- I've never seen Lost,
but it's a popular show. You asked for it,
so we're watching it and I'm grading it
based on the level of misinformation.
Chest compressions.
Bewoo.
(women screaming)
(engine whirring)
- Oh no.
(engine whirring)
- By the way if the engines are spinning,
you got to get out of the way.
They'll suck you right in.
- [Man On Lost] Help.
(engine whirring)
- I wish I had background into this show to know
whether or not he's a doctor.
He could be a doctor, he's dressed like one,
he's trying to help people,
he's heroic.
(engine whirring)
- [Man On Lost] Give me a hand.
(engine whirring)
Now.
- He knows how to work in teams,
interpersonal communication on point.
(man on Lost grunting)
- Ooh. Crush injuries are quite dangerous because
as soon as you remove whatever the object is on top
of the individual, that area gets reperfused
and it can actually cause more problems.
Including if you fracture a bone, you can develop something
known as a fatty embolism.
Where piece of the fat from the inside of the bone marrow
actually travels to your heart and lungs,
causing major problems and potentially death.
- All right, get him out of here.
Get away from the engine.
- Smart man. Get away from the engine.
Engines can explode.
- Please help me I'm having contractions.
- How many months are you?
- Oh, she's pregnant.
- I'm nearly 8 months.
- 8 months, okay.
- Oh, someone's doing chest compressions.
God awful chest compressions,
but at least they're trying.
I mean, he's lifting the hands off of the person's chest,
while doing the chest compression. That's problematic.
The hands got to stay there,
and you're not pumping with your elbows.
You're pumping with your body.
And remember you got to do it a hundred beats per minute.
(engine whirring)
- Hey, hey, hey, hey. Get away from there.
- Oh no. The engine, I predicted it.
I felt it.
(engine explodes)
Oh and it exploded.
(engine exploding)
Shards, burning, ah problems.
- You're going to be okay. Do you understand me?
- How does he know that?
The confidence on these shows astounds me.
You crashed a plane into an Island.
You don't know where you are.
You're lucky to be alive.
And he's like, don't worry I got this man.
- But you have to sit absolutely still.
- Oh really now?
Well, if she just sits still, she'll be fine.
She just survived the plane crash.
- Hey you, come here.
I need to get this woman away from these fumes.
- It's the fumes that are problematic.
- If her contractions are currently closer than
three minutes apart call out for me.
- Call out for him? Because he's going to be able to
rescue everybody.
There's explosive material flying and falling from the sky
because engines are exploding, but he's like
the fumes.
(sighs)
- Stop. Her heads not titled far back enough,
you're blowing air into her stomach.
- Oh. Oh. Oh.
How about we don't breathe into people's mouths anymore.
Just do the chest compressions in order to buy time,
you definitely want to pull the chin forward,
cause that does make it more accessible.
Like if you're doing an ambu bag,
you actually do want to pull the chin up like that.
It helps the airway.
- Come on,
come on.
- Oh. And if you say, come on, it actually doesn't help.
- Come on.
- And if you say it twice, it also doesn't help.
- Come on.
- And if you say three times, it also doesn't help.
Ooh, Ooh.
That's a serious laceration there.
That's going to require some sutures.
And why didn't, why is it not bleeding, even though
it's open? You know in the wilderness like this,
burning that wound, may not be that terrible.
- Excuse me.
Did you ever use a needle?
- I made the drapes in my apartment.
- That's fantastic.
Listen, do you have a second?
I could use a little help here.
- He said, that's fantastic.
Please stop raising your arm.
Each time you do that, you reopen the wound.
Just keep it down so the wound can stay closed
and show her by rotating.
- Look, I'd do it myself. I'm a doctor.
- Oh, he is a doctor.
Look at Dr. Jack. You know, in fact if his wound
is not bleeding out, I would not be in a rush to
close it because wounds that are dirty,
and that's definitely a dirty wound, should really
be allowed to heal by secondary healing.
Meaning that you don't do a primary closure with sutures.
Because if you do a primary closure with sutures,
you increase the rate of having an infected wound
and he doesn't have antibiotics,
that's already problematic.
I think I would just kind of clean it out,
and allow it to heal by not moving and letting the
area like chill.
(panting)
- He's not breathing.
- If a person's not responsive and not breathing,
what do you do?
Chest compressions,
chest compressions, chest compressions.
There you go.
Very poor quality chest compressions.
I give that a D minus.
Just cause he's at least on the right spot, and
he's doing them, but poor for bad timing,
not deep enough, all wrong, wrong, wrong.
- Breathe Charlie. Come on breathe.
- I get the purpose of doing chest compressions
is to try and revive somebody,
not because the chest compressions actually
do something to help revive the person.
It just buys them time, cause it circulates the blood
that's already in the vascular system.
Once the arteries deliver the oxygen to your body parts
and then it's on its way back, there's still
a little bit of oxygen left there.
So by squeezing the heart,
by doing proper chest compressions, you're just
recirculating that blood with its 10-20% of oxygen
still left inside of it.
And you kind of hope that that blood circulating,
may trigger the heart to restart.
- Jack he's gone.
Jack. Stop. He's not.
- It's actually wise to stop at this point,
because the brain has been so long deprived
of oxygen, that it's experiencing brain death.
That even if you restart the heart,
the person's not going to be functional,
they're not going to be able to breathe on their own,
they're not going to be able to move.
And as a result on an Island,
that equals death or incompatibility with life.
- Johnny.
- Oh, oh, oh.
Okay. Some coconuts or something fell on his head,
but that didn't seem like it's too traumatic.
Remember? Mechanism of injury sometimes more important
than the injury itself.
Like when a patient comes in and says their ankle hurts.
Yes. I want to look at it.
But most importantly, I want to know how it happened.
What was the weight?
Did they fall?
How far did they fall?
Did they lose consciousness?
Was it witnessed?
How long were they unconscious?
All these questions allow us to picture
how much damage actually occurred.
- You're going to have to fix it.
- I'm not a doctor.
- You're a soldier.
What do people do when they get wounded?
- I mean, if the cut is right above the eye,
do some sort of bandana and tie it really tight,
cause the rest of the skull is okay,
and you can put pressure there.
It won't bleed and you'll be okay.
- Move the towel and tilt your head back.
- I, as a family medicine doctor,
board certified and all, have no idea what's about
to happen.
- Oh, that need sutures.
Oh, he's going to burn it.
- This is not going to be pleasant.
- Is he going to explode?
- One. Two. Three.
- What about the rest of his face?
Wipe it off first.
Do not do this at home,
on an Island, anywhere.
He could have just lit the match,
and lit a leaf on fire and like patted it,
so at least it cauterized it a little bit.
My guy put gunpowder on it, like, oh
here's some T N T.
- I hate being sick.
- Me too.
- What do you think it is?
- It's food poisoning.
- What makes you think that?
- Got some cramping, dehydrated, nausea.
- Sounds like a gastroenteritis could be from Giardia,
depends on his stool.
Let's see if he mentions it.
- You want to lift your shirt up?
- Appendicitis?
- It's your appendix Jack.
- Jack.
- So she touched him on the right lower quadrant,
McBurney's point.
- Has it ruptured?
- How is he supposed to know that?
Can you imagine if I walk into my patient's room,
hey, has your appendix ruptured?
- Right there?
- They're so fake injecting him with the lidocaine,
it's literally like they're just shooting it on his skin,
you actually have to go inside.
- Okay Jack. One more.
Try not to move.
(man grunting)
Just stay still.
- She's cutting his abdomen.
Just stay still. Would you?
Lol.
(giggling)
- Whose X-rays are those, outside?
Those are spinal x-rays and they belonged to a man
about 40 years old.
And whoever he is, he has a very large tumor on his
elafore vertebrae.
- It's weird that he knows the age.
I guess he's looking at it,
how much area in between the vertebrae they are,
like if the disc spaces are preserved.
You can't know if that person is 40, 30, 50, 20.
It's such a wild guess.
- Your neck, does it hurt?
- Any numbness in your fingers and toes, like pins
and needles when your foot falls asleep, but permanent?
- Because he knows you have a tumor,
he's asking about parasthesias.
- You have a tumor on your spine.
An aggressive tumor.
- You don't know what kind of tumor someone has on their
spine off of an x-ray.
You've got a biopsy it, you're not a superhuman.
You can't visualize what the tumor is off an
X-ray. You could just see that there's something
abnormal there, but it could be multiple types of tumors.
If there's a tumor, that's very, very visible,
that's oftentimes is not the case,
maybe you'll see it, but you can't diagnose it.
You need further imaging.
You need further studies, biopsies, et cetera.
(machine beeping)
(suspenseful music as machine beeps faster)
- He's going into tachycardia. Why?
- What happened? Is he okay?
- His blood pressure's dropping.
Should he be bleeding like that?
- No. No he shouldn't.
(punches)
- Oh, oh, that is not good teamwork.
- You just made a small incision in Ben's kidneys sack.
(chuckles)
Now if I don't stitch that back up in the next hour,
he's dead.
- Yeah. He's dead now because I think he's going into V-fib.
I don't know what he cut.
I don't know what he's doing.
All this is unethical.
Non-medically accurate.
This is a joke.
- No, no. Put him down up here.
- What happened?
- There was an accident, fell off a cliff.
- In situations like that, in a trauma,
you really want to rule out internal bleeding,
because if a person's bleeding internally,
they are going to have moments to live.
If that, because you need to deliver fluids,
you need to deliver blood.
And if you can't do that on an Island, I don't know,
like you have no shot basically.
- I might need some water,
shirts, towels, anything that I can use to
stop the bleeding.
- I mean, if you're bleeding on the outside,
odds are you're bleeding from the inside,
especially with a fall like that.
So towels aren't going to do you much good.
- His lung just collapsed.
- How does he know that?
He doesn't have a stethoscope.
But if you put his ear to the chest,
or he saw that it wasn't rising symmetrically,
maybe I'll buy it.
Maybe I'll buy it.
My guy looked at his face and said his lung
collapsed. Jack has x-ray vision.
- Oh it burns.
- Closed fracture. Think we can set it.
- If his leg is turning blue, which it looked like it was,
you really should do a reduction where you put the bone
in its correct location.
Reason being is if the bone is actively blocking circulation
to the lower foot, once you correct it,
you can get a reperfusion injury and die just as
a result of that.
- Who's checking his cervical spine for fractures?
There's just like tossing around his neck.
- He needs blood.
- What?
- Blood. Transfusion.
- I don't know how he's going to do a makeshift I V.
- I was getting you this.
- A sea urchin?
- A hollow needle, sharpen up the Pearson needle.
- Aren't those poisonous?
- It's perfect.
- What I don't understand is what is he planning on doing
with this sea urchin spike?
Like he said just gonna just spike the vein and then what?
- These types of transfusions I've never seen work
before. I can't imagine that it's actually working.
Also, I have no idea as he's doing this transfusion,
how we know that he's delivered enough blood.
How does he know how much blood he's delivering?
I'm so used to ordering it through a computer system,
not just from like, all right,
let me give him some adequate amount of blood
until I guess I get dizzy and I pass out,
like I don't understand how he's measuring this.
- It's not working.
- Blood's not the problem, it's the leg.
All the blood's pooling there.
Compartment syndrome.
He didn't get this injury from a fall,
something crushed his leg.
- Compartment syndrome is really problematic
because when you have a crush injury or really any kind
of issue where you're getting intense inflammation
over a limb and it's circumferential
meaning that it happens all around the limb.
It actually starts expanding and cutting
off circulation where necrosis starts to have it.
And the treatment for this is
a fasciotomy where you actually go in
and make a cut in order to open
and allow the swelling to come out
so that the pressure gets off of the arteries
and allows blood to flow again.
(coughing)
Again, this is surprise to no one.
He has internal injuries.
He's bleeding internally.
Keep pumping him full of blood.
Great, that maybe buys him some time.
But the reality is, as soon as you pump it into him,
he bleeds it right back out internally.
This is why, if anyone ever has an abdominal injury,
like let's say a stabbing, a gunshot wound,
you literally have to open up their abdomen,
and run their bowels where you're making sure
that there's no area that your patient is bleeding
out. Because if your patient bleeds out,
and you close them and you think you're good,
and they continue bleeding, they can die.
- But I need you to push.
Okay?
- Okay.
- On the count of three.
Ready?
One, two, three, push.
Yeah, go ahead.
- You want to time to pushes with the contractions,
so when the mom is starting to feel the contraction
come on, you ask, you confirm,
and then you do a push with a count to 10.
And then once the contractions over, you let the mom relax.
When the contraction comes back, you repeat that process.
- I can see, I can see the top of the head.
- The baby is crowning.
And it's ideal at the baby's coming out head first.
If the baby's coming out breach,
that could be very problematic.
(woman pushing)
- Get the shoulders out, get the shoulders out.
One at a time.
There's a baby. That is not a new born.
(laughs)
Classic with the baby's crying.
Good color, probably good Apgar scores.
Getting the baby right on mom's chest, perfect form.
I like it.
Real doctor versus TV doctor.
I actually share a lot
of my really interesting doctor patient stories.
So click on that and as always,
stay happy and healthy.
(electronic bounce music)