Brady Unlimited III: Wolverines in the NFL & NFL News

[lineygoblue]

Not sure how reliable this source is, but I'll post it here. Take it for what its worth.

https://thedcpatriot.com/update-damar-hamlin-rep-says-vitals-back-to-normal-putting-him-to-sleep-in-order-to-put-breathing-tube-down-his-throat-currently-running-tests/?fbclid=IwAR3G2BAKkcUCJC1Blod0EjWElJLipjJmgeEPRlXBWzXktnYwgKsAzpYpwao

[Dr. Strangelove]

Sounds like that was accurate. Got him stabilized but not breathing on his own yet.

[Jeff Buchanan]

A thump to the chest CAN cause cardiac arrest w/o any underlying cardiac conditions - its rare but happens. A defibrillator which is going to be on the cart on the sidelines can restart asystole. if somebody got on him and started doing CPR within a couple of minutes after discovering he was unresponsive, could be life saving. Remember, "time is tissue." without blood flow to the brain (chest compressions can be helpful in keeping the brain oxygenated) brain damage ensues.

Not sure what it means that his "vitals are stabilized. They put him asleep to put a tube down his throat." I'm going to assume he's moving air just not enough and his 02 saturation is low. Intubation is protocol given that scenario but saying "he's not breathing on is own" is not a good sign.

[crashcourse]

doctor said his first question was who won the game. if thats true at least his neurology status is still working upstairs

[AlabamAlum]

A thump to the chest CAN cause cardiac arrest w/o any underlying cardiac conditions - its rare but happens. A defibrillator which is going to be on the cart on the sidelines can restart asystole. if somebody got on him and started doing CPR within a couple of minutes after discovering he was unresponsive, could be life saving. Remember, "time is tissue." without blood flow to the brain (chest compressions can be helpful in keeping the brain oxygenated) brain damage ensues.

Not sure what it means that his "vitals are stabilized. They put him asleep to put a tube down his throat." I'm going to assume he's moving air just not enough and his 02 saturation is low. Intubation is protocol given that scenario but saying "he's not breathing on is own" is not a good sign.

No. You do not use a defibrillator on asystole. Defibrillators are used for pulseless Ventricular Tachycardia (VT) and Ventricular Fibrillation (VF). Periodttt! Synchronized cardioversion for the unstable tachy dysthymias. It is likely that his hit caused commotio cordis, which put him in VF. Jesus, Jeff, you called a CVA a heart attack with Leach and now this? Get yourself checked. Thank god I am unblocked now!

[THE_WIZARD_]

EFZ. Everyone knows that.

[Jeff Buchanan]

Sorry about that. AA is absolutely correct. Asystole is an non shockable rhythm. I misspoke calling it asystole. Synchronized cardioversion is the correct intervention with a dysrhythmia that is VT or VF. TBH, I don't think he was ever in asystole - my error. Pulseless VT or VF was more likely.

Now, UFR, lets get this straight. Upon intervention, per reports, I've read, the patient had a pulse. I don't know what an EKG was telling the paramedics what it was but, no Shock was indicated. He subsequently was noted to not have a carotid pulse (pulseless VT or VF). It gets confusing at this point. Chest compression were initiated we have been told. I'm assuming the ambulance that he was brought into had the equipment to cardiovert VT or VF and that once it was realized that's what they were dealing with cardioversion took place and it worked. To my understanding, he was never shocked.

By the time he was transported to the ER, he had a pulse and cardioversion was successful - he had a normal cardiac rhythm but was unresponsive. To protect his airway, he was then intubated in the ER. Neurology was consulted. The standard protocol as I understand it is to sedate the patient and cool the brain tissue to aid recovery. At this point it is a neurologic emergency, not a cardiac emergency as his heart rhythm had normalized

Apparently, per reports, he is "neurologically in tact," responsive to commands, moving all his extremities and can write responses. That's a pretty good indicator that at this point, there is no serious brain damage from lack of 02 to the brain.

AA do I have this right?

[froot loops]

First thing I thought of when this happened was Chris Pronger and Christian Erikson. Pronger seemingly had the same thing as Hamlin against the Wings in 98. Slap shot to the heart knocked him out, but his must not have been that serious because he was playing 4 days later.

Eriksen collapsed at the Euros, they had to shock him back. He nearly died on the field, UEFA decided the show must go on and Denmark lost the game. Eriksen had a pacemaker and is back playing.

[AlabamAlum]

Jeff,

You defibrillate (not synchronized cardiovert) VF and pulseless VT. You use synchronized cardioversion for tachy rhythms with a pulse (e.g., VT with a pulse, SVT, AFib w/RVR- which all have a pulse).

Defibrillation and synchronized cardioversion are similar. The main differences are that synch cardioversion is at a lower energy setting (usually) and the synchronization is to avoid delivering a shock on the T-wave and causing R-on-T phenomenon, potentially throwing the rhythm with a pulse into a worse rhythm without a pulse (and more refractory to effective treatment), namely, ventricular fibrillation.

[Mike]

JFC, Jeff. Were you sick the day they taught medical stuff at med school??

[AlabamAlum]

Jeff was a PA. It’s not his fault. PA stands for “Partially Accurate.”

[THE_WIZARD_]

heh

[THE_WIZARD_]

AA...when you talk all smert like dat you make me feel like dancin'...

[Jeff Buchanan]

Mean ......

Mea culpa on "shocking asystole." Heh on "PA = partially accurate.'

Look, Advanced Cardiac Life Support (ACLS) is hard. The best practitioners of it work as a team, backing each other up to prevent mistakes. Mistakes don't happen on the regular by EMTs or in the ER by nurses, docs or mid-levels because there are well developed protocols contained in a pocket check-list. The best medical environments conduct debriefs after an emergency is concluded. Team members learn in a positive environment.

If you're ACLS certified and you have to renew every year if I recall correctly (and that's in question, fuckers), you've demonstrated the ability to identify a specific EKG rhythm you've been presented with by the examiner and apply the appropriate protocols - CPR, defibrillation, cardioversion, administer appropriate drugs, etc. You have to do this from memory for certification but in actuality, when presented with a cardiac emergency, a team assembles, one guy, usually the ER doc on duty, takes charge and directs team members. He might use his pocket check list or he might do it from memory but someone on that team has the check list open and is backing the team leader up.

Where I worked, the ER conducted ACLS drills (among other drills for high leverage ER admissions) once per month and the team walked through the ACLS protocols. In the case of a mistake, e.g., like the one I wrongly identified as the correct COA, shocking asystole, you're going to have a hospital board review your actions. I participated in one of those in the case of a CVA admission where the patient died. Like a cardiac ER admission, patient's presenting with signs and symptoms of a stroke are treated according to published protocols. In this case, some time limits were missed but it was determined that was not the cause of the patient's death. Everyone participating in the review learned. No one was humiliated.

Hospital administrators understand - or should understand - how important it is to review a critical ER admission and learn from a formal debriefing of it. In this manner there is both training and accountability. For hospital administrators, it's a tough tightrope to walk allowing for accountability in life and death circumstances while at the same time allowing for the hospital's providers to benefit by advancing their medical knowledge.

[AlabamAlum]

Heh, just messing with you, Jeff. I am regional faculty for the American Heart Association. I have been an ACLS and BCLS instructor for 35 years and a PALS instructor for 30. I still volunteer and teach megacode, so it’s fresh with me.

Anyway, the PA = “Partially Accurate” is an old one. To be fair, NP = “Needs Practice”. Always hated the latter, though. Heh.