Flatline. Movies love this.
Whenever there's a flatline, they like shocking it.
It's essentially like trying to
jump-start a car with no battery.
Hi, my name's Randy Li.
I'm a paramedic here in New York City.
I've been doing this for about 11 years,
and my role as a paramedic
is to provide prehospital care to patients.
Today, we're going to be looking at medical emergencies
from movies and TV and judge how realistic they are.
[Stuart chocking]
Stu.
Oh, he's choking.
The character is choking on a shrimp, apparently.
He never did the universal choking sign.
He definitely stopped making any kind of noise,
so that's definitely a sign.
People who are like, "Ah, I'm choking, I'm choking."
Or they say, and they kind of cough,
or they're making this audible noise, and you're like,
"Well, you're not really choking. Air's moving."
No sound was coming out of his airway.
So you can tell that there was no passage of air
one way or the other.
Mrs. Doubtfire runs over, begins doing abdominal thrusts.
In my protocols, that's exactly what you would do.
That position is correct.
The hand position is just above the umbilicus,
where your belly button is.
I couldn't see perfectly well
because obviously Pierce Brosnan's character has clothes on.
But if you're right around the belly button,
just a little bit higher,
that's where you're supposed to be.
Then do a J motion upward,
which pretty much would look like
what Mrs. Doubtfire was doing.
Depending what system you work,
there are five back blows
that are associated with it as well,
before they do the Heimlich or abdominal thrust.
The five back blows is not something we deploy here,
not in New York City.
And none of it's considerably wrong,
it just happens to be what works in your system
for what patients you encounter.
Come on! Come on!
Lifting, that's wrong.
Even if the patient was very, very small
and you could easily lift somebody up like that,
I just don't see where the benefits would be.
This is already considered a fairly dangerous procedure
because you can, you know, break ribs.
I think there were some cracking sounds in there,
so maybe he broke his back.
Abdominal thrusts, back slaps
is considered a first-aid treatment.
I think it's a fair enough example,
but you're best off to actually take a proper class
and not reference something from TV or a movie.
I gotta give it a 5.
I like it. It's Robin Williams.
Find her heart.
I'm giving her a shot in the heart,
so I guess it's gotta be f---ing exact.
I don't know exactly where her heart is.
I mean, I think it's right here.
Come on, man, hurry up!
Oh, I know this scene.
That's just wrong.
Adrenaline's also known as epinephrine.
That's not the first line of treatment.
The medication is fair if the patient was in cardiac arrest.
This is a heroin overdose, and that's definitely not right.
We would give something called Narcan. Naloxone.
That can actually be delivered three different ways.
From a civilian standpoint,
they actually do have these kits.
You can give that intranasally, so right through the nose;
intramuscularly, through the muscle essentially,
like they arm; and then IV.
You wouldn't have to necessarily stab it through the chest.
All right. All right, tell me what to do.
I've never marked anyone's chest with a marker.
That's weird. OK.
The marking is actually pretty fair
in relation to where the heart is.
There's this misconception
that it's, like, all the way over to the left.
So if you're doing Pledge of Allegiance, they go this far,
like this is where the heart is.
It's actually about right here,
just slightly over to the left.
Ready? One.
[gasps]
They always like doing this stuff.
It's great for film. It looks super dynamic.
I can't imagine ever taking a medication,
just, pop, stabbing him in the chest.
It's not how it works.
A variety of things that can go wrong.
When we deliver medication, it's to the bloodstream,
so it circulates the body.
Now, if you just hit the heart,
then it disperses in a completely different way,
and you might miss.
I mean, there's bones, there's a sternum in the way,
there's floating ribs, and ribs in general.
There are ways to do something like that
where we establish something called
intraosseous access in the chest.
That's basically drilling a needle
into the chest plate, into the sternum specifically.
And then that gives us access to give medication.
To stab it through bone like that person's suggesting,
that doesn't happen.
[Mia yelling]
I've never treated anyone that just
straight popped up like that.
In terms of an epi thing or adrenaline thing,
they generally kind of just breathe a little bit faster
and their heart rate increases.
But with this being that it's a heroin overdose
and then you give Narcan, it's a slow response.
And you'll have some respiratory responses first,
then consciousness should come back
if they were knocked out.
It's not like drinking 20 energy drinks,
where you just pop up.
I'll give it a 2,
because they said the heart was on the left
and the rest was weird.
Resnick and Dr. Farcy, we're trauma surgeons.
Show us what you got.
You can see the abdominal area's really swollen.
I'm thinking there's internal bleeding.
The telemedicine part's cool.
My system is starting to utilize that kind of thing.
It could be something as simple as a cellphone or a tablet,
not a tablet like hers, that was really fancy.
All systems currently have a system
by which you can communicate with a doctor.
However, the doctor's usually specifically on call for that.
They wouldn't necessarily be on the golf course.
"Oh, look, trauma's coming in."
No, they have to be dedicated for that specific thing.
I'm going for the skin.
OK, I'm cutting. Randy: What?
She uses shears like these.
We use this specifically to cut clothes.
At no point have I ever used this to cut
a body part or skin.
Also, it's actually ill-advised
to ever cut off any kind of flap of skin.
Let's suppose maybe there was an amputation.
At no point are you supposed to cut that off
to, like, get it out of the way.
I need you to blunt dissect with your hand, right?
Mm-mm. Mm-mm. Negative.
No, no.
We don't do surgeries in moving ambulances,
or not-moving ambulances as well.
It's not a sterile space.
It's probably pretty dirty, honestly.
If you're going to be opening up somebody,
if you're not treating with antibiotics,
you might save them for the moment,
but then they'll die of an infection.
But we will take care of gunshot victims,
and depending on your system,
the rules change slightly differently.
In my system currently, we administer a medication
called TXA, tranexamic acid,
that basically forces blood to coagulate.
So it can kind of hinder the bleeding process.
But there's not really much we can do outside of that.
What our main job is, to get them to the hospital,
where they can actually do this safely.
Slow down, man!
We have a live operation back here, just slow down!
Sure, that's a problem.
There's always this old trope for EMS,
you know, doing the same thing the hospital does
but at 60 miles an hour.
And that's true, we do do that sometimes.
We're always taught to drive
with something called due regard.
We are allowed to speed a little bit,
we're allowed to, like, go past red lights,
but you have to do it in a really, really smart way.
You have to be safe about it.
I've just straight-up yelled at the driver,
"Stop, count to 10, then go again."
For those 10 seconds, I have some time
to do my IVs and whatever I need to do.
I give them points for having telemedicine.
2?
I am so sorry.
Yeah, that's called murder.
He stabbed her!
No paramedic out there is going to stab someone.
I'm assuming it was something like a tension pneumothorax
where they had to release the air.
That basically just means that you have air trapping
in your lungs and it's expanding, expanding, expanding.
And this is the one time you'll ever hear about
a paramedic stabbing someone in the chest, essentially.
But it's with a really specific tool.
If you're using something like this,
this is a decompression needle,
so that's the needle that you would utilize.
So, you would find your landmark.
There are essentially two locations.
One's down the midclavicular line, so mid-clavicle.
And there's another spot down the midaxillary line,
so on the side over here.
At that point, you would then remove the needle itself,
and then this plastic piece would stay there.
That's how you release the air from the lungs.
Using a knife to do it doesn't work
because you're essentially going to be cutting the lung.
The lung won't have the ability to reinflate again.
[Furiosa wheezing]
Why is she making that noise?
In terms of the wheezing,
I'm pretty sure that's just done for TV
to make it sound like there's some kind of breathing issue.
Wheezing itself is usually associated
with something like asthma or anaphylaxis,
like an allergic reaction.
It's just not the symptom or sign
that will come along with a tension pneumothorax.
If you were listening to lung sounds
for someone with a tension pneumo,
you would notice that there's diminished lung sounds
on the affected side.
What kind of needle is that?
It looks like a bone.
It doesn't look like the needle was clean.
So, this is an actual IV catheter.
It's in a sealed bag. So this is clean.
I can open this right now and use it on a patient.
There's also something we apply,
some people call it a tourniquet,
we call it a venous-constricting band.
It'll allow your veins to kind of pop up a little bit more
so you can make sure you actually hit the vein.
Because that's specifically why you're doing IVs.
He took a needle that kind of looked like a bone
and proceeded to poke himself,
and then proceeded to poke Charlize Theron's character.
I, personally, as a paramedic here in New York,
do not do blood transfusions in the field.
I gotta give it, like, a 1.
As paramedics, we don't hurt our patients,
so the fact that he stabbed her,
you get sent straight to the bottom.
Palmer: What happened?
Strange: Stabbed. Cardiac tamponade.
Yay, Marvel stuff.
Dr. Strange walks in, and he says, "I'm cardiac tamponade."
Basically, that means you have blood surrounding the heart,
and it's restricting the heart from actually pumping.
How he knows that is beyond me.
Quite honestly, this is one of those situations
where we really can't do that much.
The big benefit of us showing up would be,
through our assessments, figure out what it is.
Then we have the ability to go to the hospital,
give the notification early.
Then hopefully that means
they don't have to spend extra time
reassessing the patient again.
Chest cavity's clear.
Oh, percussion. OK, cool.
So, percussing is an actual way to do an assessment.
We're trained in it, to a certain degree,
but it's not the most effective thing, in my experience.
Basically, you're checking for, like, hyperresonance,
or basically just the way it sounds.
If you thump somebody in the chest and there's fluid,
then it would be a lot more solid-sounding.
Hyperresonance would mean that it's hollow,
and it sounds a little bit different.
I would probably just take my stethoscope and listen in,
and listen to see if the heartbeat sounds
are a little more muffled versus not.
She is performing a pericardiocentesis.
She did the right procedure,
taking the needle, putting it through, essentially,
the chest to get to the heart to drain out the fluid.
I don't personally know how to do that,
because that's out of my scope of practice.
I just know what it is.
I would imagine, though, you would normally use
some way of scanning, maybe an ultrasound,
so you could see where the layer of the heart is
versus the little membrane on the outside
where the blood might have been accumulating.
So this is why it's a doctoral procedure,
not a paramedic procedure.
While we do have ultrasounds on the ambulance,
depending where you work,
in our space it's just too dangerous. Things move.
Oh, yeah, yeah, yeah, yeah. Flatline, good.
Let's shock this. This is not a thing.
Flatline, movies love this.
Whenever there's a flatline, they like shocking it.
The whole point of defibrillation, shocking a person,
is to stop V-tach or V-fib,
where the electrical conductivity of the heart,
it's going all over the place.
So you defibrillate it
to allow the heart's automaticity to take over,
to basically reset it back into a regular rhythm.
When there is no rhythm, there's nothing to shock.
It's essentially like trying to
jump-start a car with no battery.
Also, the paddles, great for TV. Super cool-looking.
I'm sure there are still hospitals out there that have them,
but it's not great for us as prehospital-care providers
because there was a very specific way you had to do it.
You had to put the gel on, you had to put it on the chest,
you had to do, like, 15 pounds of pressure
to make sure it was even, and then, pff, shock them.
We have the actual electrodes that just go on there.
They're safer, more efficient.
I kind of want to give everything 2s.
But I gotta give it a 2. I gotta do it.
I didn't know what to do.
The bike's crushing the guy,
but I didn't think I should move him.
You tell me.
I personally have gone to motorcycle accidents
where very similar to this have happened.
PD does show up first sometimes.
In this kind of situation,
I'm pretty sure they would've done the same thing
this police officer did.
They would've held off, because it's considered a procedure.
You don't know what's happening underneath,
because what if maybe this motorcycle's
sitting on top of an injury
and restricting it from bleeding more?
So they know we're coming
and then we'll just take care of it.
On three.
One, two, three.
In terms of removing it, the motorcycle, it seemed fair.
When they removed it, they noticed there were
other injuries, and obviously that's why
you remove the motorcycle, to basically give you access
to the patient to do assessments.
That's the only thing that's a little bit sketchy,
is the fact that they removed it from the patient,
they went over his head.
You wouldn't do that.
You would probably go towards the feet or away
just because there have been situations
where vehicles and things had to be elevated
so we can remove a patient out,
and unfortunately there have been times
when that elevation process failed
and it went right back down.
You would generally try to avoid any kind of area
like the face, the head, just in case there is a mishap.
Popping on a tourniquet, OK.
Tourniquets are utilized to basically stop
any kind of arterial bleed, big bleeds.
That didn't look like an arterial bleed to me.
He could have been staging,
meaning you put the tourniquet in the right place
but not tighten it all the way
just in case something happens down the line.
But yeah, that was OK.
It looks like the leg that was tourniqueted was also broken.
It must have been visually broken
for them to automatically start putting a splint on it.
So that's fair treatment.
I'm going to give him air.
See? Shears being used for shear purposes.
Oh, my God, you're not holding stabilization,
you're killing me.
That's weird, but not terrible.
Removing of the helmet, that was good.
Techniques change from person to person
on how they like to do it,
but I think that that was overall pretty fair.
They kind of flubbed a little bit
in terms of holding the C-spine, holding the neck,
so it didn't kind of jostle.
They were doing, like, holding from the back of the head,
to not twist left or right.
Basically hold it in place like that.
Normally when I do it, I hold the side of the head,
like ear-to-ear kind of area, and hold it like that.
But that could just be positioning, where they were.
That's essentially a little bit forgivable.
Don't move. It's OK.
They did put on the C-spine collar,
the cervical-spine collar, correctly.
It was a fair height.
You generally want it where
not that the head's too high up
and not that they have this ability to look down
and kind of swish their head around.
Because if there are spinal injuries,
you don't want them twisting around and causing more damage.
That's something I would do, 100%.
Little flubs here and there, but the truth of the matter
is when we're working in these environments
and doing these kind of scenes,
stuff may not go perfectly every time.
It's a 9. Easy 9.
[man panting]
Breathe.
One, two, three, four, breathe!
I think that the patient's in cardiac arrest.
So you would continually do CPR,
but that technique is terrible.
His CPR was super inconsistent.
He did five, then he stopped,
and maybe he did a couple more, then he stopped.
There's this threshold of compressions you have to maintain.
You're squishing, essentially, the heart
to pump blood through it.
You're supposed to do it about 100 beats per minute.
"The Abyss" was made back in the '80s,
so protocol for CPR ratios have changed since then.
How we practice it now,
you're supposed to do 30 compressions
on an adult patient in cardiac arrest.
And then you can have that little threshold
where you can stop to give ventilations.
So, that's questionable.
I just don't see the point of doing something like that.
Using a bag-valve mask is always going to be better
than going mouth-to-mouth,
which will allow for more oxygen to be delivered
versus mouth-to-mouth.
Ambient air has 21% oxygen. You exhale out 16% oxygen.
And then with the BVM, the bag-valve mask,
you can actually connect it to oxygen
and then deliver nearly 100% oxygen to the patient.
But if you're a layperson
and you're trying to do CPR on someone,
then hands-only CPR is a thing.
Now, other systems, they may not do that.
Maybe they still encourage mouth-to-mouth.
But according to the American Heart Association,
we do hands-only CPR.
There's enough oxygen in the blood to circulate
to buy you some time for advanced life-care support.
- Come on, baby. - Clear.
Come on, baby.
Clear!
You would definitely do the defibrillation,
but I don't know how they're looking at the heart.
There's no electrodes on her,
they're not representing any kind of EKG
that obviously reads electrical data of your heart.
So could've been another flatliner who got shot?
Maybe.
You've never backed away from anything in your life,
now fight!
Fight, fight!
Oh, my God. He just slapped her!
I've never just straight slapped somebody
and had them wake up from a cardiac arrest.
If you take it from the value of what they're doing
and not how they're doing it, not the worst.
I'm going to give it a 3.
LAFD. Open up, please.
This is not OK!
Oh, it's a Smurf.
I've seen people that kind of blue too,
but usually it's more like the tips of their fingers
or lips, around the eyes and the face,
because you have a little bit of cyanosis,
less oxygen perfusion.
You just don't have enough oxygen going through your body,
so you look blue.
Have you taken any colloidal silver supplements?
What? No.
So, they first asked about colloidal silvers.
So, there are these kind of holistic medications
where they actually literally have
flakes of silver in liquid,
but it can negatively affect you
and give you this blue skin tone.
I think it's argyria, that's the effect.
That's why you saw them initially asking,
"Are you taking this silver supplement?"
Because they're worried about argyria.
Any medications we should know about?
Benzocaine, toothache gel. She used the whole thing.
She's seizing.
I got her.
It could be hemoglobin anemia.
To assess a patient so quickly,
they did a really great job.
So, whenever we do scenarios
in EMS school, paramedic school,
we use scenarios where it's like,
OK, you associate one thing with another.
That's how you do your assessment so fast.
When the paramedic comes out with the benzocaine,
benzocaine is a medication to kind of help
alleviate pain from a toothache, essentially.
Automatically, any paramedic who knows about
this disease process,
a very large amount of, like, benzocaine,
you potentially put yourself
in something called methemoglobinemia.
Basically there's this other binding agent
on top of your red blood cells
that inhibits it from carrying oxygen anymore.
In terms of having a seizure with methemoglobinemia,
then that's totally valid, that can totally happen.
I think that's exactly what I would've done.
A patient's seizing and they're sitting in a chair,
put them to the floor, because you don't want them to flop
and then hit the floor. They could hurt themselves.
I'll grab the methylene blue chloride.
It's the benzocaine, what we use
to prevent the body from releasing red blood cells.
They deployed, administered, methylene blue,
which is a real medication.
You deliver it just for this purpose.
It basically turns the blood more receptive to oxygen.
I think it was actually really good.
I like that they explored multiple options
before they got to what it was.
I'll give that a solid 9.
My favorite medical-emergency TV show
was a show that was short-lived called "Sirens."
It was hysterical.
Thanks for watching.
If you enjoyed this video, why not click on the video above?