I'm working on a talk at the moment on Star Trek and Medicine. For research, I've been watching old episodes of The Original Series and The Next Generation. What did I find on my travels? Only the best thing in the world, so it deserves a blog post to itself.
"Ode To Spot" - Data, circa 2369 and now my favourite thing in the world.
Felis catus is your taxonomic nomenclature, An endothermic quadruped, carnivorous by nature; Your visual, olfactory, and auditory senses Contribute to your hunting skills and natural defenses.
I find myself intrigued by your subvocal oscillations, A singular development of cat communications That obviates your basic hedonistic predilection For a rhythmic stroking of your fur to demonstrate affection.
A tail is quite essential for your acrobatic talents; You would not be so agile if you lacked its counterbalance. And when not being utilized to aid in locomotion, It often serves to illustrate the state of your emotion.
O Spot, the complex levels of behavior you display Connote a fairly well-developed cognitive array. And though you are not sentient, Spot, and do not comprehend, I nonetheless consider you a true and valued friend.
With formal studying finally over (for now) I'm hoping to get around to responding to the blog post / video requests I've had from HippocraTV and elsewhere. In the meantime though, I bring you a hidden gem: Critical
It's either set in the not-too-distant future or an alternative universe where the NHS has really good funding, I haven't figured out which yet.
What makes Critical so great? A couple of things. First is the medical accuracy. It's good. Really good. You can almost, sort of, get away with justifying a weekend-binge watch as revision.
Secondly, it's not for the faint of heart but it is for those who want to get an idea of what trauma surgery actually looks like. If you're not great with blood and guts you'll probably need to make yourself a cup of tea / check your e-mails / remind yourself how brave you are more than once during an episode.
Each episode is set around the "critical" 1 hour in a major trauma response centre. See what they did there?
As with most hospital dramas, the characters live in a part of London where no one is questioning why such unique once-in-a-lifetime cases are coming in every week. Not once does a character ponder "okay, last week it was that guy with a dog still attached to his arm and this week it's a guy impaled on digger spikes, someone needs to write to the local MP".
Why doesn't it have a better rating on IMDB and Rotten Tomatoes? Sadly, I think they tried to appeal to too many people with this one and tap into the "I love watching Doctors have messy love lives!" market too. This means you get a great 10 minutes of brilliant almost documentary-like medical scenes followed by 10 minutes of very poorly written dialogue. Now maybe I've not been to enough dramatic hospitals, but I've yet to see two of my seniors have an argument about their relationship in the middle of a trauma call. Critical, however, manages to show me a world where these sort of life and death topics are discussed over something as trivial as someone dying on a table. Thankfully, the medical accuracy trumps this fatal flaw in the series and makes it watchable.
Even if you did worry you were going to become addicted to it, it's only got one season. The "future" technologies are believable and not that far-off, it's well shot, the acting is great, it's got the Mum from Outnumbered in it (Claire Skinner) who is fantastic in a non-comedy role. The second season, if it were to ever exist, would be vastly improved by dropping the underlying story-line and, instead, the addition of the kids from Outnumbered in a glorious family improvised comedy plus gruesome drama mashup.
I found all of Season 1 over on Amazon Video. Enjoy!
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.
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.
If anyone's seen my "about me" bit on the HippocraTV site, they'll see that one of my childhood dreams was to be on The Crystal Maze....
It might come true!!!!
Fingers crossed that all the HippocraTV crew can get tickets and we can do it as a team. In the meantime, here's a bit of why I loved this show so much when I was younger.
So, hopefully a few people will understand that the title of this post is deliberatly gramattically incorrect.
I wanted to do a quick update post about how pop-culture, your childhood and the things which make you happy can influence you in more ways than you think.
My friends know that I'm a huge nerd when it comes to cult TV shows, films and memes. I think I've always been that way. Oddly enough, I don't watch Live television anymore. I truly believe that TV, Film, YouTube, Facebook, Reddit, all of these things, can help you understand yourself and what your place is in this huge world, whilst also giving you a sense of community. With the sheer amount of choice these days, however, it's nice to choose what you watch and when. Unless it's The Walking Dead or Game of Thrones. In which case you have to watch that ASAP because it'll inevitably be spoiled for you via. character death memes on Facebook and Twitter.
My pop-culture influences:
#1) Jurassic Park
I am a huge Jurassic Park fangirl. My 2 favourite films of all time and Jurassic Park and The Sound of Music. I'm still unsure as to whether I'd enjoy watching a mash-up of the two.
I was around 5 years old when Jurassic Park came out and I remember it made science so exciting for me. Who can forget the friendly DNA double helix, despite the fact he resembled the loathed "looks like you're writing a letter!" paperclip helper from Microsoft Office.
Genetics, I decided, was cool. I still get a bit teary over the scene where Alan Grant sees the Parasaurolophuses and says "they do move in herds". They do, Alan, they do!!!
Genetics wasn't on the junior-school syllabus back then, I'm not sure it even is now. However, this little bit of science communication in a film which could otherwise have gone unnoticed was the coolest thing I'd ever heard, after confirmation from my Dad that it wasn't such a far-fetched idea. Since then I've had my own genetic mutations screened, have been talking with some incredible scientists, ethicists, lawyers and even programmers about applications of personal genetics. In decoding terms, the letters C, A, G and T make the physical being of you. How cool is that?!
I even went to Kauai, Hawaii on my medical elective so I could visit the infamous waterfall from the helicopter scene. It was an incredible experience and a dream that wouldn't have existed unless there had been a film about kids distracting clever velociraptors using a ladel and clever mirrored cabinet skills.
Thanks, JP!
#2) Theme Hospital
Seriously. No, seriously. Theme Hospital made me want to be a "doctor". I was 9 when it was released and must have spent hours and hours building clinics to deflate little animated people with huge heads. So this probably fits more with "hospital management" rather than "being a doctor", but it was satisfying. I think a lot of those little pixelated people went on to have long, fulfilling, healthy lives thanks to me.
Thanks Theme Hospital!
#3) ER
I know that this one may be a bit before-the-time of a lot of soon to be doctors. Retrospectively I was probably a bit too young at 6/7 to be watching this, but this is the beauty of having siblings who are 8 and 12 years older than you.
I challenge anyone to listen to the theme of ER and not think "yeah, medicine! go doctors and nurses!".
Ok, so in real life, flat-lines don't exist (unless the ECG is turned off or broken) and the odds of you getting your arm chopped off by waving near a helicopter (too-late spoiler alert) are slim. Still, ER made medicine look cool. And medicine is cool. Sure, they cut 90% of ER where they're doing discharge forms or filling in paperwork, but every now and then you do get to really help someone.
Also. Kovac. Just Kovac. Sigh.
Thanks, ER!
#4) The Simpsons
I used to watch The Simpsons at 6pm every evening with my brother. I'm not sure if anyone has gone back and re-watched old episodes, but they change as you grow up. Did you know that they managed to get Fermat's Last Theorem into an episode? The writers for The Simpsons are notoriously nerdy in the best way possible, especially when it comes to maths. Like it or not, you were or still are being subliminally influenced to enjoy maths through the world's favourite cartoon. The fantastic Simon Singh has even written a book about it and you can read one of his articles here.
Why else? Well, Lisa was an example of a young girl who loved learning. She's often portrayed as an outcast in the show, but she normally comes out ahead. She also gave me a grounding in good scientific method.
Thanks, The Simpsons!
So that's all for now. Just a quick update as I'm feeling slightly nostalgic today. Once I figure out how to improve the sound quality on my videos, I'll hopefully be doing a short series on medical genetics, what you need to know for clinical practice and possibly a heartbreaking one on why Jurassic Park couldn't actually happen.
Remember to subscribe to HippocraTV if you haven't already. We've reached over 250,000 total views. Woohoo!
I was reflecting on the famous poem "-If" by Rudyard Kipling, which has been popular in Britain since the early 20th century.
My reading led me to discover that the lines; "If you can meet with Triumph and Disaster / and treat those two impostors just the same” are written on the entrance to Centre Court at Wimbledon.
And that explains Andrew Murray and his notorious unpredictable and over-emotional response* to his 2013 win.
Which led to my next theory. That Luis Suarez probably has a copy of The Very Hungry Caterpillar in his kit bag.
Thus, I'm like a rubbish Sherlock Holmes of emotion.
