GaryPinC

Thanks, this is a great summary. I only caught the end. I think HIPPA was a bit of a concern as they wouldn't go into specific tests like echo results and EF. Kind of surprised the questioner identified herself as a cardiologist and proceeded to ask those questions. Seemed a little classless and disrespectful of someone who should know the ins and outs of PHI, IMO.

Haha, I admit you can't see the back of their heads but those are most likely surgeon's caps and facing the proper direction. I like your take better though!👍

One of our ER docs was in today and I got to catch up with him. One of the smartest, analytical guys I know, around 60 years old. He felt from the film that it fits the profile of commotio cordis. He also mentioned UC Medical Center is a leader in neurological issues and couldn't be in better hands. Also, docs said Hamlin had ARDS (somebody page Mr. Weo) and that he was administered TTM (therapeutic hypothermia).

Thanks, that's a great source but I'm not sure if it's the standard of care (NIS) and how you quantify the moderate dysfunction, especially in Damar's case compared to time of discharge.

Yep, I can tell you from personal job experience that you can see the bluish color change back to flush or pink just by doing CPR. I definitely wanted to dovetail with others have said and encourage everyone to be CPR-certified. It could be the difference.

Great question, and I don't truly know the scope of what it means. Certainly critical autonomic functions and gross measures of brain activity/responsiveness. Physicians/neurologists would be best to answer this question.

F**king great news! My impression is lung damage/pulmonary edema is the driving factor now, which should be recoverable. 🙏 🙏 🙏

Not sure if you can even get sync to work with v-tach 😉

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.

Thanks for all your input and feedback! I definitely appreciate your ambulance perspective, but as a former EMT would you want the mom in there if things go south? To answer your question, yes, but so, so much goes into it. Things like myocarditis/pericarditis temporarily changes ERPs and sensitivity of the heart to arrhythmia. In Hamlin's case, young and in top shape, with no significant risk factors you would anticipate restoring sinus rhythm quickly and minimal chance of rearrest. But we don't know what underlying genetic and environmental factors there were. Immediate CPR is a big help also, but the longer it takes to restore sinus rhythm the odds you can't bring the person back rise precipitously. My understanding from the docs is humans fall off the cliff of being able to resuscitate very quickly. Just happy they got him back, 8 minutes is a fairly long time but they were doing CPR for most of it.

I work in cardiac research where we study rearrest and also reperfusion injury primarily to the brain. I am not a doctor or health professional, just a bench researcher. But a big part of our work involves animal models with clinical electrophysiologists and ER docs. I can offer some perspectives and hopefully will keep it from getting into the scientific weeds. The short answer to your question is the first cardiac arrest could cause multiple arrests, but it's truly an individual response. The second the heart stops, in some corners of the circulatory system blood begins to clot immediately raising the risk of stroke and a massive inflammatory reaction is initiated. The body quickly becomes hypoxic with reactive oxygen species (ROS) which damage DNA, RNA, proteins and can cause cell death. In Hamlin's case, one could easily surmise he quickly became hypoxic given the physical exertion of the game. Also keep in mind that just because you restore sinus (normal) rhythm doesn't mean the heart is beating normally. What usually happens post-arrest is despite the normal rhythm, electrical contraction(depolarization/QRS complex) is incrementally slowed(widened QRS complex) and relaxation (repolarization/T-wave) is usually a mess (ST elevation, elongated/elevated T-wave). At this point the patient can be very susceptible to rearrest. And this period can be as short as a couple minutes to nearly an hour in my animal model experiences. Anyways, from my perspective, putting an arrest survivor under therapeutic hypothermia is about mitigating and controlling the inflammatory damage while also slowing the metabolic processes and the heart to hopefully prevent more arrests. In terms of the brain, the inflammatory reaction compromises the blood/brain barrier, allowing blood and inflammatory cells into the brain to kill brain cells. The first 24 hours are critical as the damage and cell death will evolve over the next couple of subsequent days. Again, therapeutic hypothermia is crucial in arresting and limiting this damage. I was in disbelief that the ambulance waited even 1 minute to allow Damar's mother to ride along. Getting him to the medical center and started cooling is critical. I just thank God he didn't rearrest in that ambulance with his mom right there.

I'd put Swenson's at the top of the "luxury fast food burgers" and that's it. Reasonably tasty with some brown sugar added to the beef, they have a large variety of burger and drink styles. And fried mushrooms as a side. Bonus points there! People around Akron swear by them though. But thanks, if I'm ever down around Dover I'll look Blazin Burgers up. Best burgers: Milt's out in Moab Utah: https://miltsstopandeat.com/ You can choose between buffalo or beef and he locally sources as much as possible. Built-in quality in a small Diner. Best restaurant burgers: Back in the '90s, I always felt Ruby Tuesday really did a great job with Burgers. Haven't been to one in at least 15 years as they've died out a bit here in Cleveland. But these days any place that'll cook a legit medium rare is a contender.

I don't agree that Georgia brought their C game on defense, OSU was just that good. Kirby Smart even said post-game OSU probably should have won. Day was masterful at keeping them off-balance. OSU was equal to UGA last night, just unlucky. Michigan's performance (poor coaching and preparation) were more typical of why the Big10 under-performs and is disrespected. If Day moves forward coaching like this, I don't think Michigan wins 2 years in a row anymore. Harbaugh's coaching is not adaptable enough and lacks depth.

Have to disagree with you on OSU. I thought Day called a great game against a loaded and always dangerous Georgia team. Stroud's lack of blitz recognition and being too content to kick from around the 30 were what killed them.

No. Michigan was poorly coached, slow to adjust,and routinely made things worse with poor playcalling. They got what they deserved.

Ball crossed the line before he hit out of bounds.

That was a masterful drive to start the second half.

OSU offense, most importantly the coaches, came to win. Now can the D stop the dogs and slow them down enough? Should be a classic if OSU doesn't get worn out.

Manuel left the Bills for the Raiders and in 2019 joined the Chiefs with head coach Andy Reid. He wasn't ruined, he just didn't have what it takes.

I live in Cleveland. Hue Jackson was a pathetic joke of a head coach long before Mayfield even arrived. You could be Hue's best friend in the entire world because he totally enjoys warping reality to deflect blame just like you.

😂 Hue's record was 1-31 his first two years, 2-5-1 when he was fired (mid-point) and you blame Baker?😂

I believe Garrett. It's pretty much the same way with pass interference. It has to impact the play significantly enough. Garrett needs to learn when to take a dive.

Op, Thanks for your thoughts. The one clear thought about the Pats I had is Mac Jones is a strong backup and not your guy. He tries to execute the offense but displays no individual playmaking ability in crucial moments to carry his team.

Ah. Well, there's your flaw. It is never definitively stated that any of them died, though I'm sure some did(maybe the 21?). And no, outside of far right circles most of the US does not believe deaths from Covid vs deaths with Covid are two VERY different numbers. Sorry, the evidence is not there. But happy to entertain evidence you feel proves your point.

Help me out here, because I fail to follow your reasoning. The article seems to drive home the point: Out of 100% of Covid positive admitted patients, 40% were admitted for Covid (severe enough symptoms) while 60% were admitted for indirect injuries/symptoms but tested positive for Covid. It's worth noting these are not 100% of total patients admitted, just 100% of the Covid-positive admittees. And you are wondering if this ratio translates to how much they overstated the death ratio? 1. 40 and 60% are not death ratios in this context. They are admittances, plenty of patients admitted for covid symptoms survive, especially at this stage of an endemic virus. This is what Sundancer is alluding to, you don't know how many of these patients survived, especially in the context of 40 vs 60. If any deaths from this 100% group were all from the 40% would that really be applicable to your reasoning? Should you change your mind and decide deaths weren't overstated, why or why not? 2. Without digging too deep, at first glance it appears the CDC examines death certificates and applies criteria for who died primarily from Covid and who died with Covid. This may be separate from the hospital declaration to control for mis-attributed deaths. You're welcome to dig further, they discuss their criteria: https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm Here's also their excess deaths graph (all causes) compared to historical data, which speaks volumes: Wherever you choose to attribute the deaths, the impact of the virus is clear. 3. Finally, these are medical professionals working hard to help people. There are very clear symptoms and progressions for most people who die from Covid. https://www.drugs.com/medical-answers/covid-19-symptoms-progress-death-3536264/ Obviously if someone has ongoing respiratory issues at the time of infection, it can get complex, but medical professionals are intimately familiar with what it looks like to die from Covid so while I believe there was some over-attribution of Covid deaths, I do believe it wasn't a large amount and may have been corrected for, even if the hospital got paid incorrectly.