- No, stop!
You don't intubate first.
Oh my God.
New medical show means new medical reaction video.
This one's called transplant high reviews and Canada brought
to the U S I'm excited.
Are you excited?
Pewy!
- I know you don't mean that.
We'll talk about this later.
- I'm gonna play a little medical detective right now.
You saw she was just pulling out clumps of hair.
She said to whoever she's on the phone with that,
she's a little tired right now.
You know what's going through my head?
Two differential diagnoses.
One, hypothyroidism or hyperthyroidism.
Two anemia.
Both can cause fatigue and hair loss.
And as part of the workup that we do,
when someone comes in with hair loss.
Now that doesn't mean it's the most likely thing to happen,
but those two little pieces of history,
just those two little things, lead me to raise the
probability of those two illnesses.
Something important to know about anemia is,
a lot of people think they need to be pale
in order to be anemic.
And that's certainly one of the telltale signs of anemia,
but it takes a while before your anemia gets so bad
that you actually get pale.
One of the easiest places to notice paleness
in an individual who is anemic is in the conjunctiva,
right outside of the eye, on the inside of the eye rather.
And if you raise up the tongue,
that area and region right there,
could also show discolorations.
But skin is one of the last places to start showing
both anemia and in other case,
completely unrelated to this jaundice.
- Do you made me Sir?
- You made my dinner.
(truck hooting)
- Oh truck!
(groaning)
What have I repeated to you over and over and over again?
If an object gets inserted inside of your body,
meaning like it penetrates your skin,
whether it's a knife, a piece of glass, a pole.
Do not attempt to pull it out on your own
because what happens is that object being inserted
through your skin is actually exerting pressure,
decreasing the speed at which you bleed out.
The number one threat to your life in that acute setting
is blood loss.
And that blood loss leads to low blood pressure leading to
less perfusion of vital organs like the brain, liver,
kidneys, leading to death.
Yes, infections is important,
the ability to move is important,
but all that comes secondary to blood loss.
We stabilized airway breathing circulation.
In fact, that's the ABCs of trauma.
Last thing you want is to start pulling it out.
It's really long.
It was actually putting pressure on an artery
preventing you from bleeding out and boom,
you start bleeding out.
You can't put adequate pressure on it
and you could lose your life.
Oh!
I don't know what in the world he's doing.
If he put his finger on her artery and did not feel a pulse,
he should begin chest compressions, chest compression,
chest compression, is because she's not breathing.
I don't know why he's punching her.
Is he mad?
Chill, bro.
- You have a skull fracture on the same side
as a blown pupil.
(coughing)
Sir?
- Oh my God, tell me he's gonna drill into his head.
- If I don't drill into this depression right now,
you're going to die.
- No, he's not going to die.
You don't know that for a fact my guy.
- I'm not going to let you die here.
- My guy do not drill him with a drill
that has tetanus on it.
Please
Remember what I told you guys about good Samaritan laws
and how, you know, if someone's heart stops or not breathing
and you perform chest compressions?
That even if it's not the exact right thing to do,
you'll probably be protected based on your state's laws.
Yeah, If you drill into someone's head,
that's like murder with evil intent.
I don't even know what that is.
This wouldn't even happen in a hospital.
Like if a patient comes into the hospital
and we suspect that they have a skull fracture,
we don't just start drilling right away.
A suspicion means that it needs to be confirmed.
Like we would do a CT scan.
This is a joke.
- [Man] 29 Years old.
- Okay.
Sir no that needs to stay on, I'm Dr. Lal
I'll be taking care of you.
How many victims were there?
- Man] Five in the restaurant and two on the street.
Vitals.
(indistinct)
Please Sir don't discharge anyone
until they find the driver.
- Can't get this guy's CTBC lights, ABG.
- So the presentation they're giving is quite accurate.
They're talking about the blood pressure,
they're talking about the pulse.
Those are really important factors that tell us about the
hemodynamic status of a patient.
Meaning how well their blood is being circulated,
whether or not they have enough blood volume,
do they lose too much blood?
The fact that his pulse is high could represent that he's
not having enough oxygenation from either lack of blood or
carbon monoxide poisoning from the smoke inhalation.
The treatment for that is giving him a hundred percent
oxygen with a mask, just like this.
It's important to monitor this patient because of his pulse
continues to climb, that means for some reason,
he's not getting enough oxygen to his vital organs.
When we look to figure out what's going on in your body,
we're actually looking at your own body's responses.
So if we see your pulse going up,
we see your body's responding to something
that tells us what's going on.
So when we're diagnosing you,
we're actually listening and learning from your own body.
It's actually one of the most interesting concepts
behind medicine.
- Sir, sir, you need to sit down!
You're bleeding, please help!
- In a level one trauma situation,
when someone's brought into the hospital.
They're surrounded by a whole team of nurses,
medical assistants, patient care technicians.
You have to right away get an 18 gauge IV in both arms,
which is a wide gauge IV to give blood products or fluids
if they need them.
The fact that he's just chilling out in the hallway
like this able to get up is completely false.
- Dr. Jed Bishop, GCS three.
- All right, so this is already a bad medical protocol.
Any time you have someone below a GCS of eight,
you'd want to intubate.
In fact, that's how we memorize it when we study.
So with three means he's not conscious enough
to protect his own airway.
So if he vomits, PSM saliva come out,
it could easily go down the wrong pipe and enter his airway,
thereby causing a pneumonia or pneumonitis.
So you wanna intubate, protect the airway
and oxygenate it 'cause the patient's not breathing
on their own well enough.
Now in this case here, this person is near death.
So that mask that's on them
is not adequate breathing support.
- [Woman] Alice!
Alice!
She lost consciousness.
- Right here, when they say she lost consciousness,
someone should be checking for a pulse.
And if there is no pulse, what are we doing folks?
I think the merge has got to come out at this point,
we're chest compressing, chest compression,
chest compression, a hundred beats per minute,
two inches deep we're saving lives.
- Let's get him on oxygen, I need fifty ketamine ideal push.
(machine beeping)
- We wanna Jay synchronized charges-
- Stop charging, do chest compressions!
You just talking about ketamine and all this stuff.
Bring her back to life
before you start administering these drugs.
You need to switch
to advanced cardiac life support right now, ACLS folks.
- Let's intubate first.
No!
You don't intubate first.
Literally you take an AMBU Bag,
you put it over their face,
you secure it and you squeeze the bag
while you perform chest compressions.
Once your two minutes of chest compressions are up,
you check for a pulse again
at that point you begin intubation.
You could even try and do intubation at the same time.
Like you don't, You it differently!
Aah!
- I think he's got a drill hole in his skull.
- Significant epidural hematoma and cerebral edema.
You need to get that to Bishop up to the Overhall now.
(laughing)
- I'm only laughing because I can't imagine what's going
through their heads.
Why do they think he has a drill hole
through his skull at the given moment.
Cerebral edema, swelling of the brain and epidural hematoma
is bleeding in the lining around the brain.
There's so much happening in this scene
and I'm so stressed out.
I'm gonna calm down.
I'm gonna woosah out a little bit.
Woosah.
- [Dr.Jed] He needs a craniotomy.
The bacteria what's left of the hematoma
and really swelling.
- Craniotomy is literally what you think it is.
It's removing a piece of the skull
in order to allow the swelling to come out,
some of the blood to come out,
and therefore allow the pressure to be released.
It's actually a really important part of surviving
close skull injuries.
- Can you breathe?
Noah?
I need help!
- Thank God they have a patient who is a doctor
because apparently there's not enough doctors
in this level one trauma center.
- Hey, I need a doctor!
- The child needing the Heimlich maneuver
inside of an ER with nurses and PCTs all around.
Why did it take a patient who's bleeding himself to go help?
- Were you in that restaurant
where my patient's heart stopped?
I need to know what happened.
I mean, whoever brought her back,
I just don't see how everything he did is possible.
Did he punch her in the chest?
- He did.
- The precordial thump I've never seen it work before.
- You know why she hasn't seen at work?
Because we don't do it.
We do chest compressions and we buy time
for people with a defibrillator to come back.
Or if a defibrillator is that necessary,
we give epinephrine.
We don't just punch people in their chest
because that is something that has proven
to be less efficacious than chest compressions
and medications or even the defibrillator.
(life support machine beeping)
- Which one of you is monitoring this patient.
- I was.
- Doing airway.
Mr. Cardigan was waiting on a cardiology consult.
- Get the ultrasound.
- Oh my God!
Why are you waiting for a cardio consult in the ER,
when you have a patient that has a trauma to their chest?
Oh my God, there's so much wrong with this.
- Till no pulse.
- What's the ultrasound see megs?
- Okay, she's got a large pericardial effusion,
she oozes the fluid out now.
- No wander!
Why didn't we do a fast scan before?
ER doctor fluid in the pericardium needs to get drained,
otherwise you have cardiac tamponade
where actually the heart gets so much pressure on it.
Can't beat effectively.
- You're saying Alice de Marco needs a heart?
- I think the question is why you aren't.
- Because we shouldn't jump to surgery.
I mean, we don't even know why this is happening to her.
If the cause is manageable,
we'd be giving her a heart she doesn't need.
That's crazy.
- Yeah, I know you want all the data,
but while you're waiting on cardiology,
that woman nearly died.
- This is pure nonsense.
You can't know that someone needs a cardiac transplant
after doing a quick ultrasound bedside.
It's ridiculous, it's joke,
a further workup needs to be done.
A proper thorough history needs to happen.
You don't know why she had that fluid there.
So a cardiology consult is appropriate now not then
when you should have scanned her heart
to begin with to see why it stopped.
- Emma, Emma is this your mother's baby?
- You didn't know?
I thought I told that nurse.
She was pregnant when my dad got sick.
It was in plant, but she was so happy.
And how was it?
- Well, I think your mother has,
what's called a postpartum cardiomyopathy.
It's a rare heart condition that can develop
after having a baby.
- God, how do you diagnose that?
This is one of those moments where TV and real science
completely collide.
Should this be in the differential,
meaning the list of potential illnesses?
Absolutely.
Should you jump and assume that it's definitely that
and tell the family that it's that before you've done
any confirmation tests?
No, it's just not in the way we do things in hospitals,
Because if we constantly had an idea that it was something
and we pitched it to the patient, it was wrong,
and then we said something else, and it was wrong.
Patients will lose faith in us.
And that's why we have a list of things that we're actively
trying to rule out or rule in.
And sometimes it's a combination of two things.
Life is never that simple or straightforward.
Are you a fan of medical dramas?
What about scrubs?
I put a playlist together for you here,
or if you want to learn a little bit more about me
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and as always stay happy and healthy