Damar Hamlin

[Radetzky]

I don't do TTM for everybody that's vented. I just shut off sedation immediately and if I get a neuro status avoid fevers. Data is way too murky.

Reports out there are showing he's down to 50% FiO2 from 100% so I'm guessing he may have had some contusion and pulmonary edema contributing

Sorry should have been more specific, anybody that’s ventilated because of persistent low GCS

what do you quote people in terms of outcome for witnessed arrest given time to cpr and time till rosc?

so much data out there and haven't read this in a while

I don’t quote anything. I give a range of possible outcomes and say we won’t know which end of the spectrum things are until 72 hours or possibly earlier if there’s a really good outcome

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[patriot6]

I had an elderly patient undergoing TAVR who developed tamponade with a subsequent severe iatrogenic cardiac injury (during needle decompression) that needed an emergent window… multiple rounds of CPR… probably 10-20 minutes total of compressions… followed by 30 minutes of MAPs in the toilet in the OR and intermittent compressions… extubated the following morning, zero deficits. Discharged a couple days later. You just never know.

 

[ucladoc2b]

So apparently according to CNN he underwent CPR again when he arrived in the ED. Had to be proned today. But FiO2 is down. Doesn’t say anything else.

Edit: apparently the family and reps are disputing the second resuscitation. He only was resuscitated on the field.

 

[Ezekiel2517]

I have a bad feeling about this one, especially after hearing they needed 9 min of CPR and then he needed further rounds once he got to the hospital. Once he got hit, he was pulseless and these out of hospital codes ... let's just say they're usually not the smoothest. And the proning obviously suggests an ARDS picture and oxygenation issues on top of all this

 

[vector2]

So apparently according to CNN he underwent CPR again when he arrived in the ED. Had to be proned today. But FiO2 is down. Doesn’t say anything else.

I wonder if he aspirated at some point

 

[anes121508]

I have a bad feeling about this one, especially after hearing they needed 9 min of CPR and then he needed further rounds once he got to the hospital. Once he got hit, he was pulseless and these out of hospital codes ... let's just say they're usually not the smoothest. And the proning obviously suggests an ARDS picture and oxygenation issues on top of all this

no doubt. out of hospital codes just aren't the same obviously. so many additional factors.

really still bugging me that at 2 min post collapse no CPR is occurring...I realize their focus is head and neck but that initial survey should have led to compressions immediately unless there is something i'm missing regarding what they are taught. Perhaps protocol to remove equipment ect for effective cpr? Just seems like need for CPR was not immediately recognized. I hope i'm confused and wrong on this but even when i rewatch the video i just don't see immediate action.

 

[Ronin786]

what do you quote people in terms of outcome for witnessed arrest given time to cpr and time till rosc?

so much data out there and haven't read this in a while

I don’t. Neurologists definition of a favorable outcome is not what most people would want for their loved ones so I find the days difficulty to decipher.

Overall it’s 10-20% if I’m not mistaken but there have been many advances recently

 

[dannyboy1]

no doubt. out of hospital codes just aren't the same obviously. so many additional factors.

really still bugging me that at 2 min post collapse no CPR is occurring...I realize their focus is head and neck but that initial survey should have led to compressions immediately unless there is something i'm missing regarding what they are taught. Perhaps protocol to remove equipment ect for effective cpr? Just seems like need for CPR was not immediately recognized. I hope i'm confused and wrong on this but even when i rewatch the video i just don't see immediate action.

Pulmonary edema not at all unusual following prolonged resuscitation. Agreed that CPR took to long to start. It’s all about how quick the compressions start and quality of CPR. I had a patient who was coded for over 40 minutes due to a drug reaction. We were all at bedside and started immediately. Extubated the next day intact.

 

[anes121508]

Pulmonary edema not at all unusual following prolonged resuscitation. Agreed that CPR took to long to start. It’s all about how quick the compressions start and quality of CPR. I had a patient who was coded for over 40 minutes due to a drug reaction. We were all at bedside and started immediately. Extubated the next day intact.

yeah that's what's i'm saying...you all started immediately and went for 40 min and ended up with a better outcome than this poor kid may have who only had cpr for 8 min. cpr wasn't started within 2 min on him. my guess is 4-5 min range.

 

[anes121508]

I wonder if he aspirated at some point

prob a multitude of pulm insults just hoping his proning is related to minimizing free radicals from higher fio2 level as opposed to a really poor paO2 Fio2 ratio

 

[Ezekiel2517]

IIRC the NFL has certain docs like critical care/EM docs on standby for NFL games. I know a critical care doc who does this for the NFL. However, I don’t believe they have to be on the sideline or even inside the stadium during games, just close by. I think an expert in resuscitation would have obviously managed this better. But I’m not surprised if the personnel immediately available on the field were not quicker to act

 

[Pappy Van Propofol]

There’s only 20-30 commotio cases reported per year and most common in little kids. The elephant in the room is the covid vaccine. I’m not saying that’s to blame but we know it’s being discussed elsewhere.

 

[Vandalia]

There’s only 20-30 commotio cases reported per year and most common in little kids. The elephant in the room is the covid vaccine. I’m not saying that’s to blame but we know it’s being discussed elsewhere.

However, the reason it is most common in little kids is because little kids are the ones most likely to be around projectiles like baseballs. Involvement in sports decreases with age.

That factor is not relevant when you are talking about a professional athlete.

The fact that it is rare does not mean it can't happen in this particular case.

 

[ucladoc2b]

However, the reason it is most common in little kids is because little kids are the ones most likely to be around projectiles like baseballs. Involvement in sports decreases with age.

That factor is not relevant when you are talking about a professional athlete.

The fact that it is rare does not mean it can't happen in this particular case.

True. Kids also have a thinner chest wall.

 

[Twiggidy]

I know it's two different sports and one involved a high impact situation, but i wonder if the diagnosis with Damar Hamlin is similar to what happened to Christian Eriksen.

 

[pgg]

I know it's two different sports and one involved a high impact situation, but i wonder if the diagnosis with Damar Hamlin is similar to what happened to Christian Eriksen.

He was my first thought when I watched it happen live. I was actually a little irritated at the announcers, that an hour went by and they never even mentioned the other pro athlete to recently get CPR on a field. Seems like someone in the broadcast team could've clued them in at some point, and given them something to talk about.

Eriksen obviously made a full recovery (and played in Qatar last month).

 

[Urzuz]

There’s only 20-30 commotio cases reported per year and most common in little kids. The elephant in the room is the covid vaccine. I’m not saying that’s to blame but we know it’s being discussed elsewhere.

I heard he ate Cinnamon Toast Crunch for breakfast the morning of the game. Coincidence? I think not.

FYI people are also discussing how the earth is flat and how aliens inserted probes into their rectums “elsewhere” as well.

 

[ucladoc2b]

He was my first thought when I watched it happen live. I was actually a little irritated at the announcers, that an hour went by and they never even mentioned the other pro athlete to recently get CPR on a field. Seems like someone in the broadcast team could've clued them in at some point, and given them something to talk about.

Eriksen obviously made a full recovery (and played in Qatar last month).

He ended up getting an ICD. Can’t confirm long qt in any of the media reports.

 

[dannyboy1]

yeah that's what's i'm saying...you all started immediately and went for 40 min and ended up with a better outcome than this poor kid may have who only had cpr for 8 min. cpr wasn't started within 2 min on him. my guess is 4-5 min range.

Also. Codes that we run have the airway secured quickly and definitively. I know I know … compressions first. But it certainly helps outcomes if you are moving oxygenated blood. I suspect ventilation didn’t happen to Hamlin for at least 5 minutes. Even then, was probably with a mask not ETT

 

[ryanjmy]

IIRC the NFL has certain docs like critical care/EM docs on standby for NFL games. I know a critical care doc who does this for the NFL.

An NFL game has more medical staff than a rural hospital:

 

[pgg]

An NFL game has more medical staff than a rural hospital:

View attachment 364237

Thank God there was a dentist and chiropractor there!

Wonder what the "airway management physician" is. Appears to be the only physician present who was maybe more qualified to run a code than the EMT.

I also wonder if the million live spectators affected any decision making, especially with regard to starting CPR.

 

[lobelsteve]

News update 1:40PM 1/4/23

A representative for Buffalo Bills safety Damar Hamlin reportedly offered an update Wednesday on the player’s health as he remained in the University of Cincinnati Medical Center following a medical emergency.

Doctors at the hospital got "promising readings that they had been hoping to see," ESPN reported, citing Jordon Rooney and the Hamlin family. Rooney reportedly added that it appeared "progress" was made. Hamlin was still in the ICU sedated and considered to be in critical condition.

Rooney also clarified to the outlet that Hamlin needed to be resuscitated only once — at Paycor Stadium. Dorian Glenn, Hamlin's uncle, told CNN on Tuesday night that Hamlin's heart needed to be restarted for a second time.

 

[coffeebythelake]

There’s only 20-30 commotio cases reported per year and most common in little kids. The elephant in the room is the covid vaccine. I’m not saying that’s to blame but we know it’s being discussed elsewhere.

Maybe it is being discussed elsewhere but definitely not by educated physicians.

Commotio is the 2nd leading cause of sudden death in athletes but sure let's blame the "elephant in the room" covid vaccine despite absolutely no evidence for this.

 

[thinkorswim]

Wonder what the "airway management physician" is. Appears to be the only physician present who was maybe more qualified to run a code than the EMT.

It can be an anesthesiologist. An older partner of our group used to tag along with the orthopedic surgeon for NFL and college home games.

I know it's two different sports and one involved a high impact situation, but i wonder if the diagnosis with Damar Hamlin is similar to what happened to Christian Eriksen.

The EP cardiologist I’m working with today says something like 80-90% of commotio cordis cases occur in baseball or softball. He also mentioned that CPR time doesn’t mean much, it’s time to defibrillation that really matters in those cases.

 

[nimbus]

There’s only 20-30 commotio cases reported per year and most common in little kids. The elephant in the room is the covid vaccine. I’m not saying that’s to blame but we know it’s being discussed elsewhere.

Should be seeing an epidemic soon. Maybe 20000/yr

 

[jwk]

no doubt. out of hospital codes just aren't the same obviously. so many additional factors.

really still bugging me that at 2 min post collapse no CPR is occurring...I realize their focus is head and neck but that initial survey should have led to compressions immediately unless there is something i'm missing regarding what they are taught. Perhaps protocol to remove equipment ect for effective cpr? Just seems like need for CPR was not immediately recognized. I hope i'm confused and wrong on this but even when i rewatch the video i just don't see immediate action.

Similar concerns - and - was it quality CPR? I haven't seen the longer video some of you have apparently seen, but unless his shoulder pads were removed immediately, CPR quality is going to suffer (along with being on a relatively soft grass/turf surface)

 

[Vandalia]

Thank God there was a dentist and chiropractor there!

Wonder what the "airway management physician" is. Appears to be the only physician present who was maybe more qualified to run a code than the EMT.

I also wonder if the million live spectators affected any decision making, especially with regard to starting CPR.

The "visiting team liaison" is always a local EM physician.

Based on the EM grapevine, there are generally also 2-3 additional EM physicians present at the stadium "on duty" for games. I heard a specific number for this game but don't want to give it since it is second hand. But there were EM physicians running the code.

 

[coffeebythelake]

Interesting infographic for the chiropractor. They should have put a duck on there instead of a doctor with a stethoscope.

 

[RadOncDoc21]

View attachment 364244

Interesting infographic for the chiropractor. They should have put a duck on there instead of a doctor with a stethoscope.

Seriously, If they’re going to pay for useless staff, I can be the designated rad onc. I would gladly take call 24/7 for every team…just saying.

 

[PTPoeny]

Similar concerns - and - was it quality CPR? I haven't seen the longer video some of you have apparently seen, but unless his shoulder pads were removed immediately, CPR quality is going to suffer (along with being on a relatively soft grass/turf surface)

I have seen mentioned in some articles that part of the delay was cutting and flipping up the pads. Given that football pads are specifically designed to absorb and dissipate impacts to the chest I cannot imagine that CPR would be effective in any without getting the pads out of the way.

 

[DocMcCoy]

There’s only 20-30 commotio cases reported per year and most common in little kids. The elephant in the room is the covid vaccine. I’m not saying that’s to blame but we know it’s being discussed elsewhere.

I’m further right than 95% of SDN. Even I gotta say, bro…no

 

[Fpg1245]

I’m further right than 95% of SDN. Even I gotta say, bro…no

I did enjoy watching Tucker try to make that connection though

 

[Ezekiel2517]

An NFL game has more medical staff than a rural hospital:

View attachment 364237

This just makes these so-called experts look egregiously bad and incompetent. Look at how long it took for them to recognize that the player lying on the field was dead. How long it took for them to initiate CPR. How long it even took for them to get an ambulance on the field. And despite a neuro specialist being on the sideline for every game, concussions are being failed to be recognized every week. Tua Tagovailoa has literally suffered 3-4 major concussions within the past several weeks. The only one they correctly identified was the one that caused him to exhibit the fencing response while lying on the turf. They kept throwing him out there to play for the other ones lol

 

[Pappy Van Propofol]

I’m further right than 95% of SDN. Even I gotta say, bro…no

For one I never said I believe that’s what caused his cardiac arrest. I’m saying the general public is questioning why young people are dropping dead and it certainly is something to discuss. To just immediately say it’s commotio which is ridiculously rare plus the guy had shoulder pads that cover his chest when he was hit. People on here freak out if the vaccine is even mentioned or for God’s sake questioned. So are we still pushing boosters on this forum?

 

[Vandalia]

For one I never said I believe that’s what caused his cardiac arrest. I’m saying the general public is questioning why young people are dropping dead and it certainly is something to discuss. To just immediately say it’s commotio which is ridiculously rare plus the guy had shoulder pads that cover his chest when he was hit. People on here freak out if the vaccine is even mentioned or for God’s sake questioned. So are we still pushing boosters on this forum?

No evidence “young people are dropping dead”, the data shows the opposite is true.

Given the number of blows to the chest NFL players receive in games and practices, (how often do you see a player with the “wind knocked out of them”?) they are long overdue for a case.

Using your logic, we know that vaccination related injuries are exceptionally rare, therefore none of the purported injuries or illnesses can be vaccine related.

 

[Pappy Van Propofol]

No evidence “young people are dropping dead”, the data shows the opposite is true.

Given the number of blows to the chest NFL players receive in games and practices, (how often do you see a player with the “wind knocked out of them”?) they are long overdue for a case.

Using your logic, we know that vaccination related injuries are exceptionally rare, therefore none of the purported injuries or illnesses can be vaccine related.

I need to know if we are still pushing boosters? I need to make sure I tow the company line.

 

[wysdoc]

News update 1:40PM 1/4/23

A representative for Buffalo Bills safety Damar Hamlin reportedly offered an update Wednesday on the player’s health as he remained in the University of Cincinnati Medical Center following a medical emergency.

Doctors at the hospital got "promising readings that they had been hoping to see," ESPN reported, citing Jordon Rooney and the Hamlin family. Rooney reportedly added that it appeared "progress" was made. Hamlin was still in the ICU sedated and considered to be in critical condition.

Rooney also clarified to the outlet that Hamlin needed to be resuscitated only once — at Paycor Stadium. Dorian Glenn, Hamlin's uncle, told CNN on Tuesday night that Hamlin's heart needed to be restarted for a second time.

I bet they counted his probable intubation on arrival at the hospital as another "code"?

 

[nimbus]

I need to know if we are still pushing boosters? I need to make sure I tow the company line.

Why are you asking us?
You know better than any of us what your workplace requires.

I’ve had 3 Pfizer and a bivalent Moderna booster. Boosters are recommended but not mandatory where I work.

 

[PTPoeny]

I bet they counted his probable intubation on arrival at the hospital as another "code"?

A different family member today clarified that there was only one cardiac arrest:

Damar Hamlin shows 'signs of improvement' while still in ICU in critical condition, Bills say, after mid-game cardiac arrest | CNN

After suffering a cardiac arrest mid-game on Monday, Buffalo Bills safety Damar Hamlin remains sedated on a ventilator as doctors work toward getting him to breathe on his own, according to an update from the player's uncle.

www.cnn.com

 

[pgg]

I need to know if we are still pushing boosters? I need to make sure I tow the company line.

toe

 

[Twiggidy]

I need to know if we are still pushing boosters? I need to make sure I tow the company line.

We're here to discuss what happened to Damar Hamlin. Your theory is at the bottom of the differential diagnosis.

 

[coffeebythelake]

For one I never said I believe that’s what caused his cardiac arrest. I’m saying the general public is questioning why young people are dropping dead and it certainly is something to discuss. To just immediately say it’s commotio which is ridiculously rare plus the guy had shoulder pads that cover his chest when he was hit. People on here freak out if the vaccine is even mentioned or for God’s sake questioned. So are we still pushing boosters on this forum?

The general public thinks that a 1/3 pounder is smaller than a 1/4 pounder hamburger. The medical misconceptions of the general public is what you as a physician should be trying to educate rather than pander to.

 

[anaesthetic]

For one I never said I believe that’s what caused his cardiac arrest. I’m saying the general public is questioning why young people are dropping dead and it certainly is something to discuss. To just immediately say it’s commotio which is ridiculously rare plus the guy had shoulder pads that cover his chest when he was hit. People on here freak out if the vaccine is even mentioned or for God’s sake questioned. So are we still pushing boosters on this forum?

Have you ever worn shoulder pads? There’s definitely room for a direct hit near/underneath the xiphoid process, especially if someone is coming from below and heading upwards towards the chest. Now imagine that with 99th percentile, NFL-type speed and power, and we’re blaming cardiac arrest, after an inciting event, on a vaccine… okay.

There’s another elephant in the room, but it’s not the one you’re thinking of.

 

[greatnt249]

For one I never said I believe that’s what caused his cardiac arrest. I’m saying the general public is questioning why young people are dropping dead and it certainly is something to discuss. To just immediately say it’s commotio which is ridiculously rare plus the guy had shoulder pads that cover his chest when he was hit. People on here freak out if the vaccine is even mentioned or for God’s sake questioned. So are we still pushing boosters on this forum?

Do you know what else is ridiculously rare? Myocarditis from COVID vaccine.

 

[ranvier]

Can they slim down the life vest to a bulky undershirt size so every athlete gets immediate defibrillation?

 

[anes121508]

what you all making of news saying "neurologically intact"?

 

[crash2500]

Reported to neurologically intact! Here's to the medical personal on seen.

 

[greatnt249]

Can they slim down the life vest to a bulky undershirt size so every athlete gets immediate defibrillation?

You're proposing that everyone playing a contact sport (or even noncontact sport if a projectile is involved) wear a Life Vest in the exceedingly unlikely probability that a commotio cordis event happens?

What everyone witnessed was a freak accident that little can be done to mitigate (assuming it was commotio cordis, which is the easiest explanation for what happened).

 

[Iso4ane]

Seriously, If they’re going to pay for useless staff, I can be the designated rad onc. I would gladly take call 24/7 for every team…just saying.

I call gastroenterologist then. So I can find out when players are full of it during the middle of a game.

 

[crash2500]

what you all making of news saying "neurologically intact"?

I would think purposeful movement. You don't make a statement like that unless you know for sure there is no anoxic brain injury.