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

[StHustle]

40 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.

what temperature is the body cooled to?

[GaryPinC]

11 minutes ago, Herc11 said:

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. 

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

[RoyBatty is alive]

6 minutes ago, StHustle said:

what temperature is the body cooled to?

Not much, 90-94 and not very long

[Dick_Cheney]

29 minutes ago, mannc said:

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. 

Highly disagree.

 

We're barely over 24 hours removed from what happened. Along with the organization's experience with everything going on with Kim, I think this is being managed just about as best as it possibly can be for an event that had never happened before and was witnessed live internationally.

[The Wiz]

7 minutes ago, StHustle said:

what temperature is the body cooled to?

I feel like I heard someone say 95.  I'm not 100% sure on that though.

[LOVEMESOMEBILLS]

 

 Good on Jim Irsay.😊

 

 

 

 

 

 

[iccrewman112]

11 minutes ago, Since1981 said:

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. 

when any average Joe gets surgery, random colleagues, friends and Internet forum buddies can’t call the hospital for an update. There is a consented individual(s) usually spouse and parents/children. Then they disseminate info as they see fit. And they can choose for a member of the hospital to be the one that communicates it to the public or whomever if they don’t want to do it themselves.

Edited January 4, 2023 by iccrewman112

[RoyBatty is alive]

Just now, LOVEMESOMEBILLS said:

 

 Good on Jim Irsay.😊

 

 

 

 

 

 

First time Irsay has ever spent any of his fathers money wisely.

[mannc]

Just now, Dick_Cheney said:

Highly disagree.

 

We're barely over 24 hours removed from what happened. Along with the organization's experience with everything going on with Kim, I think this is being managed just about as best as it possibly can be for an event that had never happened before and was witnessed live internationally.

I did not say the Bills organization is not handling the matter properly.  I said the lack of any real information about Hamlin's condition at this point is highly concerning.   

[Big Turk]

3 minutes ago, LOVEMESOMEBILLS said:

 

 Good on Jim Irsay.😊

 

 

 

 

 

 

Tied with Sheets Laundry Company...getting support from everywhere and everyone across the league...

 

[Dick_Cheney]

2 minutes ago, mannc said:

I did not say the Bills organization is not handling the matter properly.  I said the lack of any real information about Hamlin's condition at this point is highly concerning.   

I get it, but especially this day and age with social media, I think keeping an absolutely tight ship is the best move. These things take time.

 

Hopefully no news is good news.

[LOVEMESOMEBILLS]

2 minutes ago, RoyBatty is alive said:

First time Irsay has ever spent any of his fathers money wisely.

 

 Normally I would agree, but with this act of kindness, I will give him a pass. Others with alot of money donated, as of this moment he's donated the most. I can appreciate that and do.

 

 

 

[Loyal BF]

29 minutes ago, YoloinOhio said:

 

 

7 hours ago, Kmart128 said:

 

Yeah i agree. I think NFL personnel and refs on field were starting standard procedures for injuries. And then i think the teams went to locker room waiting for the NFL league office to get all the information before making a decision.

 

Also think they could have just been trying to make it look like they were gonna play again so fans dont leave and the ambulance has trouble getting to hospital with all the traffic.

 

In some social media sites, there has been much knee jerk criticism directed at the “NFL” and Roger Goodell that they did not postpone the game quickly enough or were more concerned with finishing the game than Hamlin’s health status.

 

Those idiots have done so without any knowledge of what actually transpired in the short period of time between the ambulance leaving the field and the official announcement that the game was postponed.  Very irresponsible and disgusting.

 

As time goes by, we will see comments by those directly involved, like Coach Taylor, with some details.  

 

The Washington Post has published a story that gives some insight too.....I have “gifted” the link so anyone can read it in full)....

 

A search for answers amid a life-and-death scramble on an NFL field

 

Quote

As medical personnel fought for Hamlin’s life, NFL executives grappled with how to handle the remainder of the game.

 

NFL chief football administrative officer Dawn Aponte represented the league office at Paycor Stadium. After the ambulance left the field, Bengals Coach Zac Taylor and Bills Coach Sean McDermott convened with referee Shawn Smith. Remotely, executive vice president Troy Vincent triangulated communication with Aponte, Smith, NFL Players Association Executive Director DeMaurice Smith and NFL Commissioner Roger Goodell.

 

Shortly after the ambulance left the field, Buck told viewers that the game would restart after a five-minute warmup period, based on information that had come from ESPN officiating analyst John Parry, according to a person with knowledge of the broadcast. During every Monday night game, Parry corresponds with the league’s officiating department about issues such as replay review decisions, then relays information to Buck and his analyst, Troy Aikman. But this decision had escalated beyond those with whom Parry typically communicates.

 

“They’re going to try to continue to play this game,” Buck said at 9:13 p.m.

 

Despite Buck’s report, Vincent said later the league never considered restarting the game.

 

“Immediately, my player hat went on: How do you resume playing when such a traumatic event occurs in front of you in real time?” said Vincent, an NFL defensive back for 16 seasons. “And that’s the way we were thinking about it, the commissioner and I.”

 

Some players reverted to rituals that suggested they were preparing to play. Diggs, minutes after tears left streaks on his face, stood before teammates and delivered a fiery speech. Burrow made a few gentle tosses.

 

Buck noted on the broadcast that, despite going through those motions, the players didn’t seem to be preparing in earnest. “Nobody’s out there really warming up,” he said. “Everybody’s just stagnant.”

 

Vincent said he and Goodell decided they wanted to “let the coaches and players breathe” as they mulled whether to restart the game. McDermott and Taylor met again with Smith, the referee, then returned to their teams. McDermott shouted, “Locker room, locker room!” to his players.

 

At 9:18 p.m., Smith announced to the crowd the game had been temporarily suspended. Both teams left the field. Vincent said once the game was suspended, he stopped communicating with Smith and talked directly with McDermott and Taylor.

 

Vincent strongly denied the notion that the league had told players they had five minutes to warm up, calling it “ridiculous” and “insensitive” and saying he did not know where it came from. An assistant coach from one of the teams, who requested anonymity to discuss a sensitive matter, indicated no timetable for a restart was given to the coaching staffs and credited the head coaches for taking players off the field.

 

“Nothing was ever officially communicated like that,” the coach wrote in a text message. “I was up in the box, and we didn’t get much in the way of info. I think they were trying to figure out what to do, since it was so traumatic. And Sean and Zac, with input from players, decided to take teams to the locker room.”

 

On Tuesday, ESPN released a statement, backing Buck’s report.

 

“There was constant communication in real time between ESPN and league and game officials,” a network spokesman said. “As a result of that, we reported what we were told in the moment and immediately updated fans as new information was learned. This was an unprecedented, rapidly evolving circumstance.”

 

Once players found refuge in the locker room, the NFL continued deliberations. DeMaurice Smith, the NFLPA head, had communicated the union’s desire to postpone the game. The decision, according to the NFL rule book, would fall to Goodell.

 

…snip…

 

At 9:54 p.m., Bills equipment staffers packed up gear and players began shaking hands and hugging in the corridor between the locker rooms. At 10:01, the league announced the game had been postponed.

 

“Medical advice guided our decisions,” Aponte said. “We remained in constant communication, as Troy said, with both teams, with medical personnel, with the game officials, with ownership. And we made decisions that we believed to be in the best interests of Damar’s status and the state of both teams’ players and staff.”

 

What many people forget is that cell phones are not allowed on the sidelines, nor in the coaches booths.  The only way to communicate with the NFL is through the officials on the filed.  Which are in contact with the "league’s officiating department"....not Troy Vincent or Roger Goodell.

 

The decision to leave the field was initiated by the two coaches, and agreed upon by the on field referee.....and as Troy Vincent said that he and Goodell “let the coaches and players breathe” as they mulled whether to restart the game."

 

Once in the locker rooms, as we have seen from videos, is when both Taylor and McDermott can be seen passing a cell phone.  I suspect that Troy Vincent (or more likely, Rodger Goodell) was on the line, as described by the article..."Vincent said once the game was suspended, he stopped communicating with Smith and talked directly with McDermott and Taylor."

 

The sticking point and confusion comes from ESPN saying that the communication they had with THEIR "ESPN officiating analyst John Parry” who is in contact with "the league’s officiating department about issues such as replay review decisions”.  IF the message from these from the “officiating department” was a 5 min. warm up period, they were just doing their jobs in adhering to the rules when an extended play stoppage occurs.

 

The other reality, is that the announcement that the game was postponed came at 10:01PM.  But, that is simply when the public was let in on the decision...NOT when it was actually made.

 

In a well run organization (which the NFL is) in an unprecedented situation like this that has not happened in the NFL for decades (a player in the early 70’s did collapse with heart attack) the NFL is sure to notify a wide range of people, before they announce to the public.

[Herc11]

16 minutes ago, StHustle said:

what temperature is the body cooled to?

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

[strive_for_five_guy]

10 minutes ago, LOVEMESOMEBILLS said:

 

 Normally I would agree, but with this act of kindness, I will give him a pass. Others with alot of money donated, as of this moment he's donated the most. I can appreciate that and do.

 

 

 

I have to say, there’s several names in the list of donators that I’ve never been a big fan of.  But definitely much respect to anyone compelled to show their support for Damar during a time like this.

[Joe Ferguson forever]

9 minutes ago, Mr. WEO said:

 

Acute cardiogenic pulmonary edema is not what Red Tail Hawk was talking about--ARDS is noncardiogenic pulmonary edema.  Unfortunately patients with severe anoxic injury may continue to spontaneously breath (assuming the anoxia didn't result in enough cerebral edema to cause brainstem herniation)---and, if not, they certainly be fully oxygenated on a vent even if they are pulling zero spontaneous breaths.  That scenario describes pretty much every organ donor candidate in the ICU--no cerebral function/perfusion, normal BP (with support, perhaps), 100% O2 saturation on the vent. 

It has been reported that Damar was put in the prone position.  This is used in ARDS.  It can worsen cardiogenic pulmonary edema.  This is the conclusion from a paper on prone positioning during spinal surgery for patients with reduced cardiac function:  "Conclusions: Prone positioning induces significant changes in systolic and diastolic function, as well as dyssynchrony. The negative effects of prone positioning are more severe in patients with poor baseline cardiac function."  I previously linked info on ARDS.  It can certainly be precipitated by trauma.

Edited January 4, 2023 by redtail hawk

[CSBill]

1 hour ago, YoloinOhio said:

 

Zac Taylor = All Class. Humble, a leader, empathetic, smart, compassionate. The kind of person you want in charge in the middle of a crisis. Will be rooting for him going forward; except when they are playing the Bills. The Bengals are in good shape for a long time.

[Golden*Wheels]

“When I got over there, the first thing he said was, ‘I need to be at the hospital with Damar. I shouldn’t be coaching this game,'” Taylor said. “He really showed who he was. All his focus was on Damar.”

 

Respect coach. Respect.

[Mr. WEO]

6 minutes ago, redtail hawk said:

It has been reported that Damar was put in the prone position.  This is used in ARDS.  It can worsen cardiogenic pulmonary edema.  This is the conclusion from a paper on prone positioning during spinal surgery for patients with reduced cardiac function:  "Conclusions: Prone positioning induces significant changes in systolic and diastolic function, as well as dyssynchrony. The negative effects of prone positioning are more severe in patients with poor baseline cardiac function."  I previously linked info on ARDS.  It can certainly be precipitated by trauma.

 

Yes, noncardiogenic pulmonary edema can worsen existing cardiogenic pulmonary edema...

 

Also, proning a patient with cardiac dysfunction for the reasons that you listed have nothing to do with ARDS.  They would (rarely) be proned to improve cardiac function, as you quote points out..not pulmonary (as would be done with severe ARDS).

 

There's no reason to believe severe, ARDS inducing chest trauma from CPR happened in this case.  The report of "damaged lungs" came from the same uncle that said he had CPR twice.

 

[rusty shackleford]

2 minutes ago, CSBill said:

Zac Taylor = All Class. Humble, a leader, empathetic, smart, compassionate. The kind of person you want in charge in the middle of a crisis. Will be rooting for him going forward; except when they are playing the Bills. The Bengals are in good shape for a long time.

I had NFL Network on my office TV in the background while I was working when that came on. After a minute or so into his press conference I paused working and turned up the volume. He said all the right things, handled the conference and the situation on the field perfectly. That's the kind of guy you can get behind and someone I'll be rooting for when it doesn't involve the Bills.

[Beast]

Sean McDermott is someone we can all be proud to call our coach.

[Big Turk]

2 minutes ago, Beast said:

Sean McDermott is someone we can all be proud to call our coach.

 

 

 

[boyst]

43 minutes ago, Big Turk said:

Tied with Sheets Laundry Company...getting support from everywhere and everyone across the league...

 

Scroll down. You will find Ryan Leaf gave $2,500

[Joe Ferguson forever]

32 minutes ago, Mr. WEO said:

 

Yes, noncardiogenic pulmonary edema can worsen existing cardiogenic pulmonary edema...

 

Also, proning a patient with cardiac dysfunction for the reasons that you listed have nothing to do with ARDS.  They would (rarely) be proned to improve cardiac function, as you quote points out..not pulmonary (as would be done with severe ARDS).

 

There's no reason to believe severe, ARDS inducing chest trauma from CPR happened in this case.  The report of "damaged lungs" came from the same uncle that said he had CPR twice.

 

https://jamanetwork.com/journals/jama/fullarticle/2769872

https://www.sciencedirect.com/science/article/pii/S0300957222001551

https://pubmed.ncbi.nlm.nih.gov/30654012/

Edited January 4, 2023 by redtail hawk

[ndirish1978]

[muppy]

[LOVEMESOMEBILLS]

 

 If I was a betting man I would bet a #3 patch will be on every jersey or sticker on every helmet in the league this week. That and probably a moment of prayer for Damar 

 

 

 

 

[Mr. WEO]

53 minutes ago, redtail hawk said:

https://jamanetwork.com/journals/jama/fullarticle/2769872

https://www.sciencedirect.com/science/article/pii/S0300957222001551

https://pubmed.ncbi.nlm.nih.gov/30654012/

 

ARDS happens in a clinical setting (trauma, sepsis, near drowning, massive transfusions, etc).  The criteria cited for "ARDS" in the pubmed study are simply for pulmonary edema and they were in non-trauma patients. 

 

Cardiogenic pulmonary edema is going to have the same blood gasses and xray findings they used for their ARDS criteria. 

[turftoe]

1 hour ago, StHustle said:

what temperature is the body cooled to?

See the typical hypothermia protocol below. I'm a neurologist and have been involved in numerous evaluations in the past. When a patient is in the protocol, the body cooled and fully sedated, there is not much that can be assessed neurologically.  The important neurological assessment comes early after the patient is warmed and the sedation is held. Usually serial neurological exams are performed over several days, looking for improved neurological function. It's not surprising that there have been no updates.

 

Johns Hopkins hypothermia protocol.

[Draconator]

 

 

[The Wiz]

 

[dorquemada]

25 minutes ago, Draconator said:

 

 

 

Damn, that's great

[loyal2dagame]

43 minutes ago, LOVEMESOMEBILLS said:

 

 If I was a betting man I would bet a #3 patch will be on every jersey or sticker on every helmet in the league this week. That and probably a moment of prayer for Damar 

 

 

 

 

Why stop there.  Wear the patch until he wakes up or the season ends. 

Here's to wishing he wakes up.

[Joe Ferguson forever]

1 hour ago, Mr. WEO said:

 

ARDS happens in a clinical setting (trauma, sepsis, near drowning, massive transfusions, etc).  The criteria cited for "ARDS" in the pubmed study are simply for pulmonary edema and they were in non-trauma patients. 

 

Cardiogenic pulmonary edema is going to have the same blood gasses and xray findings they used for their ARDS criteria. 

SMH...you're wrong.  traumatic out of hospital cardiac arrest would be expected to be worse than non traumatic but regardless, ARDS occurs in a large proportion of post cardiac arrest patients.  Conclusion: "Nearly half of initial OHCA survivors develop ARDS within 48 h of hospital admission. ARDS was associated with poor outcome and increased resource utilization. OHCA should be considered among the traditional ARDS risk factors."  The inpatient study shows similar results.  Those patients would almost certainly have received CPR (ie trauma).  Being hit in the chest by an NFL player constitutes trauma as well.

You seem to be saying that you can better define ARDS than the authors and journal editors!   They likely had pulmonary artery pressures and LVEF measures from echos in many of these patients.   I guess you missed this sentence in the pubmed article "excluding patients with evidence of cardiac dysfunction." The paper would not have been published and would have been torn apart if they were likely to misdiagnose ARDS.  And the question remains:  Why was Hamlin placed in a prone position if he was felt to have cardiogenic pulmonary edema?  He wouldn't.  I could cite many more papers but there's no point.

Edited January 4, 2023 by redtail hawk

[Victory Formation]

1 hour ago, ndirish1978 said:

This is beautiful.

[CDogg20]

2 hours ago, Beast said:

Sean McDermott is someone we can all be proud to call our coach.

Not just McD honestly. I am so darn proud of our boys. So close knit, from McD saying he needs to be with Damar to Diggs talking his way past officers at the hospital. Closest group of men i’ve seen in a long time. I love this team and everyone who’s a part of it

[LOVEMESOMEBILLS]

18 minutes ago, loyal2dagame said:

Why stop there.  Wear the patch until he wakes up or the season ends. 

Here's to wishing he wakes up.

 

 I agree and was thinking the same thing. Just forgot to add it at the

end of my post. Unless he wakes up and is perfectly healthy, I say till the Super Bowl has been played.

 

 

 

[LOVEMESOMEBILLS]

[YoloinOhio]

 

[Beast]

The world is pulling for Damar Hamlin and will be pulling for the Bills when Damar comes to.