Herc11

Typically they will continue with the awakening trials that I have discussed, daily. If he isn't having purposeful responses, an EEG may be done to monitor brain activity. However, it should be done with no sedation. This is not ideal in an intubated patient since it is very uncomfortable. But sometimes if there are no responses, you can take off all sedation while the patient is intubated. With no responses, they arent fighting the vent, pulling at tubes/lines, etc. Typically around day 12 they will begin talking about a tracheostomy and PEG tube (tube through abdomen into the stomach) if he isn't responding. Continued intubated can cause damage to the trachea. Hopefully we don't get that far. With all this said, I did see tweets that they said there were positive signs of improvement. This suggests there is some type of response that they've seen.. He should be off hypothermia by now and I'm sure they've done at least one SAT. The positive signs they may be seeing could be reflex response, pain response, movement, or even following commands (i dont think he is there yet based on limited updates).

Depends on the level of sedation

We hold <36 C. The ones in the protocol Beck Water have been quoting even further

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.

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.

Depends on the doctor to be honest some doctors have preferences which drugs they like to order. Also depends on other factors with the patient. 1) Propfol is common, but is lipid based. Prolonged use or high levels can cause your lipid levels to sky rocket. Propofol is purely to put you to sleep. Works fast and wears off fast. Referred to as milk of amnesia cause it looks like milk. Also, its what Michael Jackson's doctor gave him that killed him. Patients will say they never slept so good as when they were on it. Well Mike had his personal MD give it to him as a sleep aid and he gave him too much. 2) Fentanyl is commonly used in conjunction with the sedative as it will keep the patient comfortable. It will also help reduce the patients respiratory drive if the patient is breathing against the ventilator. 3) Versed is sometimes used in place of propofol, but takes a prolonged amount of time to clear the system and makes it difficult to assess brain activity. 4) ketamine is sometimes used but require high volumes of fluids which you want to be cautious of if there are kidney issues. You don't want to fluid overload the patient. 5) precedex is commonly used in conjunction with fentanyl too. However, its what I refer to as a light sedative and/or anxiolytic. Its the only one that the patient can be on during the SBT and after extubation because it doesn't reduce respiratory drive. Although it can reduce HR and cause bradycardia which is HR <60 These are some of the most common. They are run on a continuous rate that the RN will titrate to meet the goals of sedation.

A couple corrections here: 1) you don't ease a patient back into normal brain activity. As long as the patient is able to protect their airway, you extubate. The longer someone is intubated the more chance of complications/mortality. You reduce sedation at least once per day and test the pt's ability to respond. This is called a Spontaneous Awakening Trial, SAT. Are they able to follow commands? Does the patient get agitated and try to pull the ET tube out or other lines? How are their vitals when sedation is reduced? Does HR go too high? Respiratory rate? Oxygenation? There are many things a nurse is watching for during the SAT. If they fail, you resedate them. If they pass the SAT, then a Spontaneous Breathing Trial is done, SBT. For this, all sedation meds need to be off, except for precedex which helps with anxiety. We then get the RT to change the vent settings and attempt to let the patient breath on their own. Again, watch heart rate, resp. rate oxygenation. If this is passed we inform the doctor. At this time the doctor usually talks with the RT and RN and asks if they recommend extubation. 2) you don't gradually rewarm the patient. There is no time period for this. Once the hypothermia protocol is discontinued, you turn off and remove the cooling blankets and let the patient return to normal temperature prior to attempting the trials in my first point. You obviously want to do this well enough ahead of attempting to awake them for their comfort. It doesn't take a significant amount of time for temp to return to normal levels. 3) the NFL has no say in what treatment these players are getting. This is on the doctors and the protocols of the hospital he is at and where Everett and Shazier went. Hospitals have protocols that they follow that are based on "best practies." 24-48 hrs is standard for hypothermia protocol in a post-cardiac arrest/post code patient. We use 48 hours in the ICU I work at in Fresno, California.

While I 100% agree with the team and fan support AFTER what happened, this is prior to that. Of course I am not implying they wanted anything to happen on the level of what did. However, these two plays in the first 6 MINUTES of the game showed their mindset in how they were approaching this game. He did turn his back, at that point Hurst should of let up. He re-engaged and continued with a block in the back followed by driving Taron's face into the ground.

If the game is continued, I wonder what the circumstances are. Are the teams only able to continue with the roster as it was at the time of stoppage? If not then it can greatly help buffalo since we would be down 2 defensive backs. It would allow us to call up Rhodes and perhaps Johnson to return from his injury.

This has nothing to do with Hamlin's hit. However I saw this on Twitter. A dirty block in the back and drive Johnson into the ground on his head injury and then Hutchinson trying to roll into Josh's legs.

My response was for the poster you were replying to, who seemed to be asking if he should have a vascular repair intervention.

It doesn't appear to be a vascular injury. That would result in what is commonly known as a heart attack. When a heart attack occurs, vessels to the heart are not able to supply sufficient blood to the heart muscle itself. This would require intervention to restore the blood supply. Due to the fact an AED was used, this means his heart was in a shockable rythym which has to do with the electrical conduction in the heart.

I posted this previously, but it obviously got buried pretty quickly. As a critical care nurse this is what I would expect going forward. What we know is he is intubated and in the critical care unit. After cardiac arrest the patient will be in hypothermia protocol. This means he will be deeply sedated to limit any stimulation. This will go on for 24-48 hours. There will be no updates during this period, as there is nothing to update as long as his vitals remain stabilized. After the time period, they will reduce sedation and test his ability to respond. This is the first step in assessing brain function. Depending on his response, they may need to sedate him further. You typically only try these tests 1 or 2 times a day. With all this said. I wouldn't expect any meaningful updates until Thursday.

Medically induced coma

No, because you would bleed out internally within a minute or two depending on the severity.

Unfortunately we most likely won't know anything for at least a few days. As an ICU nurse, I've cared for people many times after resuscitation. Word is out that he is intubated in critical condition. This means he will be in a medically induced coma, via sedation. They will have him in hypothermia protocol for 48 hrs before attempting to reduce sedation meds to test ability to respond and breath on his own. Until they begin testing for ability to breath and respond to commands, they won't know his level of brain function. The worry is if he suffered an hypoxic brain injury. Just giving this info out so people understand what to expect with updates going forward.

You don't shock asystole. That is a Hollywood myth. You do, however, give CPR. You only shock certain arrhythmia to get the heart back into a regular rythym

Eh... to me its just like a SNL skit or any other skit show thats been around. These just aren't on TV because forms of delivering entertainment change. I grew up in the home video game boom of 80's and 90's and older folks said what you are saying about us. The older generations have always griped about what the younger generations do for entertainment whether it was radio, TV, video games, internet, and now apps. Guess society will continue to fall, or maybe its just passing us by.

A bit that Caleb from Barstool does and they are hilarious.

What if he was pushed back and broke free before the whistle and scored a TD? There is a reason you don't blow the whistle immediately when forward progress is stopped.

Cap'n would be pretty funny

The only ones still talking about this are Bills fans. Literally no one cares or thinks Oh my God those degenerate Bills fans were *gasp* THROWING SNOWBALLS!

If T.O. is getting sued for his little skirmish, this dude is definitely cashing in. Good job Willie, you really got him as he laughs his way to bank with your money.

Did you really just have a conversation with yourself? 😂

The Hulkster is BillsMafia????