- "Grey's Anatomy," season 2, episode 16 and 17,
I heard were the bomb, so I'm gonna check it out.
Beep-boop.
(sirens blaring)
(woman screaming)
Oh.
Okay, immediately, a lot of blood, screaming person,
paramedics, EMTs need to speak up here.
Um, can't tell what's happening here.
It looks like her arm is inside his chest?
Is she holding together a broken artery?
A broken blood vessel that is bleeding out?
- Paramedics found him unconscious and bleeding.
Mechanisms of injury are unknown,
but he has a large sucking chest wound.
- Vitals? - Tachycardic, in the 140s.
BP holding in the 90s.
- With that massive blood loss,
I expected tachycardia to be worse,
because what happens is when you lose blood,
your body actually loses blood pressure,
because there's not enough liquid inside your blood vessels.
When your body drops blood pressure,
there isn't enough blood reaching vital areas:
your brain, your kidneys, your liver.
So what your body does to compensate for that
is it tries to pump faster.
That's why the tachycardia happens.
- How's his respiratory effort?
- Absent breath sounds on the right side.
- Absent breath sounds on the right sounds like
that there's a collapsed lung on that side,
which can happen with a penetrating injury,
chest wall injury.
- Bubbling at the site of the wound.
He's shockey, and getting a little cyanotic.
- Shockey means that his blood pressure's getting
quite low, which means that he's not able
to perfuse his organs.
Cyanotic means that he's not perfusing his skin well,
meaning that he starts actually turning blue,
'cause there's not enough oxygen reaching his skin cells
from the small little capillaries,
the small little blood vessels
that feed the skin its oxygenation.
- Why do you have your hand inside of my patient?
- I tried to tamponade the wound,
with gauze and pressure, but the only thing
that would stop the bleeding was my hand.
Every time I try to move it, he starts bleeding out.
- Putting pressure on a wound
is the most important thing you can do
other than creating a makeshift tourniquet on the scene,
because putting pressure
can actually stop blood flow to that area.
If you stop blood flow, you can decrease blood loss.
There is a chance that some blood vessels,
specifically arteries that are muscular wall,
can actually spasm so hard that they cut off circulation,
decreasing blood loss.
- Can I take my hand out now?
- [EMT] You don't stick your hand inside of a patient
when you don't know how he was injured.
- Yeah, I know that now.
- Out of my room.
- She gets to stay?
- She has her hand stuck inside my patient.
- Yeah, so there should be an OR being prepped right away.
If you have an EMT telling you that,
if I let go, bleeding is instantly gonna happen,
that means you need to open up the patient
and prepare them for surgery,
'cause that means there's serious damage
to one of the important blood vessels in the chest.
- You have your finger on a major bleeder.
Mr. Carlson is running out of time.
The only thing you have that you have won
is an all-expense paid trip to the OR.
(bell rings)
- [Cristina] What do you want me to do?
- I want you to make that woman stop screaming
and tell us what happened.
- And also, make sure that everyone wears face shields,
because what he called a major bleeder
will squirt in everyone's eyes.
- Mrs. Carlson. (woman screams)
Are you injured? (woman screams)
Can you hear me? (woman screams)
(Alex screams) (woman stops screaming)
- If you are in the medical field,
please don't ever do that.
Support.
Be a human first.
Do not yell back at someone who's obviously
in a state of shock.
- Is this okay? Me being in here like this?
- Once Dr. Burke scrubs in, he'll have you remove your hand,
and then you can go.
- This is obviously not okay,
because when she put her hand in, it wasn't sterile.
The patient's gonna need major IV antibiotics after the fact
but in this case, it's acceptable.
Why?
Because had she not done that,
the patient would've bled out and died.
The trade off here of potentially getting infection,
but to save his life acutely is warranted.
That's why, whenever people make overwhelming
or overgeneralized statements about medicine,
I have to like, point out
that it's right sometimes, wrong sometimes.
It depends on the situation and on the patient.
It's why it's so hard when you guys ask me
very specific questions about your own health
for me to answer them.
- She's fine.
Acute anxiety reaction, give her two diazepam PO
to calm her down.
- Is she in shock?
- I'll say.
- Can you tell us exactly what happened?
- Maybe try a different approach, dude.
How 'bout just asking, are you okay?
- What happened is, my husband and his moron best friend-
- Will you stop calling me a moron?
- Moron best friend.
- Separate them.
- Decide to build some kind of big gun.
- We get an exact replica of the finest
Allied anti-tank weapon of World War II.
- And they try to shoot the thing.
- I'm the gunner.
James is the loader.
Okay, we followed the specifications exactly.
You should see it.
It's a 60 millimeters, one and a half pound rocket.
- Where is Grey's Anatomy's hospital? Seattle, right?
Yeah, missiles aren't legal in Seattle.
I don't need to look that one up.
- He shot himself with a bazooka.
- Like I said, morons, the pair of them.
- Was there an explosion?
- Huh?
- Was there an explosion?
- No. Why?
Oh, crap.
- How did these guys make a real missile
in their backyard or garage?
- Hannah?
- Yes, Dr. Burke?
- What do you feel inside of Mr. Carlson?
- Preface that with please do not move or remove your hand
before asking what you feel,
'cause the natural instinct of a human,
when someone asks what do you feel is to do this.
Do not do that near a bleeding artery or a bomb.
Fact you learn on this channel.
- Is your hand touching anything hard?
- Um, I don't know.
- Don't move your hand.
- A little late, bud.
- Hannah, I don't want you to move.
- Okay.
You should know you're starting to scare me.
- I would've been a little bit manipulative in this case,
explained that we're very concerned about the blood vessel,
and I would put the pressure like that,
because by worrying about her own life,
she could faint, lose control of the hand,
and then, boom, literally boom.
- Go and tell the charge nurse that we have a code black,
and then tell him to call the bomb squad.
- Every hospital has their own code structure,
like on the back of my badge, you could see,
if it flips over, there's like the emergency codes,
and what each one means.
And I'm pretty sure each hospital has their own designation.
There's no universal one, although code blue
is usually the one for someones heart stopping.
- So I'm touching live, unexploded ammunition?
- I'm afraid so.
- But he's not hooked up to the machine anymore?
- I had Dr. Milton take him off the ventilator.
The flow of oxygen posed a danger.
- Did they have to immediately evacuate
the entire hospital?
Because like, there's oxygen tanks everywhere,
which if there's an explosion, is a very big problem.
Oxygen itself is not necessarily flammable.
It's an accelerant for flames.
The more you know.
- They want us to evacuate.
- Evacuate? Did they say why?
- No, but your pager said code black.
(dramatic music)
- We're sure they said that?
- Yes.
- Could be a drill.
Even if it's not a drill, I can't evacuate.
I've got an open brain on the table.
If anybody wants to go, they should go.
Anybody wanna evacuate?
Going once.
- How 'bout tell people what they're evacuating for.
Like he didn't even give the full story,
and he's like, do you wanna leave?
Tell us why.
What page did you get? What's happening?
Give us more info.
- Dr. Shepard, there's an explosive device
in the OR next door.
I need you to evacuate now.
- Yeah, and I've got a guy whose brain
is exposed on this table.
I'm not gonna walk away and leave him to die.
- I mean, you could reposition him to a safer area,
at least not next door to where the bomb is.
- Pink mist.
- Excuse me?
- That's what the bomb squad calls you when you blow up.
Bomb goes off and anyone in range explodes
into a billion pieces.
- This anesthesiologist has not taken a psych course
in quite some time.
He has a very anxious individual that's keeping her hand
on a bomb, and instead of saying warm, reassuring statements
in order to encourage her and keep her hand on the bomb,
he's scaring the life of her,
trying to get her to vasovagal and pass out on the floor.
- Take this. - What?
- [Dr. Milton] Go ahead.
Now I want you to squeeze it in even beats.
Not too fast.
- Is he gonna leave?
Whoa.
- Dr. Milton?
- I've got kids.
- Oh, that's savage.
- That's it.
- Oh my God.
- Where's the anesthesiologist?
- He, um- ♪ I'm falling down ♪
- He left.
I think I'm gonna take my hand out now.
- [Dr. Mike] No!
- That device, it's homemade, which means it's unstable
and very unreliable.
Could be a dud, but we have no way of knowing.
Add to that the fact that you've got a surgeon
in the OR next door refusing to leave
and a nervous paramedic's hand inside a body cavity.
- Why is this guy running down a list of everything
that's wrong with this situation
and not addressing any of it?
Imagine you went into a doctor's office,
and doctors just rattled off every problem you have
with no plan of what to do next.
Not a very useful doctor's visit.
- I am 22 years old.
I should not even be in here.
This is some kind of mistake.
- She's panicking.
We need to clear the room.
- They need to defuse that situation.
- Just a little while longer.
Hannah. - I have to.
(dramatic music)
- Did she switch hands with her?
(dramatic music)
- Nobody move, stay exactly where you are.
- This is the most useless bomb squad person ever.
I swear, if I was there, with zero bomb experience,
I could've handled this situation better than this dude.
The only thing he's good at is dressing up
as team bomb squad.
Like he's got the boots, he's got the whole combat look,
but no knowledge, no recommendations, nothing.
- Time for you to go.
- No, I'm staying.
- There's nothing more you can do here.
We got it covered.
Cristina, this is not another cool surgery.
This ammo can go off at any time
and kill everyone in this room.
Do you get that?
- If you do not have a role in this situation,
you should not be in this situation.
That is how I would say it, and I would say it quite firmly
and if the person didn't listen,
I would ask the cool bomb squad man for his handcuffs
and address the situation myself.
- So you have a plan, right? (sniffs)
You have a way to get me out of this, right?
- I think this bomb squad guy has never seen
nor learned about any bomb.
I think he got a Halloween costume, showed up,
and was like, damn, wish I studied bombs.
- Emotional damage! (static crackles)
- In the OR, we put our patients on general anesthesia.
- Yeah?
- That involves a steady flow of pure oxygen.
(tense music)
- Yeah?
- Well, can't you turn off the oxygen in my OR?
- I can and I have, but this is your OR.
This is the OR floor's main oxygen line.
- We have to move.
- Okay.
- I can't wiggle my fingers, because we can't shift
the ammo, and now you wanna roll out
the entire gurney.
- Well, that's our safest, safest option.
- What is the concern?
They've evacuated the whole hospital.
You have a person who's gonna die,
whether there's oxygen below you or not.
What is the concern?
The damaging of the equipment?
I think there's bigger worries than that.
First of all, the person is no way gonna make it.
Medically, only in a fictional medical drama
could this happen.
I'm surprised the paramedics didn't start chest compressions
and explode the bomb en route to the hospital.
I feel like the correct move here is,
I think ethically, you have to open up the patient's chest.
He will start bleeding.
You have to get complete visual of the bomb,
and only then, when you're comfortable,
potentially remove it, which means, likely,
that the patient will die, but it decreases the likelihood
that the bomb will go off,
killing everyone else in the room.
But I think only a bioethicist could answer
this question correctly.
If this was on my boards, I would probably fail.
If this was an SAT medical question,
I would not answer it,
'cause a wrong answer loses you points.
- I'm going to extend the wound.
When I cut, the bleeding is going to intensify.
If we're going to save Mr. Carlson,
we have to pull the ammo out immediately.
- Patient's no longer tachycardic up there.
95 pulse.
Doesn't make a whole lot of sense with all that blood loss.
- How is the girl with the bomb?
- It's Meredith.
The girl with the bomb is Meredith.
- That's wifey.
(heart rate monitor flatlining)
Maybe instead of talking about your love interest,
you focus on the patient
who you're operating on their brain.
(heartfelt orchestral music)
At least they're doing chest compressions.
(heartfelt orchestral music)
Maybe lower the patient.
You can't get adequate pressure doing chest compressions
when you're on the same height as the patient.
Oop, he tried the cardiac thump.
Oh, obviously it's a medical drama miracle.
(heartfelt orchestral music)
Now what?
Is my man just gonna hold it and rock it to sleep?
I feel like he didn't even think this through.
He's like, what do I do with it now?
It would've been great if he was like, hey, Siri.
(Siri beeping)
(heartfelt, suspenseful orchestral music)
Where is he going?
Don't bring it outside to where there's other people.
And she's chasing him.
(tense, heartfelt orchestral music)
(bomb exploding) (glass shattering)
No!
(glass shatters)
I expected this to have a happy ending.
- Is my husband alive?
- Yes.
- That's gotta be the most fictional outcome ever.
My man was bleeding out for five hours straight
with two hands inside of his body, and he's just fine?
Even if he's alive in this moment,
he's in the most critical state ever: ICU care.
- Where is she?
- She's right here.
- Yeah, she just decided to chase the bomb.
(Addison sighs)
That's his ex-wife, right?
- Current wife. - Oh, current wife.
But he caught the feels.
She should be evaluated, not just showered.
Like we should give her a full neuro exam.
They're like, oh, let's make sure
she's clean for the next episode.
That was at the same time expected and unexpected.
Pretty impressive.
Did you hear about the eyeball licking craze from Japan?
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and as always, stay happy and healthy.
(upbeat music)