- Today, we are going to be breaking down and reacting
to all the crazy medicine of Chicago Med.
But before we get into it, if you're new to my channel,
welcome, my name is Dr. Jordan Wagner.
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All right, let's dive right in.
(crashing metal) (people screaming)
Ooh!
- Sir, can I see that for a second?
Can I see that for a second?
- Somebody has a head trauma like that,
you're actually worried also about C spine injuries.
If you smack your head and you smack back,
you can actually cause a whiplash injury,
and sometimes you can actually have
your spinous process fracture.
(crowd applauding) (pager beeping)
They still do carry pagers,
or nowadays it's kind of your cell phone.
Different hospitals have protocols.
At any one time, there's only a couple of ER docs
that are working, and then sometimes there's only one
trauma surgeon, so you actually need to pool your resources.
- He keeps biting down, I can't get the blade in.
- This patient is in a C collar,
having difficulty with an airway,
and he's using a laryngoscope, which is a blade,
so he can actually put an ET tube.
- Look, you bag him, I'll do CPR.
- He's talking about bagging him using a BVM,
or a bag valve mask.
The issue with that, is it's not a definitive airway,
and you're also putting air into the stomach as well,
which then can inhibit blood flow back.
If you can't intubate and the patient needs you
to breathe for them, you have to cut open their neck.
You're cutting through the cricothyroid membrane,
and shove a tube in, and it's a bloody mess.
It's going to save somebody's life, you have to do it.
(heart monitor flatline beeping)
Oh they're doing CPR, okay.
- We're almost there, it's not time yet.
- The guy doing the bag valve mask, or the BVM,
is doing it like every second, don't do that.
How many times do we breathe a minute?
12 to 20 times a minute.
People get excited and then just start pumping air.
You just need to pump every five seconds or so.
- Already hit him with the Epi times two,
still no pulse, he's in FIB.
- He hit him at with Epi two, what does that mean?
He had two separate doses of Epinephrine
and doing CPR in between.
There's two shockable rhythms; V-fib, and V-tach.
Asystole, PEA, those are not shockable rhythms.
- Get a BP and keep giving him blood,
get his blood gas and get him to the OR.
- No gag reflex, didn't even need sedation.
- If you don't have a gag reflex
and you're not paralyzed or sedated,
that means that there's some injury to the brain,
decreased oxygen at that time.
We don't know the outcome in that specific situation,
but typically brain death, it's hard to determine,
you can check pupils, that sort of thing.
Definitively it's over a couple of days.
Oh, he's doing an ultrasound.
- This woman's pregnant.
- So in trauma, somebody comes in we use the ultrasound.
We do a test called the F.A.S.T exam,
which is the 'Focus Assessment in Sonography in Trauma'.
They're looking for fluid around the heart,
fluid around the spleen and fluid around the bladder.
So they were probably doing that,
and then they found a pregnant woman.
You want to do your best to save the mother, save the child.
- 20 year old male cystic fibrosis complaining of chills,
labored breathing 10th 98.
- Cystic fibrosis is a genetic disorder.
Over time, increases risk of infections,
limits how well your lungs are actually functioning,
and could actually potentially kill you.
- Mr. Dilson I see that you're using inhaled antibiotics,
tobramycin albuterol, you wear a vibration jacket at night
and use a humidifier?
- So the cystic fibrosis also
has to do with a lot of secretions,
so that's what they're talking about.
The vibration vest to basically help get that stuff out
and get things moving.
They're stiff, you've got mucus in them,
they're not able to clear things out,
increased risk for getting sick and pneumonia often,
hence he's inhaling antibiotics and taking bronchodilators
to open up the lungs.
- Is she gonna be okay? And the baby?
- Baby checks out fine.
- Yep, good.
- Healthy heartbeat, amniotic sac and placenta are intact.
- So pretty good, ET tube is actually the,
that plastic tube coming out of the mouth,
is actually probably a little too long.
It's usually gonna be a little bit shorter,
depending on the size of the individual.
This looks like more like a type of an Aspen collar,
so there must've been some sort of cervical injury.
The vital signs on the machine look pretty good,
a little tachycardic, a little hypotensive,
but it's actually to be expected in a pregnant woman,
but also to be expected in the event of a trauma patient.
- Gina though, I'm afraid suffered a traumatic head injury.
And so far she's unresponsive.
- Yes. And I'm seeing that there is a ventriculostomy
tube chilling, so it must be a lot of swelling to the brain,
not knowing if there's blood.
The neurosurgeon bores a hole through the skull
and puts this little tube into your lateral ventricle
on the opposite side of the problem.
So basically you're draining out the CSF
to allow more space in your skull,
so your brain can swell a little bit.
Because if you swell in a confined space,
it's gonna cause more issues.
- She's gonna be okay?
- I can't promise anything.
- Then you have the issue-
- What about the baby?
It's too soon to deliver, isn't it?
- [Dr. Wagner] Yeah. - She's only 24 weeks.
- Yes, the baby needs more time.
- There's a potential of the baby surviving,
but the baby needs to be in the hospital for a long time,
in a growth container.
So the optimal position is to continue to have
the baby grow, but then when they're, it's going to
get into the issue of,
if the person is totally brain dead,
do you keep the individual alive long enough
to get everything that they need grown for the baby,
and then take the baby out.
- Oh, we're gonna lose our child, too.
- No, Miss Donahue, I'm not saying that,
and I'm not giving up on Gina.
But if the worst did happen,
it might be possible to keep her
on life support, long enough-
- I've done this once or twice,
but it becomes an interesting medical legal problem.
- Got your test results back,
I wish they were a little more encouraging.
You're pancytopenic,
which means that your cell counts are low.
- That basically means your bone marrow is not functioning.
- You've got a blood pH of 7.14,
which means- - I know.
- You're trying to adjust, so can blow off the CO2
to increase the pH, meaning making it go to like 7.2, 7.3,
getting a little bit higher.
- I'd like to intubate you.
Put you to sleep, get you on a ventilator.
You're getting fatigued.
This would just allow you to rest
so that the antibiotics can do their job.
- I've been intubated eight times.
I think I'll skip it.
- We get in these situations a lot where somebody would
benefit from being intubated to allow their body to relax,
allow the machine to help and give a break,
but in this situation the kid's been intubated eight times
and just, doesn't want to do it.
We were always taught, and it's a very good rule of thumb,
that you wanna intubate when it's a controlled setting.
So if you get to the point where the kid automatically
then stops breathing, or just quickly decompensates,
it's more of a rush situation, it's not optimal.
- Gina's intracranial pressure is rising.
- What does that mean?
- You said that she was getting better?
- Well, she is, in that her function was improving,
but the swelling of her brain is getting worse.
- Yeah, so they want a hyperventilator to get the CO2,
having to do with brain swelling as well.
- If there's any hope of beating it,
I need to get him on a ventilator now.
- There we go again.
- You heard what he said, he doesn't want to.
- We're past what Jamie wants.
- You know what, doctor?
We're actually not past what Jamie wants.
Kid has been so brutalized his entire life.
He has a right to say no.
- As long as somebody is of sound mind,
you explain the risks and the benefits
of all that you're doing,
it's the patient's decision of their own health.
- Intubating Jamie is the only hope we have
of keeping him alive.
- What's that going to give him, a week, 10 Days?
- Every doctor wants to help and do what's best
for the patient, but sometimes doing what's best
is actually doing nothing.
So this patient has a debilitating disease
that only basically can be fixed currently
in this situation by a lung transplant,
but the doctor is saying,
"Well, let's buy him more time."
- Rachel?
Rachel, can you hear me, what's wrong?
- What's happening with Rachel?
- What's happening? - I can't find a pulse.
- Oh!
- Oh my God!
- Why is the kid pulseless?
Don't go, start CPR.
Check the person, check for responsiveness,
check for breathing, check a pulse,
if you don't feel a pulse call for help,
and start chest compressions.
- You're not compressing the heart Sarah,
you got to go harder.
- But she's so small, I don't wanna--
- Harder, do it, let's go!
- You got to compress further down to squeeze the heart.
If you only squeezed down this far,
you really got to compress the heart.
Nice, good. - Come on Sarah harder.
Hold!
There we go, back inside, let's get a BP.
- What happened?
- She arrested, we got her back.
- Nice, good.
Best situation to be in, so if CPR can get the heart back,
then we know that there's something potentially
easily fixable, versus if you're working, working, working,
giving epinephrine, doing shocks,
all these different things,
and it's really hard to get somebody to heart restarted,
then you know you're in a situation where
the long-term outcome might not be favorable.
Kids most of the time arrest due to respiratory issue,
so they're a little bit different than adults.
- Hey Mejuri, I'll get an IO line.
- They put a Intraosseous IV line in,
so that basically goes into your bone marrow.
It gets drilled in.
You can give all the normal meds you give into that area.
And basically, hopefully you give enough volume,
then it plumps up the other IVs
to get better access somewhere else.
- Good job.
- I just broke a little girl's ribs.
- It's okay, that's normal.
- Reese, you saved the girl's life.
- Probably not doing CPR deep enough
if the ribs aren't broken.
Once the ribs break, then it's a lot easier.
It's just a weird feeling.
They are C looking pieces of bone that are attached
to the sternum that you need to break down.
- The crash victim I've been treating has died.
He's matched for Jamie.
- Well let's get him some lungs.
- Only thing, his fiance won't give consent.
- If somebody passes away, we do find out
and ask if the patient is an organ donor.
- Without new lungs, he will die.
- Wait.
(speaking in Spanish)
Yes.
- That was pretty intense, and the emotion behind it.
Super rare that it would happen,
super rare that this kid's getting a lung transplant.
I'm glad.
I've never seen the show, but this is like, really good,
pretty medically accurate.
If you guys really enjoy me reacting to Chicago Med,
definitely gotta check out this video right here.
And as always make sure you subscribe,
turn your bell notifications on, like the video.
Thank you so much for watching, and stay healthy my friends.
(beep) (upbeat music)