Surgical Resident Breaks Down 36 More Medical Scenes From Film & TV | WIRED

[Music] hi my name is Annie Onishi Annie is a surgical resident at Columbia University today I'll be breaking down clips from movies and TV about the emergency room and the operating room again roll the clip cardiopulmonary bypass the good doctor doesn't have adequate support and won't be able to close cardiopulmonary bypass is a technique to allow the heart to stand still to allow surgeons to operate on the heart while a machine takes the blood out puts oxygen in and puts the blood back into the patient stitch five hours 23 minutes well it's great to allow the heart to stand still so the surgery can be performed bypass has some downsides the patient dies the longer you're on bypass the more likely you are to have bleeding complications the more difficult it is to restart the heart after the operation sometime six that was 48 minutes six hours and 48 minutes is an obscenely long bypass time how long has he been on bypass by past times in reality range more along the lines of 45 minutes two to two-and-a-half hours two hours to hollywood rarely gets a good representation of what bypass surgery actually looks like damn it self extubation The Sopranos self extubation is when a patient removes his or her own endotracheal tube which is the tube that connects the patient's airway airway box to the ventilator which is the machine that's breathing for them it's actually not as hard as you would think to do that that's good right that means breathing on his own little old ladies who you'd think never in a million years would be able to do it can do it this tends to get everybody very excited and the ICU like a family I always wait up because in those moments the patient may not be able to protect his or her own airway they had to put the tube back in face transplant face off [Music] my first thought is oh my god you can't use cautery on the skin like that that's very poor form it can leave burn marks it's just not really the technical way we make skin incisions the other sort of suction cup device while it looks great on camera in reality a harvesting of a facial structures would take hours and hours and hours as the surgeon very carefully removes muscles arteries veins nerves and the like face transplant has really come a long way initially described in France and has been successfully completed here in the United States and a number of patients with devastating injuries to their Airways their mouths their eyes it's really not a cosmetic procedure at all it's life-changing and life-saving for these patients who otherwise can't live normal lives I'm here today because I want others to see that there is hope beyond the injury old-school defibrillator paddles chips we have coarse v-fib let's get an amplification right away please show me those chest compressions one more time those are without a doubt the weakest chest compressions I have ever seen if you're not sweating giving chest compressions you're not doing it right so they say that this patient has coarse v-fib hoarse be fit which is a type of ventricular fibrillation a rhythm that will require dose of electricity looks a little bit of between given to me as you can see here they're also taking their dear sweet time getting the pads on the patient [Music] Hollywood loves the manual defibrillator paddles I think it gives the doctor something to do on camera in reality it's these it's really these stickers that are used more commonly hnd let's take a look at scrubs don't worry about the patient Turk was already there learning by doing these days modern defibrillators are pretty idiot-proof they have a technology that senses what the patient's rhythm is and will deliver a shock only if indicated dr. Turk here he's using an older school defibrillator that's not obviously sensing that the patient is just ously turns out the guy was just sleeping attached to a faulty monitor and he is able to deliver a shock even though it's inappropriate again seen in the thing I hate when that happens a professor in charge of his own heart surgery Chicago med give me a 20 millimeter Dacron graft and a 3o protein stitch no no no no it's pretty unrealistic that this person wouldn't be sedated just a little bit did I fail to teach you proper surgical technique definitely not able to participate in the goings-on of his own open heart operation I thought the 300 was appropriate that's it you're out if we're gonna get real technical though I do kind of agree with the crotchety old guy 300 sutures a little bit too big to be sewing on the vena cava whoa do not touch me with that torture device flatlining pop star I love the road you know this is kind of a perfect job for me but my favorite freeze on thing is flatlining flatline is when you technically lower your heart rate until what you're dead what Bill Hader is describing here as flatlining is what we in the medical field will call asystole which is complete cessation of all electrical activity in the heart you can catch a glimpse of the afterlife I really would not recommend to viewers that they try to pursue this hobby I try to fit in a F LAN sesh at least once a week one thing that's inaccurate in this clip is that asystole can't actually be reversed with a shock it's one of these sort of unshockable rhythms it would need to be treated with infusions of certain medications like epinephrine Oh fun fact I do suppose it is possible for you to poop your pants while you're in asystole Steel Magnolias withdrawing of life support so I actually think this is a pretty fair representation of what happens when doctors remove life support one thing that they get right here is that we do turn off the monitors that there's very little noise or distraction yeah it makes for a much more peaceful environment farting in the Oh are scrubs good good whoa whoa what's that smell I don't know sir I farted yes sir look I'm gonna get real with you right here right now if farting in the or got you kicked out every single time neither me nor any of my co residents would ever graduate from residency dude self surgery Master and Commander will have to raise a rib right so as crazy as this sounds self surgery has actually been documented on a number of occasions this badass Russian surgeon dr. Leonid rogas ah've actually removed his own appendix while he was stationed by himself in Antarctica nice here's another example of self surgery and 127 hours so here we have James Franco playing aron ralston self amputating his arm after being trapped in a canyon for a number of days is the boulder ricocheted my right hand became trapped by this rock I think this is a pretty fair representation it's actually hard for even me to watch his use of a tourniquet in this scenario is very smart probably life-saving unfortunately in today's day and age a tourniquet is something that everybody should know how to use I think they do a pretty great job thank you crush injury Grey's Anatomy invented on your flesh to minimize the burns inside your skin caused by the cement burning from the inside out so this is actually a very good very creative representation of a crush injury and something called a compartment syndrome compartment syndrome is when there's some sort of pressure on the abdomen or actually from within the abdomen that's preventing blood from returning normally back to the heart oh God the second they removed that last piece of stone all of those toxins that have built up rushed back to the rest of the body he goes into basically immediate cardiac arrest he loses consciousness one minor nitpicky point though if they knew all of this was gonna happen I think they probably should have intubated him secured his airway before they removed that last piece of rock yeah organ transplant John Q or so this is pretty accurate donated organs actually do end up in the Oh our and two plastic bags full of ice and ice water which is represented here that plastic bag goes in another plastic bag goes in a special bag goes in a special box goes in a special cooler all taped up with real special tape and again portrayed in One Tree Hill I mean that sucks we always double bag for safety the dangers of patient transport Grey's Anatomy we're going to find out who this little guy in those stretchers are very heavy and very hard to control I have definitely on a number of occasions had my foot run over by one of these things you do anymore bowling for doctors to life and hip-checked by a seizure resident or a patient transporter Ryan take out Kepner I would say this is a pretty accurate representation of the amount of sass that flies around an emergency room now to work to here's a better representation of an incoming trauma from Chicago men female mid-20s GCS 3 dashboard and start the windshield here you can hear the first responders reporting to the doctors that this patient has a GCS of 3 GCS 3 that refers to a Glasgow Coma Scale the Glasgow Coma Scale measures your mental status on a scale of 3 to 15 you and I sitting here talking right now have a 15 a carrot has a 315 3 goes in House Hospital translators getting on see if maybe we could just tell them what she's saying and then it can translate it for us we want to try to tell you what she's saying yikes this is really bad this is a huge violation of this patients rights as a patient every patient is entitled to an interpreter who speaks his or her native language fluently in any medical encounter he says she says I can't stand this I wish I was dead please kill me last time we talked about removal of live ordnance from a human body cavity we were talking about downtown Seattle Grace here we're looking at a field hospital during the Vietnam War kid comes in with an unexploded grenade that's been shot into his body this is something we typically learn in medical school or routine surgical training something they neglected to tell us about in med school usually these operations have to occur in a field hospital well away from any other personnel that could get injured when an if the ordnance explodes it must be an easier way for a surgeon to make 400 and $13.50 a month first they would use an x-ray to sort of figure out what kind of unexploded bomb would be inside the patient before very carefully and under very controlled circumstances removing it cold school scrubbing in the Nick waste your time scrubbing it as it suits you but I told you rolling us to talk Gallinger through the procedure nothing more germ theory really became more widely accepted in the early part of the 20th century so here you can see this surgeon dipping his hands in a series of what looks like iodine solution to clean his hands before an operation these days we used a simple rub on alcohol-based gel very similar to pure all small talk in the operating room st. elsewhere Oh your smokes dr. Ehrlich smoked triggers you small to wheeze not so much as a puff like any other workplace we talked about weekend plans we talk about the weather we talk about politics you name it 140,000 hits of nicotine a year for at least 15 or 20 years from talks of this mess we never gossip about the patient's you never know what they can actually hear breaking bad news contagion she failed to respond okay and her heart stopped unfortunately she did die okay communicating bad news with patients is one of the worst parts of our job right one thing that this doctor does that I'm not crazy about is just speaking to the distraught husband in the middle of the hustle and bustle of the emergency room it's not just at home another thing to avoid is technical jargon such as failed to respond feel the response in a state of high stress patient family members are unable to process beating around the bush what are you talking about so the doctor then does a good job of saying your wife is dead your wife is dead during medical school and actually on going through residency every once in a while we will work with paid actors who are able to simulate these sorts of very high-stress emotional situations what happened to her okay this is definitely how you don't do it how's my son he's going to be alright oh yes he's lost his left hand so he's going to be alright in my experience there's really no place for puns in the hospital that's more the way I would take the news dangerous patients General Hospital so those are called four-point restraints they're on the spectrum of the most extreme sorts of restraints that we would need to use for a patient there actually are five-point restraints which also involve a vest sometimes psychiatric patients or patients in an ICU do need to be restrained for their own safety and for the safety of the hospital personnel around them and here's another dangerous patient in Thor sometimes we do have to do what's called chemical restraints give an intramuscular injection of something like Haldol which is an anti-psychotic medication pretty accurate bullet wounds game night step one sterile gloves check yeah I wouldn't necessarily recommend using wine as a disinfectant for an emergency backdoor surgery but I guess between the acidity and the alcohol content maybe it could work nice and small there that's really big in my opinion the bigger the incision the better it is you're more likely to be able to see stuff and anytime you're struggling just make the incision a little bigger so bullet on the grapefruit so the entire premise here that you have to remove a bullet just to take a bullet out is not exactly accurate why I know what I'm doing there's plenty of people walking around out there with bullets stuck in their bodies in various locations that aren't really causing any harm at all Thanks did you get shot twice she must have skipped step zero which is make sure you can't also find the exit that's the exit wound oh I came nothing to remove you want to see a guy who knows what he's doing check out sugar in No Country for Old Men he's doing it in a nice clean sterile setting in his bathroom here he's mixing some betadine into some normal saline as a cleansing solution he even has this pro tip down which is make yourself a little squeezy bottle by stabbing holes in the top of the bottle closing a laceration on a desert island lost do you have a second I could use a little help here with what with this look I do myself I'm a doctor but I just can't read you to sew that up honestly if I were Jack I would just leave that wound open for fear of infection but listen if you're gonna close it he's not wrong ever Patrick pair of jeans the sewing technique is actually kind of similar to hand sewing for the wound and here we are again using alcohol to disinfect a wound again I think vodka be my personal choice both for its smoothness and its flavor tension pneumothorax Mad Max just collapsing lungs sorry oh my god that is not how you fix a tension pneumothorax this is more commonly known as a collapsed lung every time a patient takes a breath air escapes from the lung but is trapped inside the thorax she's pumping it into her chest cavity she's collapsing her lungs the classical standard and safest way to treat attention pneumothorax is with thoracostomy drainage or needle drainage in the first and second intercostal space in the midclavicular line if you stab lower like where Mad Max stabs you are just as likely to hit something like the spleen or the colon because the diaphragm is moving up and down safest way is in the chest where there's really nothing else I am now where they get tension pneumothorax right is here in three kings chest I pretty much love everything about this clip I actually think this animation is very good here it demonstrates the injury to the surface of the lung that's allowing air to escape into the thorax [Music] here they demonstrate pretty solid placement of their needle thoracostomy it's exactly as described second intercostal space midclavicular line this is even a little fancier they have a three-way stopcock that will allow them to let the air out intermittently and it's also a great representation that the patient will feel almost immediately better I feel better how not to do a physical exam on a trauma patient Twilight though looks like it took quite a spill how do you feel okay might experience and post-traumatic stress or disorientation but your vitals look good no signs of any head trauma he's talking about her vitals meaning her heart rate or her blood pressure meanwhile he's doing a pretend neurological exam by flashing the flashlight in her eyes that's not how we do it might experience some post-traumatic stress PTSD is not really a diagnosis we made great then there in the ER it's something that sort of develops later on in a patient's course I think he'll be just fine while good-looking this guy is pretty lazy he's doing a very minimal superficial check of this patient who apparently just suffered some big traumatic accident sounds like you were very lucky brain death Grey's Anatomy no this must be the papers the papers you want me to sign to decide what to do with my husband now that he's dead but not really dead he's dead he is legally dead as a clarification her husband dr. Shepherd has just been declared brain dead the definition of brain death is a legal definition of death the brain stem is no longer functioning there is no chance of meaningful recovery do I pull the plug the phrase pulling the plug really bothers me because it implies we are stopping taking care of this patient terminate all life-sustaining measures when in reality brain-dead is a legal definition of death stop all curative intervention of all the catheters drains and tubes so I gotta say shonda rhimes broke my little heart with this clip I think this is a really terrible representation of brain death as described by Meredith Grey who herself is supposed to be a doctor a surgeon just like my husband was I know how this works and should understand this complex and very difficult concept you want to talk about killing my husband ma'am surgical knot tying the good doctor need a ligating suture on the splenic artery while I make the cut and you do that for me before this young lady bleeds out on this Murphy yes [Music] so they're doing a trauma splenectomy here this is one of the quickest most straightforward operations in the book I don't know why they're so surprised that he knows how to do it it's a pinch a scoop and a staple fire it should not involve everybody stopping to stare really nothing to write home about okay let's move on to the Bell / if you look at this monitor this is actually a great representation of what a real patient monitor would look like yes that top line is your heart rate tracing 130 because the patient is hemorrhaging middle line is the patient's at that third line is what's called the end tidal co2 that is the amount of carbon dioxide the patient's body is producing at that moment and those last numbers are the blood pressure 84 over 40 maybe not good doctor but good monitor an understaffed emergency room wrongfully accused because of cutbacks you are the only person on duty balance and rotate the order you better take a look at this no thank you honestly sometimes it feels like our Hospital is this busy and this crazy and we're all swamped as much as this but I think this is probably a little bit of a stretch multidisciplinary discussions Grey's Anatomy no one can agree on my story there are definitely conversations that take place between general surgery orthopedics neurosurgery anesthesia dr. Torres worried that the limbs dr. Bailey's worried about abdominal crush injury but ultimately all these people do have to come together and decide what's gonna kill the patient first that's the treatment plan that we should pursue we work as a team well that man dies scary 1970s cerebral angiogram The Exorcist so this is in old-school representation of how they used to do cerebral angiogram which is a picture of the blood vessels in the brain in this scene you can see them putting a needle into the patient's carotid artery you can tell it's the artery because there's blood spurting out they're writing a wire in threading a catheter and then injecting dye and taking x-rays this dye is a type of contrast usually with some iodine in it so that'll show up on x-rays cerebral angiogram ZAR used to diagnose problems with the blood vessels in the brain such as aneurysms or arterial venous malformations displacement at all I'm not sure what it has to do with demonic possession but I'm sure they were just exploring all entities at this point we still think the temporal lobe Oh what are you talking about conclusion listen I get it Hollywood has to take some shortcuts for a dramatic effect or comedic effect but it's also important to recognize the difference between fantasy and reality

Channel: WIRED

Views: 5,081,061

Rating: 4.9488201 out of 5

Keywords: surgery, surgical, surgical resident, surgical residents, surgeon, technique critique, surgery technique critique, surgeons, annie onishi, wired, wired technique critique, columbia university, medical scenes, tv medical scenes, movie medical scenes, medicine, doctors, doctor, doctor reviews, surgeon reviews, surgeons break down, surgeon break down, movie doctor, tv doctor, movie scenes, surgery scenes, surgeon movie scenes, surgeon scenes, surgeon breaks down

Id: P2MUNDiXazM

Length: 22min 44sec (1364 seconds)

Published: Mon Jun 17 2019

Reddit Comments

[u/[deleted]]

So you’re telling me Twilight wasn’t 100% medically accurate???

[u/JunkFace]

Come on YouTube algorithm, don’t follow me to Reddit too.