[fast breathing]
[Chuck screaming]
Jamie Lee: I can't imagine having to do that to myself.
Hi, my name is Dr. Jamie,
and I'm an emergency medicine doctor
and content creator at TheStriveToFit.
Working in the emergency room is very fast-paced,
and you see serious complications
like heart attacks, strokes.
Today, we're going to be looking at
some do-it-yourself surgery scenes in movies
and TV shows and judging how real they are.
[tense music]
Drinking saltwater is not an antidote
to any of the poisons that I know of.
However, it can help you throw up.
If you have a lot of liquid in your stomach,
trying to vomit the poison is not an unreasonable approach.
If he's already having dizziness or unsteadiness,
whether it's neurological or cardiovascular effects
from the poison, it might actually be too late.
[dramatic music]
Him putting the pads on himself, as he is
in ventricular tachycardia, that is exactly what I would do.
Any signs of instability, I would shock them.
Typically we have one pad on the front of the chest
and then another one on the back
so that when it delivers a shock, it really is transmitting
the electrical shock through the heart.
The pads that he put on himself are actually pretty small,
so the ones that you see in the hospital
will be a little bigger than that.
Our first priority is getting an IV access
so that we can deliver the medications.
In the absence of having direct access to his veins,
you know, your neck does have a big jugular vein
that you can potentially have access to.
Man: Do we know what it is yet?
Ventricular tachycardia -- digitalis.
They said it was digitalis, which is a heart medication.
I think that was the poison.
In case of digitalis, there's an antidote.
It's called Digibind.
Sometimes you know from history,
and you can figure out what the toxin is right away.
Sometimes you have to send out some levels
and it can take a really long time.
[digital keys clicking]
When you do deliver the shock,
you do see a little bit of a jolt.
I think his was a little more exaggerated, but it is there.
Realistically, the treatment to ventricular tachycardia
and arresting from that is being shocked.
He did get shocked pretty quickly
after losing his pulses and flatlining,
so I think that would've helped anyone.
Once you shock somebody back to life,
they're still unstable, because there's still toxin
and there's still poison inside his body.
So you wouldn't expect them to be functioning normally
and going about their day.
But of course, he's James Bond.
I'm going to give it a 3 out 10.
Woman: Careful, careful.
I really like this scene.
Man: Ugh.
Wasp.
Woman: What's that for?
So he is performing an emergency cricothyrotomy,
one of the more heroic procedures
that gets done sometimes in emergency medicine.
So, if somebody has a closed airway from allergic reaction
or sometimes even smoke inhalation,
one of the ways that you can treat that is
by cutting a hole in your throat and then putting a tube in
and ventilating the patient that way.
I would've probably tried to open the airway first
and see if there's anything else.
They kind of jumped right into cutting the neck, you know,
which is usually our last resort in cases like this.
They actually put some alcohol on the neck
in an attempt to sterilize the area.
So, CDC recommends that you use alcohol
that's at least 60% to 90% in concentration
in order to be able to kill bacteria and viruses.
It's not the best way to sterilize instruments
or the surgical field, but I think out in the field,
when you don't have access to sterile equipment,
that's the best thing you can do.
So for him to just kind of plop the knife into the neck,
I think that's a little unrealistic.
There's a lot of important structures in the neck.
Make sure you are going in the right place.
So you really want to touch and feel the neck anatomy
and feel the place that where you're going to cut.
And normally when we do the procedure,
we make one long vertical incision on the neck
and then you feel the anatomy,
and then you can make a smaller incision
for the tube to go into.
This is an emergency, you know, your airway closes in
and you don't have a lot of time.
The person is unable to breathe.
In cases like this where the throat literally closes in,
there's no space for you to be able
to be backing the patient or even doing mouth-to-mouth.
He's breathing, he's breathing.
That's it.
Also, if someone is not breathing
and someone is unconscious, you want to make sure
that they have a pulse, you want to make sure
that their heart is beating, and if it's not,
you want to do chest compressions
to make sure that the blood is circulating
to the brain and all the other vital organs.
I'm going to give this 6 out of 10.
A puncture wound.
You have it deep -- nicked the artery.
If the doctor hadn't called it a deep wound
that nicked the artery, I think the whole scene
would've been much more believable.
There's a lot of big, important vessels in your neck.
If you nicked one of the arteries in your neck,
that's a big deal.
You're going to need surgery for that,
you don't want to just close up the top and call it a day.
Because the artery that's nicked
is going to continue to bleed.
The doctor was doing simple interrupted stitches,
which is individual stitches to close up the wound.
That's typically what I would do
if somebody had a superficial wound.
It obviously takes some time,
because you're tying off each individual stitches.
[dramatic music]
What John Wick ends up doing is a much faster stitch.
What's called a running stitch is what I'm imagining
he's doing, where you don't tie off every stitch,
but you just keep going throughout the entire length
of the wound.
One downside of that is if the stitch becomes loose,
you basically expose the whole wound
and it can become undone.
[dramatic music]
It's very uncomfortable to have to put a needle in,
a needle out, and tie off your stitches without any kind
of lidocaine or anything like that.
But it's not very deep, you're only getting the skin
with the needles, so even though it would be uncomfortable,
it's not unreasonable that you would do this
without local anesthetic.
Doing it in the mirror, I think, would take a lot
of hand-eye coordination, but it would be possible to do it.
Maybe a 3 out of 10.
Man: What's the matter, you don't think
jockeying papers across a desk is a noble effort for a cop?
Typically, I would not take off the glass with my hands
because you really want to avoid any additional injuries.
You don't really know what you're going to encounter
when you put your fingers in your wound.
So using something like tweezers
or any instrument would probably be better.
John McClane: Pull me down for 20.
So there's a saying that goes, "Solution
to pollution is dilution."
Anytime there is dirt or foreign body or wound,
you can use tap water to kind of really flush it out.
There's actually research that shows how tap water is just
as effective as using sterile saline.
Once you take out some of the bigger pieces
and you wrap it really well, you should be able to walk
on it, unless there is some ligamental or any bony injuries,
and that might make it harder to walk.
But if you really had to, you should be able
to walk on it and just hobble.
I would give it 7 out of 10,
because I think he did the best he could
with the tools available to him,
which is just his hands and running water.
[dramatic music]
No, listen to me, Logan.
So he basically makes an incision on his abdomen.
Not even on his chest.
Has to put his hand through and essentially go
through the diaphragm to be able to reach the heart.
And that's actually just a lot
of damage that you're going to have to fix later.
You're going to have difficulty breathing
that needs to be repaired.
So, that is not the approach
that surgeons would normally take to get to the heart.
[machine beeping]
Yeah, I mean, he just did a major surgery on himself.
There's actually a couple of famous surgeons
that did surgery on themselves.
There's one that did surgery on himself
in Antarctica when he was doing research
and didn't have any access to medical care,
and he had an appendicitis,
and he knew it was going to go bad
unless he took the appendix out.
So he actually performed the surgery
on himself in the '60s.
I would say obviously these are rare cases
and they're exceptions.
[machine beeping]
[heavy breathing]
You can see that his blood pressure is very low.
It's 50-something over 30-something.
And you can hear the flatline beep,
which I feel like is used a lot in movies and TV shows
to indicate that the person has died.
Essentially means the heart is not beating.
He actually flatlined for a little bit,
and he was still conscious
while the flatline beep was happening.
So you wouldn't be awake and saying somebody's name.
You know, you would be unconscious and then dying.
1 out of 10.
Just because it's so preposterous
that he's doing his own heart surgery
by going through his abdomen and reaching in with his hand.
That's just crazy.
[dramatic music]
It looks like the character has a penetrating trauma
to her lower abdomen.
It's a little unclear how much bleeding she's having
from that wound itself.
The extent of the damage really depends on how deep
the glass went and what structures it's affecting.
Are there any major blood vessels?
Is it the bowel that's being damaged from the glass?
That can lead to a lot of different complications.
So one of them would be significant bleeding.
That can lead to death.
The other thing that I'd be worried
about is getting an infection.
[heavy breathing]
[fabric tearing]
When there's bleeding, you want to put pressure
on the bleeding, so I think she did the right thing
by wrapping herself.
In her situation, where she doesn't have access
to the hospital or medical care,
I think leaving that in there could potentially
cause more damage just because every time you bump
into something, it can cause deeper damage.
It is a wound that you could potentially die from.
Blood loss and the amount of blood that you see
in TVs and movies, it's always more jarring
and always really leaves a lasting impact on your mind.
But often as long as it is controlled,
bleeding is stopped, and the injuries are fixed,
it's often OK to see a lot of blood.
Your body will make up that lost blood.
This was maybe a 6 out of 10.
We often cut patients' clothes off.
You want to make sure there's no other injuries
to the body, but if they're able to walk
and stand on their own, we usually just have patients take
off their pants instead of cutting them.
Because, you know, it's nice to be able
to save the clothing if you can.
In his case, I think maybe there's just a lot
of dried blood and maybe it would've been painful
for him to, like, peel off the pants.
I think the warm bath is just to wash off the dried blood.
We don't submerge wounds in the emergency room.
I think that can be a nidus for infection, probably.
So you don't want to be soaking in potentially dirty water.
I really like what he's doing with the saline bottle.
He mixed in Betadine and basically made a solution
that he can wash out his wound with.
I actually often do that with my saline bottles also.
So if I don't have a spray cap,
I'll poke some holes on the cap
of the saline bottle to make it into a spray bottle.
He was injecting some lidocaine,
which is a local anesthetic.
It would be hard to see, and you probably have
to do a little bit of digging to visualize
all the fragments and foreign bodies.
That's where the lidocaine comes
in really handy, because you don't want to be digging in.
That's really uncomfortable.
With the lidocaine, then you can do a little more exploring.
In cases of gunshot wounds, we'll often take an X-ray
to see what fragments are left inside the body.
One fun thing that we sometimes do is whenever
there's a bullet entry, we'll tape a paper clip
to the wound site so that when we take an X-ray
we can know exactly where that is.
So we can kind of determine "Where's the entry wound
and where is the exit wound?"
This one, I thought he did a really great job.
He also had access to a lot of real medical equipments
and medication, so I would give it 8 out of 10.
Oh!
This scene is really difficult to watch.
He has a crush injury, and now he's making
the difficult decision to amputate his own arm.
[dramatic music]
He's applying essentially a tourniquet to his arm.
The purpose of that is to prevent the blood flow.
There are big arteries that go
through your arm to supply blood
to your forearm and your hands.
And you don't want to go through the whole pain
of amputating your own arm if you're going
to die from the blood loss.
So you want to tightly tie off the tourniquet
so that it cuts off the blood supply
to the rest of your distal arm.
He has a carabiner that he twists
on itself to make the tourniquet even tighter,
and that's pretty similar
to what a real tourniquet looks like.
There's a plastic part where you can twist
off to make it even tighter.
[dramatic music]
That is a very small knife to be cutting your arm with.
Typically, amputations are done in a very controlled setting
in the operating room, not in the emergency room.
They probably have a bone saw,
rather than having to break your own arm.
Your muscle breaks down, and you can go
into rhabdomyolysis, and you can damage your kidneys.
Your kidneys can shut down.
You can have a systemic illness
from a crush injury like this.
So the longer he stays in that position, the worse it is.
Not to mention the dehydration that he's going through
because he doesn't have access to water.
So this is really just survival.
It's life and death.
[dramatic music]
I love the audio of what it feels like
to really aggravate that nerve.
If you've ever had a pinched nerve
in your elbow, you know it's
a very electrical-like, zinging kind of pain.
So you can just imagine directly touching the nerve
and imagine what that feels like.
So I thought they did a really great job
combining the audio and the visual.
If it were me, because I know
the nerve is going to be more sensitive,
I would just cut it as fast as I can.
I think he's trying to overcome that
with his mental strength
of telling himself, "Don't pass out, don't pass out."
If the tourniquet is on correctly,
then hopefully the bleeding will be a lot slower.
And hopefully it wouldn't be to the point
where he passes out and continues to bleed
and then basically dies from blood loss.
You know, I think in terms of passing out from pain,
that really depends on the person.
Everyone has a different threshold.
I thought they did a great job, actually.
I would give this 9 out of 10.
And I'm sure part of that is because
I know that this really happened.
[waves lapping]
Ah.
You could see a lot of swelling,
and even his face looks a little more swollen on that side.
There is probably a lot of inflammation
and potentially an abscess underneath.
It happens.
People do from time to time come
to the emergency room and often it's obvious
that the tooth just needs to come out.
[heavy breathing]
[metal clanking]
I can't imagine having to do that to myself.
If you're using a skate to take out the tooth,
you risk partially breaking the tooth
or injuring other structures around.
Risky, but I think in his case he had no access to dentists.
I think you could use something similar,
like a sharp pointy knife.
If the tooth broke off and it was still there,
and now he has less of a leverage to use the skate
to take out the tooth, so if it was partially broken
and then infection would still be there.
[man thudding]
He passed out at the end. I would imagine
the pain is pretty strong; you can probably pass out
from that kind of pain.
No, no. Dental procedures at home,
definitely not recommended.
7 out of 10.
I think it's a reasonable attempt, given his circumstances.
Dislocated my shoulder, though. Hold me.
Most of the shoulder dislocations
are anterior dislocations, meaning the shoulder joint comes
out to the front, and then you want to mimic the injury
to be able to put back in.
So there's a lot of pulling down
and then kind of putting it back into the socket.
You need some countertraction,
so I think it helps to have somebody either pull,
or for you to have something to push against
before you put the shoulder back in.
[shoulder clicking]
It's better.
There's actually a very wide range
of presentations when it comes to shoulder dislocation.
It is one of the common things
that we see in the emergency room.
As many people know, sometimes people get
shoulder dislocations frequently,
and they're able to kind of pop it back
in themselves or it spontaneously goes back in,
and they never have to come to the hospital.
In some cases, whether it's someone's first time
or it's just not going back in, it stays out
and it can actually be pretty uncomfortable.
And, you know, everyone tolerance of pain is different.
Certain patients, they can use their arm
normally right away.
For them, it happens a lot, frequently,
and they can kind of deal with it.
And for some people, we put them
in a sling and we tell them, you know,
don't move it until you can go see your orthopedic doctor.
She's strong, and she has good control of her body,
so she probably knows what she can do and can't do.
I would give it a 4 out of 10,
just because I don't know if the motion that she used
to put back her shoulder was necessarily the correct motion.
Thank you for watching.
That's all we have.
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