I'm a medical student, and I complain too often about medical errors in books or on TV. So here I've gathered some common medical mistakes, hoping I might help clear up some things, and maybe teach you a thing or two. This is by no means a replaceme...
This is how it goes on TV: A patient's blood pressure drops, he's stopped breathing and the heart monitor shows a flat line. His heart has stopped! Everyone panics until someone grabs a defibrillator. They shout "Clear!". The patient's body jerks off the table, and then he gasps as he is shocked back to life.
Resuscitation is the thing that is most often portrayed inaccurately, in both books and TV. The scene above is so ingrained in the average viewer's mind, that it's nearly impossible to get writers and producers to change it. No one even questions it. It's familiar, so it must be correct, right?
However, there are several things really wrong with this scenario. Today, we'll start with flatlines.
Part 1: Flatlines
Shocking the heart while the patient is 'flat-lining' never works. Never.
I'll explain why. Your heart beats because of an electrical impulse. Each cell generates a tiny impulse. In a normal heart, they all work together, making one big impulse, which is the big peaky squiggle you see on a heart monitor -- the heartbeat. This makes sure all the muscle cells in your heart contract at the same time, so you can pump around a lot of blood.
Now, if something happens, and the tiny impulses don't work together any more, you get a chaotic line, up and down all the time. You can't recognise that heartbeat from before any more (you can see this in the image). This means that the muscle cells don't work together any more either, so your heart can't pump. It's like trying to squeeze something while wiggling your fingers. Effectively, this means your heart has stopped functioning. It can't pump around blood. This is called a ventricular fibrillation.
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This is when shocks work best. What a shock does, is 'reset' the heart. It overloads the muscle cells, all at the same time. So after being overloaded, they start beating again, but now they've been overloaded at the same time, so they restart at the same time. Now the heart contracts at the same time, and it works again.
Did you know that another name for 'shocking' is 'defibrillation'? The name can help you remember how this whole thing works. De-fibrillation is for ending a ventricular fibrillation.
A flatline is what we call asystole. It means 'no heartbeat'. There is no electrical activity in the muscle cells. So, there is nothing we can reset, even if we wanted to. Though, as you can see in the image, even the line on an asystole isn't completely flat like on TV. It's more like a very gentle wave. If it's flat, your equipment is probably broken. For those interested, asystole is treated with IV epinephrine (or adrenalin, same thing) and chest compression. There's not that much else we can do. The survival rates are, as expected, much lower than those of a ventricular fibrillation, which can be shocked.
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Those with more medical knowledge will notice I've simplified things. It's not my goal to teach you how to be doctors, but rather to show you how to avoid common mistakes.
There, that was it for today. I hope it was useful. If you have any question, ideas or observations you want my input on, feel free to leave a comment. The next chapter will be up on next Friday.
