- No, stop! You don't intubate first. Oh my God. New medical show means new
medical reaction video. This one's called transplant
high reviews and Canada brought to the U S I'm excited. Are you excited? Pewy! - I know you don't mean that. We'll talk about this later. - I'm gonna play a little
medical detective right now. You saw she was just
pulling out clumps of hair. She said to whoever she's
on the phone with that, she's a little tired right now. You know what's going through my head? Two differential diagnoses. One, hypothyroidism or hyperthyroidism. Two anemia. Both can cause fatigue and hair loss. And as part of the workup that we do, when someone comes in with hair loss. Now that doesn't mean it's the
most likely thing to happen, but those two little pieces of history, just those two little
things, lead me to raise the probability of those two illnesses. Something important to
know about anemia is, a lot of people think they need to be pale in order to be anemic. And that's certainly one of
the telltale signs of anemia, but it takes a while before
your anemia gets so bad that you actually get pale. One of the easiest
places to notice paleness in an individual who is
anemic is in the conjunctiva, right outside of the eye, on
the inside of the eye rather. And if you raise up the tongue, that area and region right there, could also show discolorations. But skin is one of the last
places to start showing both anemia and in other case, completely unrelated to this jaundice. - Do you made me Sir? - You made my dinner. (truck hooting) - Oh truck! (groaning) What have I repeated to you
over and over and over again? If an object gets inserted
inside of your body, meaning like it penetrates your skin, whether it's a knife, a
piece of glass, a pole. Do not attempt to pull it out on your own because what happens is
that object being inserted through your skin is
actually exerting pressure, decreasing the speed
at which you bleed out. The number one threat to your
life in that acute setting is blood loss. And that blood loss leads to
low blood pressure leading to less perfusion of vital
organs like the brain, liver, kidneys, leading to death. Yes, infections is important, the ability to move is important, but all that comes
secondary to blood loss. We stabilized airway
breathing circulation. In fact, that's the ABCs of trauma. Last thing you want is
to start pulling it out. It's really long. It was actually putting
pressure on an artery preventing you from bleeding out and boom, you start bleeding out. You can't put adequate pressure on it and you could lose your life. Oh! I don't know what in the world he's doing. If he put his finger on her
artery and did not feel a pulse, he should begin chest
compressions, chest compression, chest compression, is
because she's not breathing. I don't know why he's punching her. Is he mad? Chill, bro. - You have a skull
fracture on the same side as a blown pupil. (coughing) Sir? - Oh my God, tell me he's
gonna drill into his head. - If I don't drill into
this depression right now, you're going to die. - No, he's not going to die. You don't know that for a fact my guy. - I'm not going to let you die here. - My guy do not drill him with a drill that has tetanus on it. Please Remember what I told you guys
about good Samaritan laws and how, you know, if someone's
heart stops or not breathing and you perform chest compressions? That even if it's not the
exact right thing to do, you'll probably be protected
based on your state's laws. Yeah, If you drill into someone's head, that's like murder with evil intent. I don't even know what that is. This wouldn't even happen in a hospital. Like if a patient comes into the hospital and we suspect that they
have a skull fracture, we don't just start drilling right away. A suspicion means that
it needs to be confirmed. Like we would do a CT scan. This is a joke. - [Man] 29 Years old. - Okay. Sir no that needs to stay on, I'm Dr. Lal I'll be taking care of you. How many victims were there? - Man] Five in the restaurant
and two on the street. Vitals. (indistinct) Please Sir don't discharge anyone until they find the driver. - Can't get this guy's CTBC lights, ABG. - So the presentation they're
giving is quite accurate. They're talking about the blood pressure, they're talking about the pulse. Those are really important
factors that tell us about the hemodynamic status of a patient. Meaning how well their
blood is being circulated, whether or not they have
enough blood volume, do they lose too much blood? The fact that his pulse is
high could represent that he's not having enough oxygenation
from either lack of blood or carbon monoxide poisoning
from the smoke inhalation. The treatment for that is
giving him a hundred percent oxygen with a mask, just like this. It's important to monitor this
patient because of his pulse continues to climb, that
means for some reason, he's not getting enough
oxygen to his vital organs. When we look to figure out
what's going on in your body, we're actually looking at
your own body's responses. So if we see your pulse going up, we see your body's responding to something that tells us what's going on. So when we're diagnosing you, we're actually listening and
learning from your own body. It's actually one of the
most interesting concepts behind medicine. - Sir, sir, you need to sit down! You're bleeding, please help! - In a level one trauma situation, when someone's brought into the hospital. They're surrounded by
a whole team of nurses, medical assistants,
patient care technicians. You have to right away get
an 18 gauge IV in both arms, which is a wide gauge IV to
give blood products or fluids if they need them. The fact that he's just
chilling out in the hallway like this able to get
up is completely false. - Dr. Jed Bishop, GCS three. - All right, so this is
already a bad medical protocol. Any time you have someone
below a GCS of eight, you'd want to intubate. In fact, that's how we
memorize it when we study. So with three means he's
not conscious enough to protect his own airway. So if he vomits, PSM saliva come out, it could easily go down the
wrong pipe and enter his airway, thereby causing a
pneumonia or pneumonitis. So you wanna intubate, protect the airway and oxygenate it 'cause
the patient's not breathing on their own well enough. Now in this case here,
this person is near death. So that mask that's on them is not adequate breathing support. - [Woman] Alice! Alice! She lost consciousness. - Right here, when they
say she lost consciousness, someone should be checking for a pulse. And if there is no pulse,
what are we doing folks? I think the merge has got
to come out at this point, we're chest compressing,
chest compression, chest compression, a
hundred beats per minute, two inches deep we're saving lives. - Let's get him on oxygen, I
need fifty ketamine ideal push. (machine beeping) - We wanna Jay synchronized charges- - Stop charging, do chest compressions! You just talking about
ketamine and all this stuff. Bring her back to life before you start
administering these drugs. You need to switch to advanced cardiac life
support right now, ACLS folks. - Let's intubate first. No! You don't intubate first. Literally you take an AMBU Bag, you put it over their face, you secure it and you squeeze the bag while you perform chest compressions. Once your two minutes of
chest compressions are up, you check for a pulse again at that point you begin intubation. You could even try and do
intubation at the same time. Like you don't, You it differently! Aah! - I think he's got a
drill hole in his skull. - Significant epidural
hematoma and cerebral edema. You need to get that to
Bishop up to the Overhall now. (laughing) - I'm only laughing because
I can't imagine what's going through their heads. Why do they think he has a drill hole through his skull at the given moment. Cerebral edema, swelling of
the brain and epidural hematoma is bleeding in the
lining around the brain. There's so much happening in this scene and I'm so stressed out. I'm gonna calm down. I'm gonna woosah out a little bit. Woosah. Woosah. - [Dr.Jed] He needs a craniotomy. The bacteria what's left of the hematoma and really swelling. - Craniotomy is literally
what you think it is. It's removing a piece of the skull in order to allow the
swelling to come out, some of the blood to come out, and therefore allow the
pressure to be released. It's actually a really
important part of surviving close skull injuries. - Can you breathe? Noah? Noah? I need help! - Thank God they have a
patient who is a doctor because apparently
there's not enough doctors in this level one trauma center. - Hey, I need a doctor! - The child needing the Heimlich maneuver inside of an ER with
nurses and PCTs all around. Why did it take a patient who's
bleeding himself to go help? - Were you in that restaurant where my patient's heart stopped? I need to know what happened. I mean, whoever brought her back, I just don't see how
everything he did is possible. Did he punch her in the chest? - He did. - The precordial thump I've
never seen it work before. - You know why she hasn't seen at work? Because we don't do it. We do chest compressions and we buy time for people with a
defibrillator to come back. Or if a defibrillator is that necessary, we give epinephrine. We don't just punch people in their chest because that is something that has proven to be less efficacious
than chest compressions and medications or even the defibrillator. (life support machine beeping) - Which one of you is
monitoring this patient. - I was. - Doing airway. Mr. Cardigan was waiting
on a cardiology consult. - Get the ultrasound. - Oh my God! Why are you waiting for a
cardio consult in the ER, when you have a patient that
has a trauma to their chest? Oh my God, there's so
much wrong with this. - Till no pulse. - What's the ultrasound see megs? - Okay, she's got a large
pericardial effusion, she oozes the fluid out now. - No wander! Why didn't we do a fast scan before? ER doctor fluid in the
pericardium needs to get drained, otherwise you have cardiac tamponade where actually the heart
gets so much pressure on it. Can't beat effectively. - You're saying Alice
de Marco needs a heart? - I think the question is why you aren't. - Because we shouldn't jump to surgery. I mean, we don't even know
why this is happening to her. If the cause is manageable, we'd be giving her a
heart she doesn't need. That's crazy. - Yeah, I know you want all the data, but while you're waiting on cardiology, that woman nearly died. - This is pure nonsense. You can't know that someone
needs a cardiac transplant after doing a quick ultrasound bedside. It's ridiculous, it's joke, a further workup needs to be done. A proper thorough history needs to happen. You don't know why she
had that fluid there. So a cardiology consult is
appropriate now not then when you should have scanned her heart to begin with to see why it stopped. - Emma, Emma is this your mother's baby? - You didn't know? I thought I told that nurse. She was pregnant when my dad got sick. It was in plant, but she was so happy. And how was it? - Well, I think your mother has, what's called a postpartum cardiomyopathy. It's a rare heart
condition that can develop after having a baby. - God, how do you diagnose that? This is one of those moments
where TV and real science completely collide. Should this be in the differential, meaning the list of potential illnesses? Absolutely. Should you jump and assume
that it's definitely that and tell the family that
it's that before you've done any confirmation tests? No, it's just not in the way
we do things in hospitals, Because if we constantly had
an idea that it was something and we pitched it to the
patient, it was wrong, and then we said something
else, and it was wrong. Patients will lose faith in us. And that's why we have a list
of things that we're actively trying to rule out or rule in. And sometimes it's a
combination of two things. Life is never that simple
or straightforward. Are you a fan of medical dramas? What about scrubs? I put a playlist together for you here, or if you want to learn a
little bit more about me and my personality, I
took a personality test. Are they even accurate? You'll find out in this video, and as always stay happy and healthy
Nice video doctor mike 🤩😍
doctor mike make an avatar 😳
Nice video, thanks for making me laugh :)
But what happened to you eye?
GREETINGS DR. MIKE I’ve started playing this really cool game called: Full Code (available in the App Store) And it’s so addicting and all around just really awesome, so if you happen to see this, could you maybe do a video review on it? (If you have the time/don’t have to agree) I’m understanding a lot of the protocols you’re talking about BECAUSE of the game: eg: intubation because he’s unable to protect his own airways Thank you, have a good one!❤️