Damar Hamlin - Now (1/11/2023) discharged from Buf Gen & “recovering at home”

[iccrewman112]

26 minutes ago, YoloinOhio said:

I don’t think they will get any updates from anyone at UCMC.

that is because it is illegal for them to provide any updates.

[Mango]

1 minute ago, HappyDays said:

 

I saw a few journalists on Twitter say that the hospital was supposed to give an official update, but then the hospital came out and said there was no update to give yet. So there will hopefully be one at some point.

 

Not a doctor, so I am basically just guessing/hoping.

Hoping that since his breathing/O2 has improved they are letting his body decide when to start to bring him off ventilation and cooling. Maybe hoping his respiration can return to normal before waking him up? 

[34-78-83]

Just now, SectionC3 said:

So then why do you care when someone on the players’ side complains about the health insurance provided by the league? I strongly suspect it’s going to be an issue in the next CBA.  It’s the right of the players to negotiate it.  I think they’ve earned it, and have for a long time.  

retroactively too...

[YoloinOhio]

5 minutes ago, HappyDays said:

 

I saw a few journalists on Twitter say that the hospital was supposed to give an official update, but then the hospital came out and said there was no update to give yet. So there will hopefully be one at some point.

We just got one from the Bills, but that espn reporter is asking hospital reps directly for updates and that just isn’t going to happen. They will update the family and team and then it is up to them how/if they want to share. 

2 minutes ago, iccrewman112 said:

that is because it is illegal for them to provide any updates.

Exactly. 

Edited January 4, 2023 by YoloinOhio

[newcam2012]

3 minutes ago, TheBrownBear said:

Given everything this team has been through, it's hard to believe he isn't given more consideration for Coach of the Year honors.  I don't think the national audience quite understands how trying this season has been for the Bills.

This makes football so insignificant to me. I wanted that Super Bowl win so bad.

 

Now, I just want Damar to recover and function like a normal young man. 

 

I will watch the NE game on Sunday and thereafter. However, it just won't be the same w/o knowing if Hamlin is OK. 

 

Bills have the number one seed perhaps 2 and in the playoffs . Nevertheless, this season in a big way is lost for me...

[Greg S]

Just now, Mango said:

 

Not a doctor, so I am basically just guessing/hoping.

Hoping that since his breathing/O2 has improved they are letting his body decide when to start to bring him off ventilation and cooling. Maybe hoping his respiration can return to normal before waking him up? 

 

Last night on the NFLN they were talking with a doctor who specializes in these types of injuries. She said you typically won't get any updates for 24-48 hours and in that same time frame that is when they will slowly bring him off ventilation and cooling. 

[Herc11]

3 hours ago, Beck Water said:

 

 

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.

 

In my experience, we do not gradually rewarm the patient. These studies may reference what you are speaking of. But doesn't really mean it is adopted as best practice or that all hospitals follow it. 

 

Also, I did state that you do not reduce the sedation at any point while the patient is being cooled. In fact we will watch to see if the patient is shivering. A paralytic is also used, Nimbex, to control shivering. Any time a paralytic is used the patient must be in a sedated state that is completely unresponsive. We use a scale called RASS, Richmond Agitation Sedation scale to determine level of sedation. For paralytic you want a RASS of -5 and you NEVER reduce sedation while the paralytic is running. Any attempts for an SAT are not until cooling measures are stopped and the patient is back to normal temps. 

 

Sedation vacation is different than a SAT. In a SAT the goal is to determine the patients responsiveness. Sedation vacation is typically just a reduction in sedation medications.

Edited January 4, 2023 by Herc11

[YoloinOhio]

 

[YoloinOhio]

 

[BigdaddyinOrlando]

20 minutes ago, Big Turk said:

 

That's my coach....*sniffle*...said with sunglasses on at a podium.

This man is as genuine and caring coach that we all are proud to be our coach and leader of this team!! And why this team will always run through a brick wall for him!!

[YoloinOhio]

 

[Mango]

7 minutes ago, YoloinOhio said:

 

 

 

Taylor and McD have cemented their tenures in CIN/BUF for as long as they want to be there. 

[YoloinOhio]

 

 

 

 

 

[The Frankish Reich]

13 minutes ago, Herc11 said:

 

In my experience, we do not gradually rewarm the patient. These studies may reference what you are speaking of. But doesn't really mean it is adopted as best practice or that all hospitals follow it. 

 

Also, I did state that you do not reduce the sedation at any point while the patient is being cooled. In fact we will watch to see if the patient is shivering. A paralytic is also used, Nimbex, to control shivering. Any time a paralytic is used the patient must be in a sedated state that is completely unresponsive. We use a scale called RASS, Richmond Agitation Sedation scale to determine level of sedation. For paralytic you want a RASS of -5 and you NEVER reduce sedation while the paralytic is running. Any attempts for an SAT are not until cooling measures are stopped and the patient is back to normal temps. 

 

Sedation vacation is different than a SAT. In a SAT the goal is to determine the patients responsiveness. Sedation vacation is typically just a reduction in sedation medications.

As I said to our other medical expert here: a sincere thanks. People want information (it’s a natural human reaction to a tragic event), and I’m glad we have people willing to share their expertise and experience. It is much better than relying on speculation and internet sources. 

[mannc]

20 minutes ago, iccrewman112 said:

that is because it is illegal for them to provide any updates.

Not illegal with proper authorization from the family.  I hate to say this, but the lack of any real information directly from the doctors is seriously concerning. 

[YoloinOhio]

 

[YoloinOhio]

 

 

[Herc11]

3 hours ago, Beck Water said:

 

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?

 

In my understanding, it is not about damage. It about the timing of the blow. If the blow occurs at the exact millisecond when the heart is in a specific point of the T wave it can disrupt the electrical signal causing arrhythmia, V fib. 

 

The same principal can occur when delivering a shock to restore the heart from certain arrhythmias. For instance, in v-tach or SVT before shocking you MUST use the "sync" button before delivering the shock. This allows the device to detect the rythtym and deliver the shock at the appropriate time. If it is not used and you deliver the shock during a point in the T wave, you can put the heart into v-fib which is worse than the rythym you were trying to correct.

 

In v-fib the heart is basically just quivering so the use of "sync" doesn't apply. 

[GaryPinC]

1 hour ago, Mr. WEO said:

 

Unfortunately oxygenation isn't an indicator of much.  Assuming normal lung function and adequate cardiac output, he should have little difficulty oxygenating on the vent. The key moment isn't taking him off the vent.

 

There aren't necessarily going to be "good/improving numbers" in this scenario, unfortunately.  All that matters is what will be his mental status as the hypothermic therapy and sedation are stopped.  His heart can, right now, be fully back to baseline (no doubt he's had at least one echocardiogram since he went down)--the issue is did he suffer an anoxic brain injury before spontaneous circulation was restored in the filed.

Is there one key moment?  I would say it's a series of them.  "Assuming normal lung function" is not smart after a patient had an arrested heart, been defibrillated, had CPR and is on ventilator.  To add to what Redtail Hawk posted, varying degrees of acute pulmonary edema is not uncommon in this situation.

 

Oxygenation coupled with CO2 levels confirms whether or not the lungs are properly exchanging and functioning.  That's pretty damn important.  

 

To take the patient off ventilator and see their breathing reflex (and autonomic nervous system) functioning normally is a huge moment in my little world.  You're not wrong that assessing overall brain function is very important but if the autonomic nervous system is compromised, well I've never allowed an animal patient make it back to consciousness.  There are different degrees to anoxic brain injury, many quite recoverable, but autonomic compromise is a dark indicator IMO.  

[Since1981]

35 minutes ago, YoloinOhio said:

that is because it is illegal for them to provide any updates.

Yup. What part of HIPAA doesn’t any modern adult (reporters) not understand? Hamlin’s  uncle + internship friend obviously acting as family comms people. And anyone with life experience also knows, major health recoveries are a slow process—not Twitter paced.