Hamlin: Don’t expect any news sooner than tom

Jan 3, 2023, 11:26 AM

or the next day

All just educated guesses and assumptions
But….

(Long: don’t read it you’re not interested in medical treatment process, it’s all about brain from here)

As soon as he got to the hospital last night, they would have done anything they needed to stabilize pulse/rhythm and blood pressure. Then he would be taken to CT/MRI for scan of head, chest, abd/pelvis looking for anything abnormal.

They used a defibrillator which leads me to believe the hit caused a dysthymia (vtach/vfib), not a bleed of any kind, just a guess.

So assuming they didn’t find anything on scans (bleeding they needed to stop) he would be transferred to ICU and placed on “targeted temperature management,” cooling pads used to decrease the body’s oxygen consumption allowing more oxygen to be available to brain in effort to prevent further anoxic (without oxygen) brain injury. Anoxic injury and swelling typically takes a couple days to show on a scan, so they would not have seen it last night.

Yes, he was undergoing CPR, but even the best CPR for 9 mins is going to result in cellular death in the brain. Each cell that dies from lack of oxygen releases toxins that tell the surroundings cells to die too, all which results in swelling. Swelling is fine when you hit other soft tissue, it creates problems when that soft tissue is surrounded by your skull. This is the actual problem with downtime (no pulse) is the anoxic injury to brain and trying to prevent further brain injury.

The target temperature management has different sedation levels in different hospitals I’ve worked in, so he may be able to “wake up” on his own during the TTM or they may have him deeply sedated depending on that hospital policy. They will leave him cooled to either 33 or 36 degrees Celsius for 24h, so say 1a this morn to 1a tonight. Then rewarm over 2-4h and keep controlled normal temperature for another 24h. Then they’ll start taking down sedation, get another CT or MRI and the final part; hurry up and wait.

At this point, he will do what he’s going to do.
The longer there are no reports of him being awake, following commands, and being purposeful, the less likely he will.

Obv his physical conditioning and age give him an advantage, but it really depends on how long he was pulseless. Over ten mins pulseless gets exponentially worse by the minute.

Sending prayers to all involved
Feel free to ask questions, I’ll give best educated guesses if you’re interested

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Quick A&P review:

Venous blood returns to R side of heart and is *”deoxygenated” -> lungs for gas exchange of O2 and CO2 -> “oxygenated” blood enters left side of heart -> pumped out of left ventricle via aorta to coronary arteries, carotids to your brain, and mostly to your lower body

*Oxygenated blood is really a misnomer. As blood circulates through the body not all the O2 molecules are utilized by the body. Typically venous blood returning to the heart still has a fair amount of O2.. oxygen saturation of say 40-60%. Current layperson CPR standards focus on circulation alone relying on the O2 that remains available with each cycle through the body. Ideally, this is less than 2-4 mins, but is different for each person.

Hamlin would have had an advanced airway placed, a breathing tube used on a ventilator a more field friendly one called a king tube through which a bag valve mask could be used to administer 100% oxygen.

Does that help?

Side note: this is the problem with ARDS (acute respiratory distress syndrome) that many viral pneumonia patients face, most recently but not unique to Covid, and why CPR was futile.

In ARDS / covid, patients have inflammation that creates impaired gas exchange (o2 and co2 at the alveolar to capillary level). This impaired gas exchange cannot be improved with 100% oxygen as it’s a gas exchange issue. So when someone would cardiac arrest, the primary issue was hypoxia (low O2 blood levels) resulting in the heart failing from not enough O2 and a cardiac arrest. Simultaneously, blood CO2 levels increase causing a decrease in blood pH to low levels the body does not function well in. Doing chest compressions on folks whose primary issue cannot be fixed (the gas exchange) was futile hence the rate of failure to resuscitate covid pts once they reached that point.

Hamlin: Don’t expect any news sooner than tom

Thanks Soywaker!***

Was thinking about you as I typed this friend

Thank you!!***

Re: Hamlin: Don’t expect any news sooner than tom

I’m suggesting that the longer he was pulseless, the higher

Re: I’m suggesting that the longer he was pulseless, the higher

one other quick question involving cpr

Good question

Re: Good question

Re: I’m suggesting that the longer he was pulseless, the higher

Whatever the local organ procurement group is has been contacted

Re: Hamlin: Don’t expect any news sooner than tom

Who is tom?***

Re: Who is tom?***

Tom Morrow - my neighbor's third cousin's

always one on T net... lol. This is why I log on, as well

Too soon.***

Re: Hamlin: Don’t expect any news sooner than tom

Give education credit where due

Great news!! Thrilled to read this in ESPN article

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