Medicine goes POP! "Mrs. Mia Wallace"

So, at HippocraTV, we're doing a series on popular culture and medicine.

To add to it, I want to dispel a myth surrounding a situation hopefully no one will ever find themselves in.

Intracardiac adrenaline shots (Do NOT do this..) aka "That scene from Pulp Fiction"

The video, for those who need a quick refresher, is below. It's NSWF (not suitable for work) due to language, but it's a f**king Tarantino film, so it's to be expected.

#1) The anatomy gripe.

He talks about "piercing the breast plate". The magic marker is not on the breast plate.

#2) The only time you should ever see a needle going "into a heart" is with pericardiocentesis.

(though in the late 80s they did look into it for heart attacks...) but it's now considered obsolete. 

Sadly, I've been (un)fortunate enough to see this in a real-life emergency and it's a very delicate, complicated procedure. Let's break it down:

"Peri" is a prefix coming from Greek meaning "around" and "cardio" is in relation to the heart. The pericardium is the sac which surrounds the heart.

Sometimes this sac gets filled with fluid like blood or fluid secondary to an infection. The pressure of this fluid stops the heart from being able to do the major job of refilling with blood to pump around your body, to your brain and everything else which keeps you alive. When this happens, it's called cardiac tamponade. In this situation, you need to reduce the pressure around the heart by removing the fluid. How do you do this?

CAREFULLY and ideally with ultrasound guidance. 

#3) The pericardium is very delicate

If, in this scenario, they located the heart and got the needle "into" it, they would have to go through this sac and into the heart with a giant needle. This would cause trauma to the heart and, more than likely, subsequent bleeding. Though you could argue that they keep the needle there and therefore create a seal, but she doesn't walk around with the needle for the rest of the film, so let's assume it doesn't stay there forever. Blood would leak into the sac around the heart and cause a tamponade. Removal of fluid around the heart is through a procedure called pericardiocentesis. To finish off the Greek lesson from earlier, "-centesis" relates to "the act of pricking". If you want to get drugs to the heart then you go through a vein, not to the heart itself. Unless you're a consultant cardiologist, just don't even think about putting a needle anywhere near there.

#4) Mia has taken heroin. You don't use Adrenaline to treat a heroin overdose.

Heroin causes respiratory depression. Let's say she was breathing in this scene, the adrenaline could theoretically increase her respiratory rate, but only for a short period of time, certainly not longer than the heroin in her system.

#5) You wouldn't react that quickly.

You just wouldn't. Unless you were having a nice nap and someone stuck a huge whopping needle into you. Then you might.

Okay, fine. So what do you do with a heroin overdose?

Not the thing they did in Pulp Fiction. The first question with any unconscious patient is, do they need cardiopulmonary resuscitation? Airway, Breathing, Circulation. Revise your basic ABCs and resus. If there's no pulse, then get on that chest with your hands and start CPR as quickly as possible.

Call 999. Check for breathing and a pulse. You might need to do CPR. Here's a handy video to remind you about how to do that with everyone's favourite nice-guy, Vinnie Jones. 

Okay, okay, CPR.. but what if they're breathing and have a pulse?

Call 999!

On Heroin overdoses

Heroin is a highly addictive opioid painkiller. In the case of a heroin/opioid overdose, it stands to reason you'd probably like to use something which actually blocks the action and reverses the effects of the drug. In this case, we have a drug (hooray!) and the one you'll see most commonly in textbooks is called Naloxone.

Although the ways naloxone works isn't fully understood we know that it sticks to the same sites as opiates, like heroin.. in fact, it sticks better to these sites than heroin does, making it an competitive antagonist. 

The half-life (the time it takes for a drug to lose half of it's activity) of naloxone is shorter than that of heroin, so it's normally given in small, spaced-out doses if someone comes in with an opiate overdose.

So, wait, Harriet, I have loads of adrenaline and a big needle in my house, what should I do with it?

Well, first of all, the only time you should really have those things in your house is in a pre-made, sealed Jext pen (which used to be called "epi-pens"). These are used when you have a life-threatening allergic reaction, anaphylaxis. If you do have one of these, or know someone who does, then make sure you always check the expiration date and seal.

In this case, it's all packaged up for you and you have to use the pen as instructed, which for adults, is taking the top off and pushing the pen hard into the thigh, hold it hard on the thigh for 10 seconds and then massage the area. Then call 999 (or whatever emergency service number you use in your country). 

This website  (the official one of Jext) is great and has some brilliant videos. 

Did I miss anything? Get anything wrong? Want this in a video? Get in touch with the comments section!

Until next time HippocraTV crew, happy 2016, stay safe and lots of love.

- H