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FizFashizzle posted:medical stuff. I'm sure LeeMajors has hit a bunch of these points Another point id add here but cardiac arrest is intensely bad for your other organ systems, especially your kidneys—so depending on how long he was in arrest, he can have significant complications in recovery. Manual, or even mechanical, chest compressions are really only effective at perfusing your heart and brain, but very specifically for perfusing your coronary arteries. It’s rudimentary but it works. ACLS rhythms are either “shockable” or not. The sort of R-on-T cardiac arrest we witnessed is most likely shockable ventricular fibrillation or ventricular tachycardia, which has the best chance for rapid reorganization by electricity or “defibrillation.” It’s a good sign they got pulses back on the field but even 5+ min of CPR without defibrillation can cause serious neurological deficits in addition to whatever other medical complications could arise. Luckily it seems like he got really competent care immediately and bystander CPR really saves lives. With his baseline level of health and proximity of resources he has about the best possible opportunity for recovery. But to be a complete realist out of hospital cardiac arrest generally has something like a 0.4% survival rate. Vengarr posted:https://www.procpr.org/blog/training/cpr-length/amp I agree, with the caveat that we tend to paralyze and sedate these folks post-arrest so we can keep the advanced airway in place to optimize ventilations. I’ve had folks wake up immediately and rip their airway out, so we do this aggressively. So yes, a lack of resp effort can be grim and indicate neuro damage but we aren’t going to get information at that level of granularity. Id like to know if his pupils are reactive. LeeMajors fucked around with this message at 13:47 on Jan 3, 2023 |
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Jan 3, 2023 13:43
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BIG-DICK-BUTT-gently caress posted:maybe for unwitnessed events. It's like 10% surivval to hospital discharg for people who experience witnessed cardiac arrests and undergo CPR. Likely higher for this guy since he's young and doesnt have other comorbidities You're right--looking back I quoted traumatic arrest survival from ITLS which doesn't really qualify here (although it is traumatic etiology, this is truly a medical event). I think I last saw 8% for Utstein inclusive medical OHCA events from the AHA, but I'll admit I haven't looked that hard for numbers in a few years. I agree with everything you said here--he has by far the best possible circumstances for survival all around. And yeah, he's on a wave of ketamine or propofol or benzos right now while they keep him nice and cool for another 12-24hrs. We can't really draw any conclusions from him being ventilated still. Like I said earlier though, it concerns me if they were having to perform compressions for up to 10min. VF with an AED nearby should be pretty quickly correctable in this case, as I wouldn't expect it to be particularly refractory. LeeMajors fucked around with this message at 14:56 on Jan 3, 2023 |
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Jan 3, 2023 14:53
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I think it’s an ok question to ask if myocarditis increases cardiac irritability (I’m sure it does) but also commotio cord is is well-known and there’s a clear mechanism and overall it seems weird to do the Joe Rogan Just Asking Questions nonsense over this.
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Jan 3, 2023 15:34
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Every hospital ICU is chock full of geriatric ROSC patients with no Avenue to good neuro outcomes. We absolutely know nothing other than his heart is still beating.FizFashizzle posted:Medical stuff Honest question, are you required any sort of large body trauma life support credentialing as a PA? ITLS/PHTLS all goes into this but athletic trainers (or any medical specialist near specialized clothing or equipment think fire dept, bomb squad etc) have explicit training to quickly remove pads/helmets etc for resus. I’ve got some training on it but pads are designed to remove quickly or with few tools and training staff would know how to knock it out immediately. Typically I think you can cut ties over the chest and immediately have full access iirc
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Jan 3, 2023 15:48
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Cthulu Carl posted:I mean, if it's an underlying issue what got missed or was the result of an impact at just the right moment in just the right place, is there anything they can do? Maybe have EMTs on the sideline, roughly at the line of scrimmage instead of at the ambulance? Let’s just implant defibrillators in every NFL player the day after the draft.
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Jan 3, 2023 16:15
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Apples McGrind posted:alright yeah, i suppose that's fair. All the medical staff is constantly re-evaluating every protocol for safety and emergency response and I guarantee they’ve put hundreds or thousands more hours into it than any of us. Short of banning football of course (probably the only actual solution). Those pads are designed to come off quickly and completely when needed.
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Jan 3, 2023 16:23
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wilderthanmild posted:I think it's because a lot of people conflate heart attacks and cardiac arrest. It’s exactly this
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Jan 3, 2023 16:40
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Apples McGrind posted:also probably one of those situations where the trauma of seeing an event unfold like that kinda just puts you into autopilot mode, and you just sorta follow the checklist you're given. i can't imagine the refs sincerely wanted that game to continue. This is also 100% true and why a huge portion of medicine is broken into algorithms--especially in pediatric care. So much so that a pediatric EM doc in Miami built an entire system around standardizing medication doses for kids based on ideal body weight estimates by rote memorization on your hand (1-3-5-7-9 for ages 10-15-20-25-30kg IBW). In times past, we used length based tape or sat there converting pounds to kgs and trying to remember 100000000 weight-based pediatric doses mid-cardiac arrest while trying to IO a tiny little leg and do compressions on a baby. It's a recipe for disaster (and often was).
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Jan 3, 2023 16:51
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There isn’t an appreciable difference between ACLS in the hospital and in the field and the first 10min are the most critical. It’s hard to effectively resus someone in a moving vehicle and most large services have moved to working patients in place through and entire ACLS algorithm. Post-ROSC is the most fragile time so we tend to hang pressors, anti-arrhythmics, sedate as needed for airway control and make sure we are maintaining pulses. If you lose them again in motion it’s harder to restart the resus without all the set pieces in place.
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Jan 3, 2023 22:38
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It could be either. Ventilation delivery runs the spectrum from full mechanical ventilations, where you set a rate and volume and let it ride, to highly sensitive ventilations that sense your effort and provide assistance. Native breathing is a negative pressure exercise—diaphragm contracts, creates negative pressure in lungs and airbrushes in. Ventilation is a positive pressure action. This can damage sensitive upper and lower airway tissues over time. Tubes going into tracheas make an avenue for infection. He could’ve aspirated before the intubation occurred. He could have pneumo or hemopneumothoraces from the chest trauma of the resus. All resuscitation is extremely traumatic. We absolutely ruin the chest walls of people we compress—and by extension, the organs underneath. It could also be oxygen settings. The normal percent of oxygen in room air is 21%. You can dial that in up to 100% on basically every ventilator I’ve seen for supplemental oxygen, adjust pressure to keep alveoli from collapsing. delfin posted:merely that they've judged that they can take their time and do it completely by the book, given the circumstances and symptomatic evidence. But if they're hauling rear end, all bets are off. I’d caution against feeling that way. Time sensitive maladies (trauma, strokes, STEMIs) will get a 5min scene time but the longest scene times I have are securing airways and working arrests. This falls into the latter categories, and mixing vasoactive agents and paralyzing and sedating folks takes time—and more importantly is very hard to do squealing down the highway. LeeMajors fucked around with this message at 02:23 on Jan 4, 2023 |
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Jan 4, 2023 02:19
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BigBallChunkyTime posted:He's been flipped onto his stomach to relieve pressure on his lungs. Proning was one of those things they used a lot for the worst covid vent patients with ARDS. But again, we don’t know enough to know anything really other than he’s capital R, capital S, Really Sick.
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Jan 4, 2023 03:41
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Big Beef City posted:We get how cool you are, dude It’s also not true lol
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Jan 5, 2023 15:07
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Neuro intact means that they’ve evaluated him for sensorimotor deficits and prob did brain MRI to evaluate for anoxic brain injury. You can be “awake” enough to open your eyes with tube in place and there’s a scale to evaluate level of sedation (RASS). Patients aren’t generally kept -5, I think generally -1 is good for neurological assessment from what I remember from ICU rotation.
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Jan 5, 2023 17:13
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Narcissus1916 posted:PATIENTS can remove the tube themselves? Holy hell, that must be incredibly uncomfortable if not extremely painful. The last neuro intact save I had, I defibbed him out of ventricular tachycardia in a hotel lobby, he woke up, snatched the tube out (with an inflated cuff  ) and vomited seafood everywhere screaming WHAT THE gently caress HAPPENED
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Jan 5, 2023 17:53
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adaz posted:some more details on what happened came out of that doctor's press conference --> That’s good and it sounds like they got pulses back after one defib—so probably no sustained compressions. One “round” of CPR is typically 2min then you compress for another 2min after a shock is delivered before a pulse check. Then time to sit while BP and HR stabilize, secure airway, sedate, anti arrhythmics as necessary. Timeline really makes sense with that.
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Jan 5, 2023 23:09
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Sash! posted:Two of the three times I've been put fully under for surgery or something, the first thing I said was a number. Apparently I was still counting down. The first time I saw someone wake up from a cardiac arrest, she coded mid sentence (VF arrest from a big inferior MI). We defibbed her, got pulses back, then before I could secure an airway she woke up and started speaking right back where she was in her sentence. It was one of the trippiest loving things I’ve ever seen. She checked herself out RMA like two hours after her heart cath. Meth, man.
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Jan 6, 2023 04:12
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seiferguy posted:As far as I can tell he's still in critical condition, so he's probably not out of the woods yet. I’m sure he’s still a huge pneumonia risk and they’re likely doing a lot to manage other issues (metabolic derangement, renal status, chest trauma, full battery of neurological tests) so they’ll likely keep him “critical” in ICU for management, but being able to wean off tube so quickly is great.
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Jan 6, 2023 17:53
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Chris James 2 posted:My dad passed two months ago, two months after emergency heart surgery. The surgery was a success but he had pneumonia as a result (among other complications that arose), and it didn’t go away and eventually wore him down. It’s no joke, no matter the age group Ed Aschoff died at 34 due to pneumonia complications. It’s wild how deadly it can be.
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Jan 8, 2023 00:56
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BigBallChunkyTime posted:I wouldn't imagine they allowed Damar to fly back to Buffalo. Did they have him in a private ambulance the whole way? Or a private airplane. Air medical transport does critical care fixed wing too, with ambulance rides on either end.
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Jan 10, 2023 05:06
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Docjowles posted:LAir travel seems stressful on the body? Although I defer to Lee and other medgoons on that. Presumably he'd be flying in some sort of controlled situation with medical equipment and staff, not just rocking up to Southwest in boarding group C. It’s also a long trip in a bumpy ambulance. Those airplanes are designed for transporting people in a flying intensive care room. Dude is a millionaire and suffered a workplace cardiac arrest as an employee of a multibillion dollar league. He didn’t bump down the road in a lovely interfacility van with 400k miles on it like some random impoverished dialysis patient.
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Jan 10, 2023 05:26
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tangy yet delightful posted:While I do think it's highly likely he did fly back on a medical plane, a quick google tells me the drive was probably 3 hours if perhaps flying was contraindicated with his lungs or what have you. And I will say this from my private IFT life in the past, the newest and best units and crews were the ones sent on transports to/from airports as well as longer distance rides, so if I were to broadly assuming all private companies have rotating stock that includes newer trucks - if Damar was taken by road it would have been in a unit less than a year old with perhaps even a 3 person crew (2 medics (crit care/vent certs), 1 emt). Yeah a flight would be smoother but an E-350 van ambulance with new suspension is pretty smooth if not driven by a moron. I’m just being grumpy about EMS in general and I’m sure whatever service took him would’ve extended their best crews, if not an MD ride.
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Jan 11, 2023 02:13
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Rogue Elephant posted:Adrenaline is a hell of a drug. It’s wild to watch someone try to walk on an open tib-fib fx after a bad motorcycle wreck.
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Jan 12, 2023 18:50
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Toaster Beef posted:Yeah, that was Prothro. Career-ending injury. He's had 11 surgeries over the years to repair it, but it's still not back to 100%. Just loving heinous. Mike Shula just had to go all-in on humiliating Florida as hard as possible in the 4th. What a dingus.
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Jan 17, 2023 15:00
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