Surgeon Breaks Down 22 Medical Scenes From Film & TV | WIRED

hi I'm Annie Onishi Annie Onishi is a surgery resident no no I graduated residency I'm a fellow in trauma surgery and critical care now you asked for it I'm back breaking down more clips from film and TV roadside liver surgery the good doctor here's your liver I'm gonna need you to sign for it how long ago did you take it out three hours we just lost three hours technically three hours and five minutes your clocks on the cooler so once an organ has been removed from a donor that starts the clock for what's called the cold ischemic time that is the amount of time that the organ is not actively receiving blood flow from the original patient and from the recipient what about a police escort my doctor's an MD does actually personally deliver that cooler you get to write on an airplane sometimes get to write in the back of an ambulance lights and sirens it can be pretty exciting I don't know what you're looking for sure yes I can feel it it's firmer I don't know what that means there must be a clot but there isn't a clot this can show no clot there's no way you would be able to detect a clot or a thrombus inside the liver that's just not unless you had an ultrasound vision of the tips of your fingers you wouldn't be able to do that we have to immediately remove the clot and flush the left lobe to protect it from the ice baths you don't need to protect the liver from the ice bath I'm not sure what he's talking about okay we need to stop the car sure yes yes we need to operate right [Applause] so great thank googled queen of segments that's like super cutting-edge super accurate so the Queen ode segments are how we anatomically divide the liver based on its blood supply and its biliary drainage so there are segments one through eight this is correctly labeled it's missing segment 4a and 4b but other than that that's that's pretty good this is also not what a liver looks like so when a Limor is procured from a donor it actually comes with a bunch of stuff attached to it so it comes with the the big portal triad attached to it that has a basically the business end of the liver how the liver drains it comes a little piece of intestine attached to it still bunch of blood vessels in the back we bring more than we're going to need basically it does not look like that this is better than having a baby in my car do not put that liver into me subcutaneous infestation evolution I would put a tourniquet on the leg and trap it and then and go after it that's what I would do going the other way how you going in rectally personally I don't think I could get to this directly it does look pretty simcha taneous agree there is always time for lubricant Oh clinch so as an expert in rectal foreign body surgery telling the patient not to clench is not gonna work you really have to give these people a lot of sedation and get them pretty much totally asleep if you're gonna go up there and fish something out he looks like he's in a ton of pain and obviously very uncomfortable there's no chance of getting anything out I've never personally seen a bug like that craw from the leg into the colon what do we do the only bugs I've ever encountered have been in Kenya there's an intestinal parasite called ascariasis it's a series of tapeworms that end up living inside the intestinal tract and actually cause obstructions don't you ever do that again Craig Oh thyroid out of me from anaconda [Music] that's not exactly how you do that a cricothyrotomy is an emergency procedure that is performed when a patient has their airway that cannot be intubated from their mouth so looks to me like the indication here for Craig is that this patient has some sort of wasp in his upper airway so maybe there's some swelling in the airway so typically a breathing tube will go into the mouth into the trachea and then we can connect that tube to a breathing machine so the patient can still breathe in an emergency situation like this yeah I would probably just use my knife get down to the cricothyroid membrane and yes enter sharply like he did there I'm not sure what kind of tube it is but it looks like a reasonably sized tube but they would need to start ventilating right away it doesn't work if you just stick it in there you have to breathe for the person chaotic emergency Grey's Anatomy I can't frighten the doctor here says that she can't crike and I don't know why I can almost always cry he's got stuck you emphysema and this thing that she says sub-q emphysema what that refers to is that child has air in the skin and and soft tissues on the chest that's usually a sign that something really bad has happened to this kid he probably does an emergency chest tube and he certainly needs his airway controlled somehow all right - orange drawer orange drawer I knew that no chest sounds on the right HSP seconds anybody actually have chest tubes so clearly in this chaos the nurses are not here so the doctors are trying to do the job of both the doctors and the nurses and this is what would happen I'm trying to set up this saline drip and I can't get just like to stop beeping anyone so that's a hundred percent accurate so when doctors like me try to set up IV pumps which is normally the nurses job usually we can't figure it out usually there's bubbles there's beeping there's alarms nothing works and a nurse usually has to come and rescue me IV drip rate it's different for kids depending on the size so anybody the calculator how's that taste Izzy's 30 kilos that broselow tape that's a real thing so when a child comes in it is a tape that you literally measure their body length with and it will give you the best estimate for how much that kid weighs as far as our taste is he's 30 kilos and a concentration of dopamine is 1,600 mics per CC so 5 times 30 is 150 times 60 minutes and hours 9,000 divide that by 1,600 infusion rate is 5 point 65 cc's per hour so that's the kind of math that nurses do in their heads all the time or they have memorized from giving this medication so frequently I feel like an idiot brain transplant and get out so in get out they perform a series of really barbaric and racially driven brain transplants luckily in my opinion brain transplant is not a thing and probably won't ever be a thing rookie mistake you're all sterile you're all scrubbed in and then you touch your mask start over so technically those glasses don't count as eye protection he's a psychopath that he should really know more about sterile technique in real brain surgery you don't actually remove the skullcap you made sort of a curvilinear incision along the plane of what part of the school you're gonna remove so this is clearly dr. Armitage is special torturer brain surgery tre oh wait I am so confused I don't really recognize any of those instruments I think the instruments second from the bottom looks a little bit like something called a Roger which is how you remove bone fragments from things I see some suture scissors up next honestly the thing on the left looks like a speculum for lady parts but I'm not sure man I've told you not to go in that house directing your own surgery Ronin I've done this many times before we just cut up there just a little but the operating surgeon here is using an 11 blade that's typically not really used on skin in this manner typically to make the first incision on the skin and use a 15 later a 10 blade take the clip this is a sponge stick you see a ton of sponge sticks in medical dramas it's unbelievable this is not how you use a sponge stick a sponge stick is typically used deep in the body it's a piece of gauze wrapped around what's called a ring forceps I'm sure it's used to very gently retract a very delicate structures that are deep and in the way it's not used to the lot that's open it up spreads but Robert DeNiro is describing spread spread spread which means actually inserting the tips of that instrument and spreading tissue so you can make a cavity bigger that is a maneuver that we in surgery very commonly if we need to get access to a certain place dropping someone off at the year and then leaving Hustler's this is actually a thing we sort of tongue-in-cheek refer to this as the homey drop usually it's because either they happen to be right by the hospital when they got hurt or somebody's too scared to call the cops or call EMS usually we're just grateful that they brought the patient to medical attention so we can help them heart surgery from Krank - mm-hmm that is not what the human heart looks like first of all it doesn't continue beating once it's all disconnected without sounding too creepy yes we do comment on people's insides so as silly as that looks that does actually exist in real life it's called a total artificial heart it's usually used as a bridge to a transplant for a patient who has something very very wrong with their with the actual muscle of their heart yes this is definitely some back-alley heart surgery I really would not recommend going to these doctors Jack's appendectomy lost [Music] so you do actually flick the needle like that that's to get the little air bubbles out so you don't inject air into the patient no Jack they found some chloroform at the medical station I could not you out managed with the lidocaine lidocaine is a local anesthetic that's used to numb the area it's what you commonly might get in your gums at the dentist that is a massive incision for an Appy that was huge totally unnecessary a penis short for appendectomy which is the surgical operation to remove the appendix spreader I think that she's probably asking for what's called a self-retaining retractor that's a little skimmer tracker that would stay open by itself freeing your hands okay look that's actually what's called a finished shuttle retractor not typically used on the abdomen I'm sorry jack right well he's just being loud and fidgety I would want him knocked out too but we actually there's a lot of reasons we put patients under general anesthesia for surgery obviously one is comfort the other is total muscle relaxation so we actually give you a little bit of a paralytic so your muscles completely relax and that actually makes incisions on the abdominal wall much easier would you rather be dreaming about something nice back home eating human brain from Hannibal see the brain itself feels no pain carries that that concerns you so it is actually true the brain itself has no pain fibers so once the patient has been sedated and the craniectomy part has been performed they don't actually didn't have the brain in any way here's the sack that contains the brain so here this little membrane dr. Lecter's removing is something called the dura it's not really that stretchy or kind of shiny like that or rippable like that but that is an actual layer that protects the brain between the brain tissue itself and the skull and if you look at this diagram here you can see all the different layers in the head so you have the scalp the skull and there's a potential space with the different layers of dura followed finally by the brain tissue actually below all of that that's smells great I personally prefer mine with a little more garlic than that but I'm sure this is fine though I'm not a brain surgeon I do know that in some neurosurgical procedures the patient is actually wide awake so that fine elegant tasks such as speech or fine motor movement can continue to be tested while the surgeon is operating on that particular area of the brain so that way the surgeon knows this is the area that's controlling this for this patient we shouldn't cut that we shouldn't touch that self surgery in Wolverine I gotta get that thing first of all I wish my scalpel is attached to my hand like that that'd be pretty cool that looks like pretty pure CGI to me doesn't look like real x-ray there are some operations that we do use active x-ray so we can monitor certain parts of the body while we operate on them keep going so our orthopedic colleagues always use something called the CRM which is a dynamic moveable x-ray to take pictures of the bones as they're getting fixed same thing with vascular surgeons they very commonly use x-ray to take pictures of the blood vessels that they're operating on and to fix those blood vessels so the use of x-ray in and of itself during surgery is very common the surgical checklist er don't remember being asked if dr. Benton could scrub in for this this is an example of how a surgeon comes in with his hands sterile and somebody else helps them get dressed put him under let's do this little whoa what about the checklist excuse me safe surgery checklist this safe surgery checklist is a real thing that's practiced every day in every operating room in this country I've had 10 cases today doctor it only took a minute 1 minute John Carter here for a right cadaveric renal allograft does the patient have a known allergy no does anesthesia anticipate a difficulty array no is the risk of bleeding greater than 500 CCS so that's a great representation of a surgical time out that's really thorough it goes through all the major important things any nursing concerns you don't have any reperfusion solution we won't be needing it they said they didn't have enough profusing the solution in the room so the nurse went to go get it and that's gonna save them some trouble later on in the operation so people aren't rushing around trying to get what's needed I think that this is an excellent teaching opportunity we take this practice from airline safety so before an airplane takes off the pilot the copilot and the air traffic controller go through a checklist where they check every single system on the airplane make sure everything's in working order before the plane takes off a surgical checklist is the same thing we make sure that we have identified the proper patient that we're doing the correct operation that we have all the equipment we could we need and it really is meant to reduce medical errors and surgical errors now let's just take that time and introduce the wrong she'll Elaine scrub nurse paula cheney circulating nurse a Schumacher anesthesiologist her hand a loperamide shift surgical resident Ethan Dean Surgical intern that's actually a great representation of who all is in an operating room he had the attending he had two assistants that resin in the intern those two nurses they're the circulator and the scrub tech as well as the anesthesiologist this is actually very accurate warning antibiotics given in the last sixty minutes just starting them now if you running any biotics prior to incision you cut the risk of infection by half dr. Benton you're a guest here and I don't like guests as a friend of the patient you're welcome to sit observe and shut up in real life surgeons are definitely not that impatient they will absolutely wait for the antibiotic to go in because they don't want the patient to get an infection any concerns from the surgical team only that you're wasting my time so it seems like this surgeon who's about to do this operation is sort of anti checklist that's really a no-go these days so we always do a time out in a matter way that has a lawsuit waiting to happen impersonating a nurse the dark night so nurses do where Nursing Uniforms that's a little outdated old school most of them are just regular scrub tops and a uniform top that just says RN in the name of the hospital so if Harvey Dent really had a burn like that in real life he would be intubated he don't be on a bunch of medications receiving a ton of IV fluids he would be really really sick and really not able to fight back when the Joker comes and here in the background you see some coronal images which is a means a picture taken in this dimension of the body that looks like an MRI slice of a brain it looks pretty normal I'm not sure why Harvey Dent would have needed to have had an MRI I don't want there to be any hard feelings between us Harvey a patient intakes are a Parks and Rec everything you write down is confidential we need you to give real answers so there are definitely some patients I meet that are not super trusting of doctors it's okay you know it usually comes from probably a bad experience but there are better ways than what she's doing to sort of work around that and get the patient alarm up to you a little bit Ronde you redacted all the information answered some of them for date of birth you wrote springtime you should be a little more friendly her tone is little terse she looks a little impatient her facial features are not super friendly warm welcoming or patient so she could probably take a chill pill and try again organ procurement Robocop to make it fast because six minutes before the I'm not sure what she's talking about the brain is always gonna be this list there's no such thing as a brain transplant so this is the way how they would brain surgeons like to do crazy activies which is like a full top skullcap craniectomy but that's not really how it's done in real life as far as I know there's no suction cup effect but correct me if I'm wrong so this makes no sense at all so this guy supposed to be dead this is a bypass machine so the bypass machine is pumping blood for him in a supposedly dead body so not terribly consistent I have never seen a dissection like that I don't think you can get all those parts out together unblocked like that I mean to transplant organs you just put them in a little bag with ice in a plastic bucket you don't use this bubbling the fishtank sort of set up I've never seen that before we're all literally a gunshot wound from Seraphim Falls you don't necessarily need to remove a bullet just because you have a bullet inside but if you want to have Pierce browse and take his shirt off and flex this is a good excuse to do it so you could definitely use a red-hot metal blade to cauterize a wound but that thing was not actively bleeding so I really I would just have left that alone another shirtless guy using fire to cauterize his wound Rambo three [Music] here's another guy with limited medical resources and what appears to be a soft tissue injury in the absence of you know hemorrhage or something that really needs to be controlled I would just I would just leave these wounds alone but I think this is pretty reasonable technique to cauterize but again completely unnecessary serious I'm serious the janitor makes the diagnosis the fugitive can you give us a hand here you bring this kid down to observation room - it would not be typical for someone from the housekeeping staff to transport a patient this doctor / janitor is looking at the x-ray what looks like a baby you can tell sort of from the dimensions of the chest and the way the bones look he's also looking at that x-ray backwards you can tell because the heart is not where it's supposed to be [Music] your brother they downstairs I can't exactly tell he's crossing out and what he's about to write but on any medical record it would be really suspicious to cross something out you'd have to get new for him investors so patient handoff doesn't really work like that these days usually it's a series of phone calls from the nurse in the ER to the accepting nurse and the o.r on the floor same thing with the doctors there's a series of what we call handoffs about the patient what the diagnosis is what workups has been done what other tests don't need to get done it's usually not like this where it's kind of a word-of-mouth and a trust this guy in the janitorial uniform to give me this Candace diagnosis that's a little suspect I don't typically affectionately rub the faces of my patients before they get wheeled off the surgery no that's not really my style horse tranquilizers are straight to the neck old-school what kind of good is this that's a tranquilizer gun not exactly sure what tranquilizer was in that tranquilizer dart but one common tranquilizer that we might use in the emergency setting is something called ketamine yes it is a drug that works very quickly it doesn't cause any major hemodynamic shifts meaning it will alter your blood pressure too much and it's a quick on quick off kind of drugs so it's pretty it's a pretty good medication to sedate a person in the emergency room if you have to do some some quick procedures we so definitely as the medication is setting in patients will start to feel foggy start to feel groggy and may yeah I have some mental slowing whoa impersonating a doctor catch me if you can gentlemen what uh what seems to be the problem bicycle accident spongy check strikes again actual tibia about five inches patella dr. Harris yes do you concur I mean he sort of looks like a doctor he talks like a doctor I think he could probably trick a couple people but I think that this is a little bit of a stretch I think we should take an x-ray then stick him out you put him in a walking cast so I completely disagree with his suggestion I get this kid in a walking cast what that looks like is called what we call an open fracture meaning you can see the bone through the injury so that actually is pretty involved it's usually more of a severe injury that patient you should probably go up to the operating room get a really good washout for concern for infection and probably get some surgery to fix that bone a dead giveaway here is the nausea most doctors aren't too squeamish here's an example of a patient arrival in code black 16 year old boy fell down stairs minor okay hey how you doing buddy fine I fell this is all probably overkill did you see Danson sir no I did anything else you can tell us nothing so this is a pretty good example of the first responders doing what's called giving report they are bringing the patient in they're telling the doctors and nurses in the hospital what happened to the patient this sounds like this patient fell on a set of stairs minor burns no ko when they say no ko means no loss of consciousness or no knockout anything else you can tell us so here we have two nurses sort of dividing and conquering one nurse is getting what's called collateral history from the person who came into the hospital with the kid and the other nurse is attending to the child's medical needs right now except really dumb actually I fell down some stairs this seems like a pretty stable patient with a relatively minor mechanism of injury so for that reason there's no trauma team or a bunch of surgeons running around trying to figure out what happened at the kid it's pretty much just nurses at this point tick-borne illness house has tick paralysis dan tracked a tick onto his jeans quite still ordinarily cosinus electric shock this girl's allergies are not ordinary administering SP it's just gonna get worse so that bag-valve-mask that's like atrocious right there bag valve mask ventilation is seen here with this purple that's called an Ambu bag as well as that mask that's on the patient's face that Ambu bag should be squeezed in a very particular way to observe the Chester eyes on a certain rate so the rate at which she is squeezing which is really fast that's gonna cause a couple things number one is hyperventilation number two she's just gonna fill that patient's stomach with air which can cause a lot of other problems down the road as long as we're stuck here it's like a good time to look for that tick actually was wearing off so he says here the atropine is wearing off atropine is a medication that we would use for bradycardia which is when the heart rate is really slow so it sounds like she got really bradycardic they gave her atropine it's wearing off meaning her heart is slowing down again and on the monitor you see that her heart rate is 45 so it's pretty slow we treat her symptoms she dies we find the cause she lives that tick is an IV drip of poison we unhook it she'll be fine oh my god see usually with tick borne illness you get like a what's called a dilated cardiomyopathy but that takes like weeks to months tada this is that's just this is not real I don't know how to tell you conclusion I realized that a lot of what Hollywood does in the or in the ER is for dramatic effect but it's pretty fun to check out what they do right and what they do wrong and don't forget if you're enjoying technique critique subscribe to Wired

Channel: WIRED

Views: 2,259,377

Rating: 4.9484034 out of 5

Keywords: surgeon, surgery, technique critique, wired technique critique, surgeon explains, surgeon reacts, surgeon breaks down, surgeon breaks down movie scenes, surgeon reacts to surgery scenes, doctor reacts, doctor reacts to surgery scenes, doctor reacts to real surgery, doctor reacts to medical scenes, surgeon reacts to medical scenes, doctor, movie surgery, surgery scenes, medical scenes, movie medical scenes, medical scene breakdown, annie onishi, wired annie onishi, wired

Id: 1SPe82HIf4o

Length: 26min 22sec (1582 seconds)

Published: Mon Dec 09 2019