Seeing the Elephant (Experiences with Death)

[mikea7]

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Hello, all,

Well, I've seen the proverbial elephant for the first time. Last week, I went to the gym with a friend; we'd planned to get there, change, warm up, and play some basketball, as usual. While I was in the locker room they put out an intercom call for a doctor. I finished changing, thinking that it must've been something minor and would be taken care of by someone who was better qualified.

When I got to the basketball court, the crowd was evenly split between the end near the entrance and the far end, at which a group stood around a prone body on the floor. A guy I'd seen before told me that this young man had just collapsed during the game. As far as I could see, no one was doing CPR, though it looked like someone was knelt by the figure as if examining him. By this time, it must have been around 5 minutes since his collapse.

Shortly, the paramedics arrived and began CPR. They tried a defibrillator, then had to intubate the kid because he wasn't breathing on his own. His pulse was weak and sporadic when they wheeled him out, and by the time the EMTs came back to get their stuff, they let us know that he was gone.

The way he looked as they took him out...I've never seen anything like that color, the look of his eyes...

He was 20, and, according to the news, died of a "heart attack" (much more likely SCA.)

I've been very upset this past week, and can't get the images out of my head or the fear and regret out of my heart. I imagine that, as I see this more often, the sharp edge of fear will be dulled somewhat, though, knowing me, the sadness and regret may never change.

I've been trained in CPR in the past, and will be trained again. And I'm more sure of my path in life now than I have been in many years. And yet...I won't get that chance back; his family will never get him back. I feel terrible for them, and there's nothing I can do to change the reality.

This was a guy close to my age, just living life and having fun, and then it was over. And I saw it happen and could do nothing.

Does anyone have experiences and insights they'd like to share with me? I only recently decided to make medicine my life's work, and so I'm painfully new to this sort of thing. I know it'll fade some in time, but for now it just hurts.

If you've been there, how have you coped? To paraphrase Sara Henderson Hay: how can this small body hold so immense a thing as death? 🙁

 

[mikea7]

Hello, all,

Well, I've seen the proverbial elephant for the first time. Last week, I went to the gym with a friend; we'd planned to get there, change, warm up, and play some basketball, as usual. While I was in the locker room they put out an intercom call for a doctor. I finished changing, thinking that it must've been something minor and would be taken care of by someone who was better qualified.

When I got to the basketball court, the crowd was evenly split between the end near the entrance and the far end, at which a group stood around a prone body on the floor. A guy I'd seen before told me that this young man had just collapsed during the game. As far as I could see, no one was doing CPR, though it looked like someone was knelt by the figure as if examining him. By this time, it must have been around 5 minutes since his collapse.

Shortly, the paramedics arrived and began CPR. They tried a defibrillator, then had to intubate the kid because he wasn't breathing on his own. His pulse was weak and sporadic when they wheeled him out, and by the time the EMTs came back to get their stuff, they let us know that he was gone.

The way he looked as they took him out...I've never seen anything like that color, the look of his eyes...

He was 20, and, according to the news, died of a "heart attack" (much more likely SCA.)

I've been very upset this past week, and can't get the images out of my head or the fear and regret out of my heart. I imagine that, as I see this more often, the sharp edge of fear will be dulled somewhat, though, knowing me, the sadness and regret may never change.

I've been trained in CPR in the past, and will be trained again. And I'm more sure of my path in life now than I have been in many years. And yet...I won't get that chance back; his family will never get him back. I feel terrible for them, and there's nothing I can do to change the reality.

This was a guy close to my age, just living life and having fun, and then it was over. And I saw it happen and could do nothing.

Does anyone have experiences and insights they'd like to share with me? I only recently decided to make medicine my life's work, and so I'm painfully new to this sort of thing. I know it'll fade some in time, but for now it just hurts.

If you've been there, how have you coped? To paraphrase Sara Henderson Hay: how can this small body hold so immense a thing as death? 🙁

 

[Thewrongstuff]

Thats a really sad story...did somebody perform cpr on him before emt came or not?

🙁


And can somebody clarify my ignorance, I thought that they did saline injection/ reperfusion nowadays for this stuff?

 

[armybound]

A few comments to make.

First off, please don't tell names and identifying information of "patients," as this is a violation of HIPAA and generally not a nice thing to do.

Second, if you are experiencing emotional or mental distress because of this, I highly recommend you find a mental health professional to sort out your feelings. It's not uncommon for EMTs/first responders to suffer from PTSD-like conditions after experiencing a traumatic event.

Third, the first experience with death was the hardest for me. I hope you can get any help you need and it ultimately makes you a better healthcare provider.

Fourth, how did the EMTs know he was "gone"? They don't have the authority to make that decision, unless there was dependent lividity or decapatation.

 

[Thewrongstuff]

A few comments to make.

First off, please don't tell names and identifying information of "patients," as this is a violation of HIPAA and generally not a nice thing to do.

Second, if you are experiencing emotional or mental distress because of this, I highly recommend you find a mental health professional to sort out your feelings. It's not uncommon for EMTs/first responders to suffer from PTSD-like conditions after experiencing a traumatic event.

Third, the first experience with death was the hardest for me. I hope you can get any help you need and it ultimately makes you a better healthcare provider.

Fourth, how did the EMTs know he was "gone"? They don't have the authority to make that decision, unless there was dependent lividity or decapatation.

Oh please, its not a HIPAA violation at this point for this specific situation, stop trying to sound smart.

 

[armybound]

Oh please, its not a HIPAA violation at this point for this specific situation, stop trying to sound smart.

You're probably right. And that's being cautious, not 'sounding smart'.

 

[Thewrongstuff]

You're probably right. And that's being cautious, not 'sounding smart'.

Sorry I came off too harsh, didn't mean to but bureaucratic stuff annoys me in general, let alone when used unnecessarily. I apologize.

http://www.gmhsc.com/Documents/HIPAA_Media_Guidelines_--_SC_1.pdf

 

[armybound]

Sorry I came off too harsh, didn't mean to but bureaucratic stuff annoys me in general, let alone when used unnecessarily. I apologize.

http://www.gmhsc.com/Documents/HIPAA_Media_Guidelines_--_SC_1.pdf

You'll also notice that the guy gave specifics about what healthcare was given, which could probably only be found in medical records. You're obviously more informed with HIPAA than I am, but I don't know if giving out detailed medical information + identifying info (a name) are OK or not. so we'll go the cautious route just for the time being.. I don't think knowing his name is necessarily important for the purpose of the thread anyway.

 

[MeowMix]

I had a similar experience 20 years ago when I had no first aid or CPR training. A woman sitting next to me at a concert collapsed. I rolled her over but had no idea what to do. She was still breathing at that point, but eventually her heart stopped.

I never forgot the details of that day, every little thing. I will never forget that feeling of complete helplessness and having to call out in a crowd of 10,000 people for someone who knew how to do CPR, and how long it took for someone to arrive. Time blunts the intensity of the emotions, but I think that experience will stay with you forever. It's not a bad thing; it reminds you that even simple skills can help, though sometimes there is nothing you can do even with the best skills and equipment.

 

[nick_carraway]

You're probably right. And that's being cautious, not 'sounding smart'.

I also think it's etiquette to not announce something like a deceased person's name unless there's a reason to.

Personally, I wouldn't want people writing about me by name on a forum after I die. Hell, I wouldn't even want a lot of people who I know to find out that I'm dead much less a network of random people.

 

[Thewrongstuff]

Here is the news story...

http://starbulletin.com/2008/01/10/sports/story04.html

It says he died in the hospital at night 🙁

 

[nick_carraway]

Here is the news story...

http://starbulletin.com/2008/01/10/sports/story04.html

It says he died in the hospital at night 🙁

Yeah but that's a news service. That said, even the news should just report the facts for things like this. Would it be polite of me to start blogging about a girl who I saw die on the highway by name? Mentioning the look in her lifeless eyes? The almost-smirk she had on her face? I'm sure people would love to hear that about someone they might know.

I think the post would have still been powerful without the name included.

 

[135892]

Sorry to hear about what happened

I actually was unfortunate enough to experience a similar situation. One of my teammates on my high school basketball team collapsed one day at the end of practice and had to be taken to the hospital. I went home, hoping that he would be fine and that this was nothing too severe, but later that night, I found out that he had passed away. It was a really tough situation for me, but I eventually got through it. It really is sad when a young, seemingly healthy kid just gets his life taken away.

 

[decafplease]

A few comments to make.

First off, please don't tell names and identifying information of "patients," as this is a violation of HIPAA and generally not a nice thing to do.

Second, if you are experiencing emotional or mental distress because of this, I highly recommend you find a mental health professional to sort out your feelings. It's not uncommon for EMTs/first responders to suffer from PTSD-like conditions after experiencing a traumatic event.

Third, the first experience with death was the hardest for me. I hope you can get any help you need and it ultimately makes you a better healthcare provider.

Fourth, how did the EMTs know he was "gone"? They don't have the authority to make that decision, unless there was dependent lividity or decapatation.

OP, I don't think you need to see a therapist because you saw a young man die. If you have thoughts of suicide or fall into a serious depression, then I'd look for a counselor. It's totally normal after loosing someone or watching someone die to have feelings of grief. We all cope in different ways. Religion, lack of religion(or God), apathy, cathartic writing or art... the list goes on. Find an outlet. Trust me, you'll need it in medicine.

 

[DavisStudent]

A few comments to make.

First off, please don't tell names and identifying information of "patients," as this is a violation of HIPAA and generally not a nice thing to do.

Second, if you are experiencing emotional or mental distress because of this, I highly recommend you find a mental health professional to sort out your feelings. It's not uncommon for EMTs/first responders to suffer from PTSD-like conditions after experiencing a traumatic event.

Third, the first experience with death was the hardest for me. I hope you can get any help you need and it ultimately makes you a better healthcare provider.

Fourth, how did the EMTs know he was "gone"? They don't have the authority to make that decision, unless there was dependent lividity or decapatation.

Although I'm not totally sure, and it likely varies by local protocols, paramedics can often call their base hospital and speak with a doctor to end resuscitative efforts. Atleast at the hospital where I work as an ER tech, we often get calls from medics wanting permission from the doctor to pronounce a patient.

But what a tragic story. I feel deeply for the family, friends, and all those affected by this.

 

[Piyush]

OP, always find the good. Its sad that you had to witness someone die, but I think its better to see someone die when you are not directly responsible as a doctor/med student. In your career, you will loose patients. For many, loosing a patient is their first encounter with death. However, you had the chance to experience that before signing your life off to medicine. At least, and compared to fresh docs or upper year med students, now you can decide if you have the resolve to deal with it, or if you should try something else.


I hope you feel better soon, and get back on your career path, and not let something like this deter your, rather use this as a way to reinforce your decisions to study medicine.


Piyush.

 

[Thewrongstuff]

Yeah but that's a news service. That said, even the news should just report the facts for things like this. Would it be polite of me to start blogging about a girl who I saw die on the highway by name? Mentioning the look in her lifeless eyes? The almost-smirk she had on her face? I'm sure people would love to hear that about someone they might know.

I think the post would have still been powerful without the name included.

Koko, I understand how you feel about this even though I disagree 👍

OT but if this person was a random joe nobody from the media would have really cared. The celebrity factor was in play.

 

[armybound]

Koko, I understand how you feel about this even though I disagree 👍

OT but if this person was a random joe nobody from the media would have really cared. The celebrity factor was in play.

even "celebrities" have expectations of privacy, despite how it seems in our current society.

 

[Thewrongstuff]

even "celebrities" have expectations of privacy, despite how it seems in our current society.

Yeah, sad fact is that our current privacy laws basically allow the paparazzi to semi-harass them. Imagine having a hard time taking your kid out to the park because of some creepy idiot following you flashing around his digital rebel xt.

 

[armybound]

Yeah, sad fact is that our current privacy laws basically allow the paparazzi to semi-harass them. Imagine having a hard time taking your kid out to the park because of some creepy idiot following you flashing around his digital rebel xt.

how did you know I have a 350D? are you stalking me?

 

[135892]

Yeah, sad fact is that our current privacy laws basically allow the paparazzi to semi-harass them. Imagine having a hard time taking your kid out to the park because of some creepy idiot following you flashing around his digital rebel xt.

I wouldn't mind this at all, as long as I was making the millions these actors make...

 

[nick_carraway]

Yeah, sad fact is that our current privacy laws basically allow the paparazzi to semi-harass them. Imagine having a hard time taking your kid out to the park because of some creepy idiot following you flashing around his digital rebel xt.

Reminds me of a news story I saw... not sure from where or from how long ago... or if I made it up completely.

I think I have a memory problem...

 

[smq123]

And can somebody clarify my ignorance, I thought that they did saline injection/ reperfusion nowadays for this stuff?

Saline "injections" are used when people are very, very dehydrated.

They can use catheters to unclog arteries and reperfuse the heart in actual heart attacks. What this person had was probably not a real heart attack, though - that's what the newspapers are calling it because that's the thing that people are most familiar with.

It's unusual for 20 year olds to have myocardial infarctions, and, even if they did, they wouldn't die that quickly. This guy probably had an underlying heart defect that, combined with the stress of physical activity, caused a sudden cardiac death (which is completely different from an MI). It's a scenario that routinely shows up on medical school exams and on USMLE exams. That's also why there's an increasing movement by parents to have EKGs as part of standard athletic physicals, because EKGs can often pick up these heart defects.

Oh please, its not a HIPAA violation at this point for this specific situation, stop trying to sound smart.

It may not be a HIPAA violation per se, but it's important to get into the habit of discussing patients in general, vague terms. Generally speaking, you should never give out detailed medical information with clearly identifying information - i.e. names, a specific job title, a unique accomplishment, etc.

 

[neuroprotector]

For crying out loud, guys. How insensitive are we that our first responses to the OP are not related to the events that took place, but were a discussion over whether he violated HIPAA!

Regardless, I think that's a pretty serious story. I bet a lot of people here have heard of the bystander effect, and I guess this is another instance of when it occurs. I guess it's good to know about things like this, so that when it actually hits the fan, we can be ready to act.

 

[Old Grunt]

Not to be crotchety, but to "see the elephant" implies someone was trying to kill you since it is a euphemism for being in combat that originated in the civil war (and perhaps earlier).

Sooner or later, we all see and deal with death and dying. It's not quite the same as being as witnessing death and destruction on the battlefield IMO.

The way we coped in combat was to lean on each other and develop a sort of gallow's humor that I suppose acted as a mental callous. Even still, you can't completely seperate yourself mentally, and I don't suspect that veterans ever truly do. Perhaps you should try talking to someone else that was there. They might be having the same issues.

At any rate, sorry that you are having a hard time with it all. If you find yourself dwelling on the matter, you should go talk to a professional. There is no shame in that.

 

[JMB2213]

mikea7,

i'm sorry you had to go through that experience. i went through similar instances when i had residents with near death experiences and one with a suicide. after a traumatic experience, the most important thing for you to do is to find an outlet, something that allows you to take your mind off of the event. it has passed, and there isn't anything else you can do to change what happened.

what you can do is be proactive about being prepared for any future instances. for example, after the suicide, i made a commitment to learn about depression and warning signs and also reaching out to people i knew.

each person deals with near death/death experiences differently, so you need to pay attention to your needs. do things that keep your spirits up - go workout, hang out with friends, etc... for me, it was helpful for me to talk to a counselor and to some of my close friends about the suicide, what i did about it, how i knew the person, what i could do in the future, etc. talking about my feelings and my role in the situation helped me realize how i could make a difference in the future. i think its especially important to let your close friends/family know what's going on, so they can be a support net for you.

i hope that helps. i don't think handling death will ever get easier for me, but i do think i have learned a few ways to cope with death, take care of myself after a traumatic experience, as well as how to react in emergency situations (not freeze up).

take care of yourself and feel free to pm me if you want to talk.

-jmb

 

[Thewrongstuff]

Saline "injections" are used when people are very, very dehydrated.

They can use catheters to unclog arteries and reperfuse the heart in actual heart attacks. What this person had was probably not a real heart attack, though - that's what the newspapers are calling it because that's the thing that people are most familiar with.

It's unusual for 20 year olds to have myocardial infarctions, and, even if they did, they wouldn't die that quickly. This guy probably had an underlying heart defect that, combined with the stress of physical activity, caused a sudden cardiac death (which is completely different from an MI). It's a scenario that routinely shows up on medical school exams and on USMLE exams. That's also why there's an increasing movement by parents to have EKGs as part of standard athletic physicals, because EKGs can often pick up these heart defects.



It may not be a HIPAA violation per se, but it's important to get into the habit of discussing patients in general, vague terms. Generally speaking, you should never give out detailed medical information with clearly identifying information - i.e. names, a specific job title, a unique accomplishment, etc.

Wait a minute...

Reports say that he died in the hospital and that he had a heart attack. Why is it not possible that he died of reperfusion injury post percutaneous coronary intervention? The later you wait the more apoptosis screws you up upon reperfusion


And about saline, were you ever told about this stuff..I think its experimental:

http://www.topix.com/content/cbs/2007/09/new-treatment-brings-patients-back-from-the-dead
Bill ended up at Penn, where he got the new experimental treatment of chilled saline that's injected.

Cooling pads are then wrapped around a patient. The body temperature is normally 98 degrees, but cooling brings it down to 92 degrees. Doctors keep it there for about 24 hours. This process is called intentional hypothermia.

"It decreases cellular injury when the cells are deprived of oxygen, so with less injury we are able to do a better job of getting people back," said Dr. Becker.

A similar cooling therapy was used on Buffalo Bills football player Kevin Everett, after a devastating spinal cord injury. He's now able to move after getting a quick infusion of cold saline.

But Dr. Becker said the cooling therapy needs to be faster, so they're developing a slushy type saline that contains ice particles. It would be injected into the blood stream to quickly reduce body temperature.

 

[mikea7]

I've edited the post to remove the name. Sorry.

Thanks to all who have replied, even the ones that responded with criticism. 🙂 You're entirely right, I shouldn't have included the name, in case someone who knew him read it. But it was a major news event here, so I guess I didn't think all that through hard enough before posting the name so that people could look up the articles if they wanted to. This has affected me very deeply, and he was a real person to me, so any disrespect is not intentional, obviously, and comes more out of my brain being scrambled at the moment than anything else. Trust me, it was pretty horrific.

Thanks especially to those who have offered suggestions and advice. Please keep them coming...I appreciate your thoughts. I imagine that we all deal with it a bit differently, and it's that perspective that I need right now.

I can only imagine how those who are in combat and have actually "seen the elephant" must feel...they see this kind of thing all the time...

Be gentle, guys. I'm new here. 😉

 

[nick_carraway]

I've edited the post to remove the name. Sorry.

Thanks to all who have replied, even the ones that responded with criticism. 🙂 You're entirely right, I shouldn't have included the name, in case someone who knew him read it. But it was a major news event here, so I guess I didn't think all that through hard enough before posting the name so that people could look up the articles if they wanted to. This has affected me very deeply, and he was a real person to me, so any disrespect is not intentional, obviously, and comes more out of my brain being scrambled at the moment than anything else. Trust me, it was pretty horrific.

Thanks especially to those who have offered suggestions and advice. Please keep them coming...I appreciate your thoughts. I imagine that we all deal with it a bit differently, and it's that perspective that I need right now.

I can only imagine how those who are in combat and have actually "seen the elephant" must feel...they see this kind of thing all the time...

Be gentle, guys. I'm new here. 😉

I imagine that it's the little things that stick with you after seeing something like that. Not necessarily death, since you can get used to seeing someone die. It's probably the same for soldiers and doctors who see something human or familiar in someone who's no longer alive; a wedding ring maybe, a familiar smile, or how their eyes looked in your example.

Sure, those little things will bother you every time you see them but I think you need to realize that this doesn't need to affect you too much. Realize that you just have to pick yourself up and move on; it's not helpful to anyone if you dwell on it. Sure, someone died but it doesn't mean that it needs to affect your life negatively or forever.

BTW, I had never heard of "seeing the elephant" so I retract my previous post. I thought you were referring to the "elephant in the room" that no one acknowledges.

 

[Vihsadas]

I've never seen anything like that color, the look of his eyes...

Yup. Once you see it, you'll never ever forget the first time that you do. I saw it in my family (mother) and it'll stay with you forever. Sickly yellowish-gray...

 

[MattD]

OP, I don't think you need to see a therapist because you saw a young man die. If you have thoughts of suicide or fall into a serious depression, then I'd look for a counselor. It's totally normal after loosing someone or watching someone die to have feelings of grief. We all cope in different ways. Religion, lack of religion(or God), apathy, cathartic writing or art... the list goes on. Find an outlet. Trust me, you'll need it in medicine.

Are you kidding me? Somehow you're in a position to know the mental/emotional state of the OP and feel competent to assess whether he needs therapy or not? On what grounds? Get the F out of here, that's a comment only a callous tool would make.

btw, blah blah blah giving medical advice on sdn is a violation of TOS blah blah blah

so shut the f* up

 

[mikea7]

Whoa--thanks for looking out, man, but all opinions are respected here. 🙂

As for the concept of cooling the body, with injected saline or otherwise, and then being able to bring people back after a sudden cardiac arrest...I'd heard of this, but had thought it was still a way down the line. It would truly be amazing if we could just keep that window open for a few minutes (hours) more.

 

[Thewrongstuff]

Whoa--thanks for looking out, man, but all opinions are respected here. 🙂

As for the concept of cooling the body, with injected saline or otherwise, and then being able to bring people back after a sudden cardiac arrest...I'd heard of this, but had thought it was still a way down the line. It would truly be amazing if we could just keep that window open for a few minutes (hours) more.

From what I know it's effective and it was catching on way back in 2005. No idea what's up w/ it now. The point the Dr. made was that cells don't really die till much later than we thought, its all about regulating the mitochondria apoptosis factor or whatever its called.

 

[MattD]

Whoa--thanks for looking out, man, but all opinions are respected here. 🙂

maybe by you......


Sorry but I just happen to believe that anyone with a tom cruise view of mental health doesn't belong on these boards, much less in medicine.

 

[nick_carraway]

As for the concept of cooling the body, with injected saline or otherwise, and then being able to bring people back after a sudden cardiac arrest...I'd heard of this, but had thought it was still a way down the line. It would truly be amazing if we could just keep that window open for a few minutes (hours) more.

Ditto. I saw the story on it a while back--I guess it could've been 2005.

I had no idea that it was being used in the field.

 

[coffeebythelake]

Are you kidding me? Somehow you're in a position to know the mental/emotional state of the OP and feel competent to assess whether he needs therapy or not? On what grounds? Get the F out of here, that's a comment only a callous tool would make.

btw, blah blah blah giving medical advice on sdn is a violation of TOS blah blah blah

so shut the f* up

What's with the attitude? The guy never assessed the mental state of the OP nor did he give medical advice. I think it is well recognized that these events can be traumatic for first responders and bystanders... maybe not to the point of suicidal thoughts but it is still good to talk to somebody about them.

 

[smq123]

Wait a minute...

Reports say that he died in the hospital and that he had a heart attack. Why is it not possible that he died of reperfusion injury post percutaneous coronary intervention? The later you wait the more apoptosis screws you up upon reperfusion

Believe me, I understand how reperfusion injury works. But, in a 20 year old, it is VERY unlikely that he had a traditional MI. He would have had to have had some kind of weird dyslipidemia that accelerated plaque formation in his arteries.

If that were true, then the injury that led to his sudden cardiac death would have been so extensive that PCTI would not be effective. PCTI is only effective if a limited number of arteries are clogged - we can't use PCTI for all heart attacks. There is a strict criteria for when PCTI is useful. I know that the media likes to make it sound like PCTI can save everyone, and that it's making the old-fashioned CABG obsolete, but that is DEFINITELY not true.

Furthermore, since the patient dropped so suddenly, PCTI would not be helpful - it takes too long. It's not like you show up to the ER with a massive MI and they whisk you away to the cardiac cath lab within 5 minutes. It takes some time to set it up - it can take up to half an hour, which, in this guy's case, is simply too long.

Finally, as I have said, it is very unusual for 20 year olds to have an MI. Even if they do, people with "traditional" MIs don't suddenly collapse like that. What IS relatively frequent, however, is that he had some type of cardiac heart defect or cardiomyopathy. A heart defect may, suddenly, interfere with heart conduction leading to arrhythmias. If you get into Ventricular fibrillation (V-fib), then you're toast, and you would likely collapse in seconds. It is every ER and ICU doctor's worst nightmare (well, one of them anyway). PCTI doesn't do ANYTHING to help patients in V-fib.

If you look up Hypertrophic Cardiac Myopathy (HCM, sometimes called HOCM), then you'll probably find case reports of perfectly healthy 18 year olds dropping dead on the basketball court - just like this guy unfortunately did.

And about saline, were you ever told about this stuff..I think its experimental:

http://www.topix.com/content/cbs/2007/09/new-treatment-brings-patients-back-from-the-dead
Bill ended up at Penn, where he got the new experimental treatment of chilled saline that's injected.

Cooling pads are then wrapped around a patient. The body temperature is normally 98 degrees, but cooling brings it down to 92 degrees. Doctors keep it there for about 24 hours. This process is called intentional hypothermia.

"It decreases cellular injury when the cells are deprived of oxygen, so with less injury we are able to do a better job of getting people back," said Dr. Becker.

A similar cooling therapy was used on Buffalo Bills football player Kevin Everett, after a devastating spinal cord injury. He's now able to move after getting a quick infusion of cold saline.

But Dr. Becker said the cooling therapy needs to be faster, so they're developing a slushy type saline that contains ice particles. It would be injected into the blood stream to quickly reduce body temperature.

It is experimental, so it's not commonly used. I'm sure that most ERs are not equipped to do this. In any case, it only helps if you are able to get the patient out of whatever fatal arrhythmia he/she is in - which is not always possible. It might not have been possible in this case.

Standard therapy is continue chest compressions, just to keep blood circulating to the brain. Then an AED is used to (hopefully!) cardiovert the person back into NSR (normal sinus rhythm). It doesn't always work, though.

 

[moe_4eva]

It is experimental, so it's not commonly used. I'm sure that most ERs are not equipped to do this. In any case, it only helps if you are able to get the patient out of whatever fatal arrhythmia he/she is in - which is not always possible. It might not have been possible in this case.

Standard therapy is continue chest compressions, just to keep blood circulating to the brain. Then an AED is used to (hopefully!) cardiovert the person back into NSR (normal sinus rhythm). It doesn't always work, though.

It is my understanding that the problems that they encounter is when they warm the patient back up after stabilizing them. The cold saline decreases the inflammatory response, but once the patient is warmed up, the inflammatory response returns in a delayed response, creating a whole new set of problems.

And to the OP, I completely understand, I had a terrible time with my first dead patient. It does get easier, so hang in there.

 

[smq123]

Ditto. I saw the story on it a while back--I guess it could've been 2005.

I had no idea that it was being used in the field.

1) It isn't.

2) Saline injections, in this particular case, is just an academic question now. (Or, as some people like to call it, just "mental masturbation.") If you have v-fib or v-tach, saline injections don't do squat. You MUST correct the arrhythmia FIRST, which, from the news reports and the OP, sounds like the EMTs could not accomplish. Giving saline injections before using an AED is bordering on malpractice.

 

[armybound]

this thread really got off to a rocky start, and I apologize to the OP for that..

but let's try to keep out comments towards each other civil.

 

[futuredrcrawfor]

This is quite an interesting tread title- I had never heard experiences with death called seeing the elephant but I think I can make it all come together-

During my trip to Africa I went to Kruger Park for a safari and we got to see a dead elephant (dead 4 days and smelled gross!) and watch lions eat it- so that is seeing an elephant and experiencing death.

But in all seriousness- I have had to watch doctors talk with patients and families about ending their chemo because there isn't anything else you can do. I follow several cancer kids and have had 5 kids that I have worked with die in the past year. I wasnt physically there but it is still hard to witness through blogs and families stories.

 

[PeepshowJohnny]

Listen to SMQ, she knows of what she speaks.

A twenty year old dropping dead of a "heart attack" is unusual, but there are some very well recognized syndromes that cause it. My mind immediately jumps to Hypertrophic Cardiomyopathy (the growth of the heart's septum is disorganized and leads to problems) Long QT syndromes (Channel dysfunction causes arrhythmias that predispose to death) anomolous origin of coronary artery (just want it sounds like), cocaine abuse (not to besmirch the guy, but it's possible). There's probably a whole bunch of other differential I'm forgetting because I'm just a stupid medical student.

That said, the bad thing about these conditions is not only the affect young people, they are DAMN hard to reverse. When old grandpa goes in with his heart attack, the process tends to be evolving and slow and interventions such as angioplasty and/or very powerful clot busting drugs (depending on what you have available) can save lives. Unfortunately, with the things that affect young kids, they're thunderclap "he's gone" scenarios. The initial event is so cataclysmic and damaging that it's irreversible.

 

[MattD]

What's with the attitude? The guy never assessed the mental state of the OP nor did he give medical advice. I think it is well recognized that these events can be traumatic for first responders and bystanders... maybe not to the point of suicidal thoughts but it is still good to talk to somebody about them.

Reread what he said. He specifically said that 'he didn't think' the OP needed therapy.

 

[Asp]

I had a similar experience 20 years ago when I had no first aid or CPR training. A woman sitting next to me at a concert collapsed. I rolled her over but had no idea what to do. She was still breathing at that point, but eventually her heart stopped.

I never forgot the details of that day, every little thing. I will never forget that feeling of complete helplessness and having to call out in a crowd of 10,000 people for someone who knew how to do CPR, and how long it took for someone to arrive. Time blunts the intensity of the emotions, but I think that experience will stay with you forever. It's not a bad thing; it reminds you that even simple skills can help, though sometimes there is nothing you can do even with the best skills and equipment.

If it's any comfort, she probably would have died anyway.

http://jama.ama-assn.org/cgi/content/abstract/274/24/1922

"Of the subset of 662 individuals (32%) who received bystander CPR, 305 (46%) had it performed effectively. Of these, 4.6% (14/305) survived vs 1.4% (5/357) of those with ineffective CPR (OR = 3.4; 95% CI, 1.1 to 12.1; P < .02)."

Though it seems CPR does triple the survival rate -- sweet.

 

[Old Grunt]

Are you kidding me? Somehow you're in a position to know the mental/emotional state of the OP and feel competent to assess whether he needs therapy or not? On what grounds? Get the F out of here, that's a comment only a callous tool would make.

btw, blah blah blah giving medical advice on sdn is a violation of TOS blah blah blah

so shut the f* up

Damn.

Who pissed in your wheaties?

 

[smq123]

A twenty year old dropping dead of a "heart attack" is unusual, but there are some very well recognized syndromes that cause it. My mind immediately jumps to Hypertrophic Cardiomyopathy

I know - after studying for Step 1, it's almost knee-jerk at this point. "19 year old + sudden 'heart attack' = HCM"

 

[MattD]

Damn.

Who pissed in your wheaties?

Probably my dog, he's been pissing on everything else lately :-<