
I'm not gonna have my child play sports.
It's exact opposite.
Playing sports is good for them
and a lot of athletes actually have some kind
of exercise-induced asthma
or just maybe regular asthma altogether
and they still perform very high caliber.
- (coughing and gasping)
- Whoa.
It's cold in that water.
His heart rate's definitely slowing
as a result of a dive reflex.
That's so scary.
Never let children play on ice.
There is something to be said about drowning
in really cold water where it actually slows the heart rate
down through that dive reflex and as a result,
makes your body require less metabolic demand means
that you could survive a little bit longer
without brain injury.
Rewarming protocol is really important here.
- Does that mean he's dead?
- No ma'am, you're not dead until you're warm and dead.
We're gonna do some rapid rewarming
and hopefully we'll be able to get him back.
- When we say rapid rewarming
we not only can put obviously heat packs
around the body, et cetera, but we could also give
warmed up fluids throughout the body as well through the IV.
And those are the worst chest compressions I've ever seen
in my life.
- Get the portable ECMO machine.
- (indistinct) - Got it.
- What is this?
- Yes, please tell me your heater works.
- Look, what is she doing?
What is this?
She's literally going like this.
I just broke my webcam.
- Is that time y'all to find out who's got the sheer
audacity to Terri's 78 ounce (indistinct)
which is about 78 ounces more sirloin than any mortal
should eat in one sit-.
- 78 ounces of sirloin is a huge load of fats and sodium.
That's where my main concern comes from
because like if you eat a lot of protein, okay, whatever
but sodium quite dangerous, fat could be problematic.
It can start forming gallbladder issues.
Just nausea, vomiting, ugh.
Oh. And that's a concussion.
- (indistinct), We're gonna get you outta here
as soon as possible.
Sonya. Is there any chance that you're pregnant?
- Pregnant with prime rib.
- BPs 90 over 60. - But her heart rate's 116.
I don't think it's a heart attack.
- You don't judge whether or not someone's having
a heart attack if they're hypotensive and tachycardic.
Hypotensive meaning low blood pressure,
tachycardic meaning high heart rate.
In fact, when someone becomes hypotensive that means
that they don't have enough fluid
or something's going on where they're losing blood.
They're basically losing volume in their circulatory system,
in their plumbing system.
When you don't have enough pressure there,
you can't get the blood to certain areas of the body
like the brain and vital organs.
Your heart can try and compensate for this by pumping faster
so your it becomes tachycardic,
it becomes a faster heart rate.
That's cardiac output.
So the fact that this person says, oh
she's not having a heart attack
or she's having a fast heart rate is complete BS.
- Can you tell me what year it is?
- Tuesday.
- Concussion. - Just doesn't make any sense.
- Yeah, she hit her head.
It makes total sense.
- Her bladder's distended. - (indistinct) Stomach.
It's a eating contest.
- Why are they diagnosing her?
Stabilize and bring to the emergency room.
- Is that her place there with the empty pitchers?
- Oh yeah, she was throwing 'em back.
- This is hyponutremia. - Water intoxication.
- We need to reposition her.
- No, no, no, no, no, no, no, no.
You do not look at empty glasses and say someone
has water intoxication.
You stabilize them so that they're not dying in the field.
You bring them to the hospital
and you allow people to do a blood test that will very
quickly confirm or deny your supposed diagnosis here.
- Grab me a catheter and a Foley bag.
We need to divert fluids now.
- Divert fluid from where?
- That's it, as soon as we get her on the regular,
the hospital handle this
we give her a catheter now we'd be liable.
- Her bladder's about to burst.
It's my call.
- How does she know her bladder's about to burst?
When someone becomes hyponatremic
and their sodium level drops below 135.
Usually that happens as a result of medications
or health conditions like kidney issues.
But it could also happen through something, process known
as water psychosis where people who are not
in a well mental state chug a lot of water
and that essentially dilutes the amount of sodium
that's in the bloodstream 'cause when you have low sodium,
that could mean you have excess fluid or actually
low sodium that you're getting rid of too much sodium.
So in a person who consumes a lot of water,
they end up diluting the sodium level.
As a result, tissues start to swell.
And the reason tissues swell is 'cause the water starts
leaving in order to try and equalize,
leaving the bloodstream and goes into cells.
And when they swell, that could become problematic
especially in areas of the brain where there's limited
space, swelling can actually cause brain death.
- Mateo? - Yep.
- Unplug the battery.
Judd, Marjon.
Make sure there isn't any fluid leaking.
It's gonna ignite.
- Face shield stuck.
- Leave it alone. Don't force it.
Let's just see what we're dealing with first.
TK, put him on the life pack.
- Copy, Cap.
- Hey sir, we are here to help.
Can you tell me your name?
- Looks like he has a sub-, not subdural,
subconjunctival hemorrhage.
- BP's spike, Cap.
- We're looking at possible orbital compartment syndrome.
- No, you're not!
Stop making up things.
I'll give 15, right now, different diagnoses
that are more likely than what she just said.
This person is on drugs
because they're wearing a knight costume
out in the middle of the day.
They have a concussion 'cause they just got hit by a car.
They have a brain bleed,
which could be a subdural or epidural hematoma.
They could actually have an aneurysm that's ruptured.
They could just have cranial hemorrhage.
They could also be having cardiac arrest
because of chest trauma.
Like the amount of things that could be going
on before she makes this ridiculous diagnosis is insane.
- BP's coming back down to earth, Cap.
- Cap, look at his lips.
And I do not like this rash.
- It's erythema. - Like that could be
a raccoon sign 'cause he fractured his basilar skull plate.
- This isn't a regular head wound.
This is carbon monoxide poisoning.
- Must (indistinct).
- Which explains the delirium.
- How did she get to carbon monoxide poisoning?
- Well this could be something.
About five blocks from you, there's a novelty pizza place.
Swords and Slices.
- Come on man.
Carbon monoxide poisoning is very real and people die
every year in the United States
'cause of carbon monoxide poisoning,
it's usually the result of a terrible accident going
into a well-ventilated space solves that issue.
And the reason carbon monoxide poisoning even
happens is because the carbon monoxide actually
displaces the oxygen on the hemoglobin
which is the oxygen carrying portion
of the red blood cell that now can't carry oxygen.
As a result, you start having really bad health effects.
- It's a medieval mass casualty.
- That's a good thing they weren't open yet.
- And what they don't have a CO2 detector?
- Jud, why don't you find the control and shut it down?
- Oh, why don't you get the people outside
and that'll help all of them.
- We're gonna need more O2 off the truck.
- No good.
We used the last cylinder O2 about five minutes ago.
- Oh, so how about bringing them into a medical center
instead of treating them right there on the street?
- We should eat here sometime.
Place seemed dope.
- (laughs mockingly)
Want to learn the secret to happiness?
Click here for my interview with the professor
the Doctor of Happiness.
Most viral Ted Talk on happiness,
actually click here to check that out.
And as always, stay happy and healthy.
(upbeat energetic beat plays)