Beck Water

I'll just put out here from personal experience - the adage "a lie (or misunderstanding, or misinformation) travels around the world before truth has a chance to put on her shoes" applies in emergency medicine as elsewhere. Doctors and nurses who are focused on saving a patient's life are understandably not the best communicators to relatives. One layperson relative is not the best communicator to another relative. In situations where someone close to me has required emergency care, I've been told things by an LPN relative that didn't make sense, and then received different information when I had a chance to speak to the physician. It's not deliberate, it's just the old "game of telephone" where things get altered as they're passed along.

Thank you for saying this. I do understand that some people don't want to wade through technical discussions on the thread. I think most of them arise because people re-tweet or bringing in numbers I don't think are consistent with the current state of the medical art, and then we get into Brandolini's Law Anyway, I go back and forth about if I say something am I just annoying people, it's good to have the perspective "yes, but other people find it helpful" We all cope with grief and fear in different ways. Some of us pray most effectively with tools in our hands, and in this case information is a tool.

Can you share where you heard this? Who is "they"?

Fantastic post, Thanks! So basically, any cardiac arrest/ROSC leaves the patient susceptible to re-arrest? But now we have reports that he did not re-arrest so that's great if true. On the ambulance, I'll give my perspective as a former EMT which could be full of wind, but whatever. I think the ambulance most likely waited because the emergency physician or one of the paramedics was performing a procedure, in consult with the trauma center, that was quicker and easier to perform while the ambulance was not in motion. You know how using your cell phone is hella easier when you're sitting still vs. jouncing around a city street? Yeah, That. It's kind of an unusual situation BECAUSE there is an emergency physician and airway specialist and a broader range of equipment and drugs available to them at the stadium. So the physician/paramedics could well have been in contact with the trauma center and they mutually decided to do whatever they paused to do vs. waiting 10-15 minutes to arrive at the Trauma Center. It's my understanding that since Kevin Everett and Ryan Shazier's injury, the NFL is "all in" on hypothermia treatment. They reportedly started an IV - I'm told that chilled IV fluids are now maintained at Pittsburgh stadium, so quite likely elsewhere as well - and they could well have packed him in cooling packs or ice to start hypothermia, stadia most certainly are supplied with ice and blue ice packs. They might even have paused to do this before heading for the ER. Sal C reported that Damar's mom was on her way down while he was still on the field, standing behind the Bills bench saying "I want to be with my son" and he summoned Dane Jackson who got the attention of the Bills Chaplain, and they then worked with security to get her on the field ASAP. I think she just got down to the while the ambulance was still there so they put her in, and if the ambulance had been ready to leave before she got there it would have left and security would have put her in a car and followed.

My point was that imposing a deadline of 24 hrs as a point to be concerned, is intrinsically speculative. What is it based upon? To answer your question: Obviously, it would be great if 24 or 48 hrs brought positive news but no, I'm not concerned because 24 hrs have gone by without news. Obviously, I'm very concerned and worried that he needed to be resuscitated 2x and that he was said to not be breathing on his own after resuscitation - though, there seems to be some contradictory info on that. But, I know that patients who are initially unconscious after resuscitation do recover fully, so I'm still hoping for the best. I also know that sedation with or without hypothermia are used to reduce oxygen demands by the brain and allow time for healing. Some of the hypothermia protocols call for 24-48 hrs of hypothermia, followed by gradual rewarming - with no attempts to look for return of spontaneous breathing until rewarming is complete. I said up-thread that we might not hear anything until today at the earliest, and some others with experience said Thursday. The NYT article linked upthread quoted experts saying that if there is no improvement within 72-96 hrs that would be concerning. The hypothermia protocols from Johns Hopkins and U Penn note that improvement may not be seen immediately after the protocol, and that decisions should not be made for 72 hrs after the protocol is fully completed. So I'll go with the experts, and say that if we don't hear of improvement ~96 hrs post incident (Friday night), I'll be concerned.

One of the experts interviewed in the Times article made a point that seems relevant - that the more concerned physicians are about neurological damage, the more aggressive (meaning likely to use/likely to extend duration) they may become with sedation and hypothermia. Hmmm. Speaking with my engineer hat, the protocols must then vary depending upon the cooling devices available. Ice bags or cooling gel packs are hard to maintain at intermediate temperatures, but a blanket featuring flexible tubing through which a bath circulates water should be able to be controlled for gradual re-warming.

If the blow throws the heart into fibrullation is that due to muscle damage, or does the blow actually damage one of the nodes or bundles? Because if the node itself is damaged in some way (bruised?) that might explain the repeated cardiac arrest? I agree you don't average studies. My feeling is a more recent study (assuming both solid work and some procedural or treatment-based explanation of differences), it supercedes the older study. So if a newer study says hey, portable AEDs are much more common now and that plus bystander CPR make a huge difference to survival, I regard the more recent study as superceding the old. As someone said up-thread, outside of a hospital, there is likely no better place to receive care for a true medical emergency than on the field at an NFL game. And it's possibly better than a hospital, because there's a dedicated team standing by (as opposed to everyone on shift already working like mad) and they have access to something like 90-95% of the initial equipment a trauma center ER would use. It's a good question, but you're likely correct IMO. Also, the older 10% survival abstract says that roughly half the cases occurred at homes, playgrounds, schools etc - outside organized sports.

So per information posted above, the NFL DOES have a trauma team standing by, not at the hospital but actually on the field. It consists of a physician trained in Emergency care, an airway specialist, 2 paramedics, plus the physicians and trainers who travel with the visiting team and the physicians and trainers of the home team. They all get together 90 minutes or an hour before the game, and discuss roles and responsibilities in different emergencies including cardiac arrest - who will maintain the airway, who will perform chest compressions, who will set up and operate the defib, presumably who will remove the facemask and pads, how the ambulance will be brought onto the field, what hospital will be used etc. Links posted upthread.

Hi Herc, I had that phrase in quotes because it was used in the post to which I was responding to. I think the person in question was thinking of weaning off the vent, but unsure what exactly they meant and probably should have asked not quoted. IF (and we don't know this) Damar Hamlin has been placed in a post-cardiac arrest hypothermia protocol, information on the interwebs from two major medical centers seems to differ from your corrections in terms of the protocol they use. Johns Hopkins has a writeup explaining the treatment for patients and family: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/therapeutic-hypothermia-after-cardiac-arrest (which someone cited upthread) says the following: University of Pennsylvania has a protocol online: https://www.med.upenn.edu/resuscitation/hypothermia/assets/user-content/documents/TherapeuticHypothermiaProtocolforCardiacArrest.pdf This protocol also mentions that the patient is maintained on sedation while being cooled, maintained in hypothermia, and rewarmed (Phase 1 2 and 3). They use the term "sedation vacation" as you use "spontaneous awakening trial": Last, a study in the New England Journal of Medicine comparing hypothermia to normothermia calls into question whether hypothermia has a benefit and there are several similar studies: (possible benefit for out of hospital arrest with no bystander CPR, but this doesn't apply to Hamlin) and reiterates that the protocol is not used if the patient was conscious and responding to commands after pulse was restored (which in one interview, Hamlin's friend and marketing manager said he was at one point, prior to sedation and intubation). Again, the hypothermia protocol may not have been used, but if it was, the protocols and patient reference from two major medical centers appear to differ from your information/the protocol with which you're familiar, to say that gradual rewarming IS part of the protocol, and sedation vacations/spontaneous breathing trials are not used during hypothermia treatment.

I believe they mean the time between arrest and the commencement of resuscitation efforts, not the time required to actually restore a pulse. At least, that is the standard measurable in articles about CPR outcomes. Yes, that was my point; we don't need to be speculating like "the standard is to ease the patient into brain activity so if it's more than 24 hrs it's a concern". We don't know what treatment plan the doctors treating him are actually following or what the expected course of that treatment plan is.

Usually, Tuesday is the players day off.

Except that some recent protocols people have linked treat cardiac arrest where the patient does not resume consciousness after circulation is restored, with 24-48 hrs in a medically induced coma/medically induced hypothermia, followed by a 17-20 hr gradual rewarming - before any attempt to "ease the patient into resuming normal brain activity". I have no information on what is really "standard" these days, but in the past the NFL has pretty much used cutting edge therapy to treat injured players (Kevin Everett, Ryan Shazir), so even if 24 hrs is "standard" why do we believe it applies here?

With all respect - I think we should back away from the speculation and the opinions about the meaningful nature of 24 hrs on a ventilator. First of all, we don't know that Damar in fact had commotio cardis. Physicians are speculating that this is the cause of his cardiac arrest, but most also note that it is not a certainty. For example NYTimes article linked up thread: There are other causes, some discussed in this thread. It's also up to testing to rule out a heart attack, where cardiac arrest is caused by blockage. It's rare in a young guy, but it does happen, and commotio cardis is rare, too. Dr. Michael Mack, the chairman of cardiovascular services at Baylor Scott & White Health in Dallas pointed out: Note that this guy, a physician and the actual chairman of cardiovascular services at a major medical center in Dallas, cites 72-96 hours post-trauma as a period where "real concern" is warranted - not 24 hrs. He notes that comas may be induced to improve recovery. If Damar Hamlin was sedated and is being treated with the hypothermia protocols several linked up thread, drugs and not his injury are controlling how long he's under, and they may not even be trying to bring him out until tomorrow or Thurs. I don't put this out here to be a smart ass, but to counter manufactured deadlines of concern like "people SHOULD be concerned if he's still under after over 24 hrs". We aren't his medical professionals. We aren't treating him. Obviously it's optimal if he's conscious and waving as he gets loaded into the ambulance, but he wasn't. That being the case, his medical team is probably concerned about minimizing brain injury. It follows that when to be concerned depends on the treatment being administered and the expected course of treatment.

And to that point - in the more recent study I linked up-thread (the 69 person abstract references 1998 and 1997 papers), survival has improved DRAMATICALLY in more recent years, and the authors attribute this to increased AED availability. In the 10% study, there are indications that in many cases, you are correct. "34 occurring during organized competitive athletics and 35 that occurred during informal recreational sports at home, school or the playground or during other non-sporting activities." Organized competitive athletics do not uniformly have doctors or paramedics or even AEDs and people trained to use them, particularly when they involve younger kids, lower levels of competition, or poorer communities. Informal recreational sports at home or on the playground or during other non-sporting activities almost certainly don't.

There's an article in the Pittsburgh Gazette giving some more information about NFL emergency preparedness (details pertain to the Steelers but the framework is the same for any game. https://www.post-gazette.com/sports/steelers/2023/01/03/nfl-protocols-cardiac-arrest-steelers-acrisure-stadium-damar-hamlin-rayn-shazier/stories/202301030019

Just a point that on a normal week, player preparations for a Sunday game start the previous Wednesday.

As far as recognized cases of Commotio Cordis, never going to get a large number because it is rare. The problem I have is that the study referenced from 1998 appears to be superceded by a more recent study showing much improved survival rates of recent years. It's sort of like citing 1998 HIV survival rates in the face of much improved available treatments. Sure, you can have that, provided you put posts regurgitating random tweets from random reporters retweeting stats and studies that elicit the vomitus reaction there too.

Oh, Lori, No No Girlfriend, Don't do that, don't go there. First of all, as several have commented or linked tweets by doctors commenting, we don't yet know that it was Commotio Cordis. It's one possibility, but there are others. Second, These are two manuscripts from 1997 and 1998. A lot has changed since then in emergency medicine and in competitive sports. This is the more recent study we want https://www.heartrhythmjournal.com/article/S1547-5271(12)01254-4/fulltext Damar Hamlin had everything that leads to a better outcome going for him: Immediate CPR, immediate oxygen administration, immediate use of an AED (automated external defibrillator. His odds are likely to be even better than the 58% given for more recent 6 years. No, no. Don't toss around statistics from the land of "Someone Did My Own Research and came up with a Thing" God Bless Us Every One who try to educate ourselves, but the flaw is when you're not in that field, you don't necessarily see all the publications, you aren't able to put the results in context and critically evaluate the big picture.

This This This. And if you don't have the opportunity, please try to create the opportunity. The Red Cross and many hospitals have classes; some will come to your business or club and teach a class for a minimum number of people. Workplaces that have AEDs usually have an emergency squad, find out and ask to join.

I'm sorry.

I've never heard of that either, and I spent several years working in the ER of a major trauma center and have two nurse relatives who spent decades working at nursing homes and in hospice. If the patient/family want CPR, you do it and do your best. You don't make a judgement about "who won't survive" and decided to "fake it" and go through the motions. Good grief.

Thought it was moderated, and the moderators were part of the problem? Anyway we had a decent Chiefs fan drop by at one point and explained where the decent Chiefs boards were. Apparently even Chiefs fans regard Chiefs Planet as a Sinkhole.

Mix. Early photos he's surrounded by Bills staff, but emergency physician, airway specialist and paramedics would have quickly been summoned.

Is there a licensed retailer you recommend?

I'm not crying, You're crying. OK this one got me, I don't know why, I'm crying.