- I've shared some pretty wild stories with you guys
through the years on this YouTube channel,
but I thought we'd watch a very popular show called
"Untold Stories of the ER".
But before we get to it, I have to urge you.
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Let's get started.
Bee-woop!
- These are the real stories of the ER
that doctors never talk about.
(laughs) - Already!
I'm gonna call BS on that one
because ER doctors love sharing their stories.
This isn't even about ER doctors.
Doctors love sharing their stories.
And I know many people will jump and say,
what about HIPAA?
What about patient privacy?
If we don't give the patients identifiers,
their name, their date of birth, a picture of them,
it's totally okay to talk about their case.
Otherwise, how in the world would doctors ever learn?
We have to talk about cases.
- Are you alright?
(screams)
- It's Scott Reed, I'm a paramedic.
I said, send the ambulance routine.
We don't need lights and sirens.
We don't need the fire department.
Just send an ambulance routine,
I think she just fainted on the bathroom floor.
- If this ever happens to you,
call 9-1-1 and tell 'em to bring everybody.
In this situation, it's quite specific
'cause he's a paramedic, he knows what's going on.
I prefer that right away you call for help.
If a person's unconscious and you aren't sure,
start chest compressions.
That could be a difference between saving their life
and them losing their life
just because you were self-conscious
or weren't sure if you should do chest compressions.
If you aren't sure, the person's unconscious,
you've called for help,
chest compressions, chest compressions, chest compressions.
- [Operator] We're on route with a 38-year-old female
who's had a syncopal episode.
She's semi-conscious.
Blood pressure is 60 over 40 and dropping.
- Okay, so that's the most dangerous part about all of this.
The fact that her blood pressure's dropping
means that she's not getting enough circulation
to her vital organs.
Think brain, kidneys, liver.
And when that happens,
the only option for us, in the medical community,
is to give a ton of fluids to increase the blood pressure
into the circulatory system.
If that doesn't work,
our next resort is to go to artificial pressers
which are basically adrenaline-like medications
that cause all your blood vessels to constrict really hard
to raise the blood pressure
to make sure that the blood reaches everywhere in your body
that it's supposed to.
If that doesn't happen in time,
that could be a cause of death, it's called shock.
So basically she's going into shock and we don't know why.
- An ECG, a stat, portable chest x-ray.
CBC, E7,
(nervous exhale) Troponin, a D-Dimer, an ABG.
The stat did say cardiology consult.
I need an Echo right away please.
- Okay so all these tests that he's ordering all make sense,
these are all the tests that you'd want to know
just to possibly get an idea of what's going on.
When a patient comes into the ER,
you don't know anything.
You don't know if they're anemic,
you don't know if they have an infection,
you don't know if they have an pneumothorax.
Has their lung collapsed?
Is she having a heart attack?
So you need all of these tests done as quickly as possible
so you can slowly start stabilizing the patient
and creating a course of action.
- She's apneic, we're gonna lose her.
Bag her, bag her.
- So when a person loses consciousness like that
and they're out of it
and you have to breathe for them,
right away that's a sign that
that patient may need to be intubated.
Intubate is when you put a breathing tube down for them.
Obviously, the most important part of that
is to help them breathe.
But the second most important part
is to protect their airway
because if she were to vomit,
then that vomit can go right into her lungs
and cause even a more serious problem.
When a patient is unconscious,
they don't have a gag reflex to protect them
from inhaling vomit.
So that's why we rush right away to intubate.
- Yet, for Dr. Christopher Michos.
- This Dr. Michos needs to tell me
what's going on with his scrubs.
I like cool scrubs,
but I don't know what's happening with those.
Maybe this episode is from a really long time ago
and those were in then.
I think I'm gonna have to make him like,
send him a sample of my upcoming scrub line.
- His face and whole body was covered in hives
and he was retracting.
His muscles were being pulled into his chest.
This is a critically sick child.
The serious medical condition known as anaphylaxis.
- So two things happen during anaphylactic shock
that are very dangerous.
One is that the oral airway starts swelling
and when that happens, obviously,
you can lose your ability to breathe.
The second thing that happens is because you have shock,
all of your blood vessels dilate,
and therefore it drops your blood pressure.
This is another form of shock that can be quite deadly
'cause again you're not perfusing and getting blood flow
to all your vital organs.
Anaphylaxis is deadly.
That's why we hand out epi-pens to all of our patients
who have gone into anaphylaxis
or are at risk of going into anaphylaxis.
That's why when epi-pens are expensive
and people can't afford them,
I get really mad.
- We gave him additional antihistamine.
We gave him intravenous steroids.
- So antihistamines are great for an allergic reaction
but they don't do anything to treat the symptoms
of anaphylactic shock.
What you really want to do
is make sure that the patient has a secured airway
and that they're getting enough blood flow
to all their vital organs
which can mean giving them a ton of fluids or pressers.
- It was about 3:00 AM on a Saturday night
and the bars had been let out,
most of the trauma that you're gonna see has come and gone
and it gets quieter in the ER.
- That's actually true.
When you're on-call, you do have this eerie silence
that starts setting in around 3:30, 4:00 AM
and that's usually the time where before our morning rounds,
if you're on a 24-hour shift,
maybe you can sneak in a one-hour nap.
I will say that after that nap, you tend to feel worse
'cause you wake up and you're just jarred
and you want to continue sleeping.
So my general advice for medical students, residents
or anyone who's doing those types of shifts,
keep it short.
Do a 30-minute nap and then get up and do some work
because if you start entering the REM cycle
and come out too early,
that could be really problematic
and you'll wake up all groggy.
- [Nurse] 18 years old, missing left forearm.
Didn't do vitals yet.
- [Doctor] Okay, Becky get vitals.
Let's get him on the bed.
- Did any of those cuts,
are they on the abdomen?
Did any of them go into lungs?
Into the stomach?
Anywhere that we need to deal with right now?
- The first thing we do in these types of trauma situations
is undress the patient as quickly as possible
'cause it's very easy to miss a wound
if you don't have the patient there completely naked.
And that sounds like a weird thing to do
but if you step one foot into any level one trauma center,
you will see the first thing doctors do,
take scissors and cut off all the clothes.
We need to see if they're bleeding from anywhere
because if they have a puncture wound in their abdomen
and we miss it,
and they're pooling blood into their abdomen,
they can just go ahead and die right in that moment
without us being able to even help them.
- Let's open in chest.
- You wanna do that here?
- [Narrator] The procedure is called a thoracotomy
and it's almost never performed
outside the sterile environment of an operating room.
- I've never heard of a thoracotomy
being performed in an ER, ever.
- Scalpel.
- At least try and create a sterile field.
Don't just say we're gonna open up her chest, scalpel.
Angie doesn't currently have a pulse.
I feel like a lot is inaccurate in this representation.
- What did he say?
- I don't know.
You're gonna have to talk to the mother.
- You speak Greek.
- You're Greek?
You speak Greek?
- My wife is fluent in Greek
and she would be happy to help.
I'm in a bit of a situation here and I need your help.
Can you help me translate?
- So this is kind of messed up
because it is a HIPAA violation,
it's like a patient privacy issue.
But in an emergent situation,
perhaps that could be put on hold.
What happens in regular hospitals,
we have translator phones for this
where one person picks up one phone
and the other picks up the other
and through a translator or interpreter,
we can actually have a normal conversation.
I don't know why he needs to call his wife
and get her involved.
- Sometimes it's like a needle in a haystack
trying to figure out what's causing the allergic reaction.
- If a child is having a severe allergic reaction,
an anaphylactic shock,
it's not of utmost important in the ER
to figure out what it was from.
The most important thing is to stabilize the patient
using epinephrine and if that fails,
to put a breathing tube in and then give steroids,
high doses of steroids,
keep the pressure up through fluids and or pressers.
And then later down the line we can start figuring this out.
I'm surprised he started doing all this investigation here.
- Low and behold, I'm looking at the apron
and I'm thinking food.
And not because I was hungry.
Papu, your apron.
Nuts, nuts.
(laughs)
Whenever a doctor is yelling nuts at you,
you're doing something wrong.
- Stay away from those nuts.
He would have to carry an epi-pen to counteract
should he ever come in contact with nuts again.
- Please carry your epi-pens
and make sure they're not expired.
Don't want to be over the Atlantic Ocean
having me stab you with a giant epi-pen
that's not made to be used as an epi-pen,
it's just epinephrine for someone's heart stopping.
- [Narrator] Nurse Penny Reed has survived
an eight-hour open-heart surgery.
- Feeling that my mom might not be able
to be a normal person again after all of that was scary.
- That's the thing, when someone loses their pulse
for that long,
patients' families have questions for us like
how is this gonna affect them?
Are they gonna be the same?
And many times, we just don't have an accurate answer
so the most honest thing we can say is
we don't know, but we'll hope for the best.
Sometimes people don't like that,
but unfortunately medicine is as much an art
as it a science.
- When I woke up, they told me I'd had open-heart surgery
for blood clots and they told me I'd had a thoracotomy.
- You don't always get a lot of victories.
So it was the best moment of my career so far.
- That's one of the great things of being an ER doctor.
When you intervene in a patient's case,
you get the result and that gratification right away.
As a family medicine doctor,
a lot of times I'll give a treatment or a plan
that will take months or years to even come to fruition
when we're talking about weight loss,
reducing cancer risk,
it's not as instantly gratifying as a surgeon
or as an ER doctor
but moments like this are really, really powerful
and hard to come by as doctors.
- [Narrator] Jason Exner still works in the same
small community hospital
along with a new colleague.
- Haha, I can't imagine how many puns they share together.
Hey, if you don't get me my tools,
I'm gonna take your heart back.
Okay that was corny, sorry.
The YouTube algorithm has been a little bit funky lately
so in case you missed my last three amazing videos,
click here for the playlist
and as always, stay happy and healthy.
(upbeat music)