GCS3. Stich.

Clear!

[melancholy piano music]

Coarse V-fib, [woman gasps]

Hi, my name is Annie Onishi.

[Narrator] Annie is a surgical resident

at Columbia University.

Today, I'll be breaking down clips from movies

and TV about the emergency room

and the operating room, again.

Roll the clip.

Cardiopulmonary bypass, The Good Doctor.

[Doctor] The valve doesn't have adequate support,

it won't be able to close.

Cardio pulmonary bypass is a technique

to allow the heart to stand still,

to allow surgeons to operate on the heart,

while a machine takes the blood out, puts oxygen in,

and puts the blood into the patient.

Stitch. Five hours, 23 minutes.

While its great to allow the heart to stand still

so the surgery can be performed,

bypass has some downsides.

[Surgeon] The patient died.

The longer you're on bypass,

the more likely you are to have bleeding complications,

the more difficult it is to restart the heart

after the operation.

[Lead Surgeon] Pump time?

[Surgeon] Six hours, 48 minutes.

Six hours and 48 minutes is an obscenely-long bypass time.

[Surgeon] How long has he been on bypass?

Bypass times, in reality, range more along the lines of

45 minutes to two, 2 1/2 hours.

[Surgeon] Nearly two hours too long.

Hollywood rarely gets a good representation

of what bypass surgery actually looks like.

[Lead Surgeon] Dammit!

Self extubation, The Sopranos.

[Male Doctor] Four milligrams Ativan.

[Female Doctor] He pulled his tubes out!

Self extubation is when a patient removes

his or her own endotracheal tube,

which is the tube that connects the patient's airway,

[Male Doctor] The airway box.

to the ventilator,

which is the machine that's breathing for them.

It's actually not as hard as you would think to do that.

Well, that's good right?

That means he's breathing on his own.

Little old ladies,

who you'd think never in a million years

would be able to it, can do it.

This tends to get everybody very excited in the ICU.

Take the family out.

Please wait outside. Where's the evidence?

Because in those moments, the patient may not be able to

protect his or her own airway.

They had to put the tube back in.

Face transplant, Face/Off.

[computer beeping]

[machine beeping]

My first thought is, oh my god, you can't use cautery

on the skin like that, that's very poor form,

it can leave burn marks, it's just not

really the technical way we make skin incisions.

The other sort of suction cup device,

while it looks great on camera,

in reality, a harvesting of facial structures

would take hours and hours and hours as the surgeon

very carefully removes muscles, arteries, veins,

nerves, and the like.

[computer beeping]

Face transplant has really come a long way,

initially described in France, and has been

successfully completed here in the United States

in a number of patients with devastating injures

to their airways, their mouths, their eyes.

It's really not a cosmetic procedure at all,

it's life-changing and lifesaving for these

patients who otherwise can't live normal lives.

I'm here today because I want others to see

that there is hope beyond the injury.

Old school defibrillator paddles, CHiPs.

We have coarse V-fib,

let's get an amp of epi in right away.

Increase the ventral flow rate.

Show me those chest compressions one more time?

Epi.

Those are, without a doubt, the weakest chest

compressions I have ever seen.

Well, no wonder we're losing him.

If you're not sweating giving chest compressions,

you're not doing it right.

Stop CPR please.

So they say this patient has coarse V-fib

which is a type of ventricular fibrillation,

a rhythm that will require a dose of electricity.

Let's hit him with the paddles,

set it for 280 and give 'em to me.

As you can see here, they're also taking their

dear sweet time getting the pads on the patient.

Ready at 280.

Hollywood loves the manual defibrillator paddles,

I think it gives the doctor something to do on camera,

in reality, it's really these stickers

that are used more commonly.

Are you sure?

Double checked it.

Lets take a look at Scrubs.

Don't worry about the patient, Turk was already there,

learning by doing.

Charge, clear!

[patient screams]

These days, modern defibrillators are pretty idiot-proof.

They have a technology that senses what the patient's

rhythm is and will deliver a shock, only if indicated.

Dr. Turk here, he's using an older-school defibrillator

that's not obviously sensing

that the patient is just asleep.

[Man] Turns out the guy was just sleeping,

attached to a faulty monitor.

And he is able to deliver a shock,

even though it's inappropriate.

[man screaming]

Again, seen in The Thing.

Clear!

[Man] Clear. [beast breathing]

[man screaming]

I hate when that happens.

A professor in charge of his own heart surgery, Chicago Med.

[Surgeon] Give me a 20-millimeter Daycron graft,

and a 3-0 Prolene stitch.

What, no, no, no, no, no.

3-0 is far too heavy for a graft this size.

It's pretty unrealistic that this person

wouldn't be sedated just a little bit.

Did I fail you teach you proper surgical technique?

Definitely not able to participate in the

goings on of his own open-heart operation.

[Surgeon] I thought the 3-0 was appropriate.

That's it, you're out.

If we're gonna get real technical though,

I do kind of agree with the crotchety old guy,

3-0 suture's a little bit too big to be

sewing on the vena cava with.

Do not touch me with that torture device.

Flatlining, Popstar.

I love the road, you know,

it's kind of a perfect job for me,

but my favorite free time thing is flatlining.

Heart rate dropping.

Flatlining is when you technically lower your

heart rate until, well you're dead.

What Bill Hader is describing here as flatlining

is what we in the medical field would call

asystole, which is complete cessation of all

electrical activity in the heart.

[Bill] You can catch a glimpse of the afterlife.

I really would not recommend to viewers

that they try to pursue this hobby.

I try to fit in a F-line sesh at least once a week.

One thing that's inaccurate in this clip

is that asystole can't actually be reversed with a shock.

Clear! It's one of these,

sort of, unshockable rhythms.

It would need to be treated with infusions of

certain medications like epinephrine.

Oh, whoa, did I [beep] my pants?

Not this time.

Fun fact, I do suppose it is possible

for you to poop your pants while you're in asystole.

Steel Magnolias, withdrawing of life support.

[pen tip writing on paper]

[machine stops working]

So I actually think this is a pretty fair

representation of what happens

when doctors remove life support.

One thing that they get right here is that

we do turn off the monitors, so that there's very

little noise or distraction,

[machine stops working]

it makes for a much more peaceful environment.

Farting in the OR, Scrubs.

[Head Surgeon] Good, good,

whoa, whoa, what's that smell?

[Surgeon In GrayPatterned Cap] Patterned Cap] I don't know.

[Surgeon In Fire Cap] Sir, I farted.

[Head Surgeon] Get the hell out of my OR.

[Surgeon In Fire Cap] Yes, sir.

Look, I'm gonna get real with you, right here, right now.

If farting in the OR got you kicked out every single time,

neither me nor any of my co-residents

would ever graduate from residency.

[Surgeon In Gray Patterned Cap] Dude.

Self-surgery, Master and Commander.

You'll have to raise a rib.

[man panting]

Right in.

[patient gasps]

So, as crazy as this sounds, self-surgery has

actually been documented on a number of occasions.

This bad-ass Russian surgeon, Dr. Leonid Rogozov

actually removed his own appendix

while he was stationed by himself in Antarctica.

[Patient] Is that all of it?

Aye sir, you're patched up nicely.

Here's another example of self-surgery in 127 hours.

[dramatic music]

[man grunting]

So here we have James Franco, playing Aron Ralston,

self-amputating his arm

after being trapped in a canyon for a number of days.

As the boulder ricocheted, my right hand

became trapped by this rock.

I think this is a pretty fair representation,

it's actually hard for even me to watch.

[man yells]

His use of a tourniquet in this scenario

is very smart, probably lifesaving,

unfortunately in today's day and age, a tourniquet

is something that everybody should know how to use.

I think they do a pretty great job.

Thank you.

Crush injury, Grey's Anatomy.

[Patient] What's that?

I'm pouring vinegar on your flesh

to minimize the burns inside your skin caused by the cement.

I'm burning from the inside out?

I'm dying aren't I?

Hey, hey, Andrew,

I'm banning that word from your vocabulary.

So this actually a very good,

very creative representation of a crush injury

and something called

a compartment syndrome. What?

Compartment syndrome is when there's some sort of

pressure on the abdomen or actually

from within the abdomen

that's preventing blood from returning

normally back to the heart.

Oh god.

The second they remove that last piece of stone,

all of those toxins that have built up

rush back to the rest of the body,

he goes into basically immediate cardiac arrest

and he loses consciousness.

Easy, easy.

One minor, nit-picky point though,

if they knew all of his was gonna happen,

I think they probably should've intubated him,

secured his airway,

before they removed that last piece of rock.

Yeah?

Organ transplant, John Q.

[Surgeon] Heart?

So this is pretty accurate,

donated organs actually do end up in the OR

in two plastic bags full of ice and ice water,

which is represented here.

That plastic bag goes in another plastic bag,

goes in a special bag, goes in a special box,

goes in a special cooler,

all taped up with real special tape.

And again portrayed in One Tree Hill.

Dr. Casper to the ER. [ice falling to the floor]

I mean that sucks.

[Intercom] Nurse Henderson to admitting.

[dog gulping] And we always

double bag for safety.

The dangers of patient transport, Gray's Anatomy.

[child crying] We're gonna find out

who this little guy is.

[onlookers gasping] Oh, I'm sorry, I'm so sorry!

Those stretchers are very heavy and very hard to control.

I have definitely, on a number of occasions,

had my foot run over by one of these things.

You doing anymore bowling for doctors today?

I've been hip checked

by either an anesthesia resident or a patient transporter.

Try and take out Kepner.

Oh! Oh god!

I would say this is a pretty accurate representation

of the amount of sass that flies around in emergency room.

That'll work, too.

Here's a better representation of an incoming trauma,

from Chicago Med.

Female, mid 20s, GCS3,

struck the dashboard and starred the windshield.

Here you can hear the first responders

reporting to the doctors that this patient has

a GCS of 3.

GCS3.

That refers to a Glasgow Coma Scale.

The Glasgow Coma Scale measures your mental status

on a scale of three to 15.

You and I, sitting here talking right now have a 15.

A carrot has a three.

15,

three. There he goes.

In-house hospital translators, Getting On.

See if maybe we can tell them what she's saying

and then they can translate it for us.

[Nurse] We gonna try to tell you what she's saying.

Yikes.

[speaking in foreign language]

This is really bad, this is a huge violation

of this patient's rights as a patient.

[speaking in foreign language] That's gotta be something.

[Nurse] Did you get that?

Every patient is entitled to an interpreter

who speaks his or her native language fluently,

in any medical encounter.

He says, She says, 'I can't stand this,

'I wish I was dead, please kill me.'

Last time we talked about removal of live ordnance

from a human body cavity,

we were talking about downtown Seattle Grace.

Here, we're looking at a field hospital

during the Vietnam War.

[Hawkeye] Kid comes in with an unexploded

grenade that's been shot into his body.

This is not something we typically learn

in medical school or routine surgical training.

[Hawkeye] Something they neglected to tell us about

in med school.

Usually these operations have to occur

in a field hospital,

well away from any other personnel that could get injured

when and if the ordnance explodes.

[Hawkeye] There must be an easier way for a surgeon

to make $413.50 a month.

First, they would use an x-ray to sort of

figure out what kind of unexploded bomb would be

inside the patient, before very carefully,

and under very controlled circumstances, removing it.

Why, this is one hot potato.

Old-school scrubbing in, The Knick.

You could waste your time scrubbing in

if it suits you, but I told you, your role is to talk

Gallinger through the procedure, nothing more.

Germ theory really became more widely-accepted

in the early part of the 20th century,

so here you can see this surgeon dipping his hands

in a series of, what looks like, iodine solution

to clean his hands before an operation.

These days we use a simple, rub on, alcohol-based gel

very similar to PURELL.

Small talk in the operating room, St. Elsewhere.

[Doctor] Who here smokes?

[Louise] Dr. Ehrlich smokes.

[Doctor] Figures, you smoke, Louise?

[Louise] Not so much as a puff.

Like any other work place, we talk about weekend plans

we talk about the weather,

we talk about politics, you name it.

[Doctor] 140,000 hits of nicotine a year

for at least 15 or 20 years, from the looks of this mess.

We never gossip about the patients,

you never know what they can actually hear.

[Doctor] Moron.

Breaking bad news, Contagion.

She failed to respond, Okay.

and her heart stopped, Right.

and unfortunately,

she did die. Okay.

Communicating bad news with patients

is one of the worst parts of our job.

Right. One thing

that this doctor does that I'm not crazy about,

is just speaking to the distraught husband

in the middle of the hustle and bustle

of the emergency room.

I just saw her, we were just at home.

Another thing to avoid is technical jargon

such as, failed to respond,

She failed to respond.

In a state of high stress,

patient family members are unable to process

beating around the bush.

What are you talking about?

So, the doctor then does a good job

of saying, your wife is dead.

Your wife is dead.

During medical school,

and actually on-going through residency,

every once in a while we will work with paid actors

who are able to simulate these sorts of

very high-stress, emotional situations.

What happen to her?

Okay, okay.

This is definitely how you don't do it.

How's my son?

He's going to be all right.

Oh! Oh, thank god!

Yes, he's lost his left hand,

so he's going to be all right.

You son of a bitch!

In my experience, there's really no place for puns

in the hospital.

That's more the way I would take the news.

Dangerous patients, General Hospital.

[Patient] Someone help me, please!

[Orderly] No one can hear you!

Help!

Please help me!

So those are called four-point restraints,

they're on the spectrum of the most extreme

sorts of restraints that we would need to use for a patient.

There actually are five-point restraints,

which also involve a vest.

Someone hasn't been taking Ow!

her medicine.

Sometimes psychiatric patients or patients in an ICU

do need to be restrained.

[Nurse] I need some help in here!

For their own safety and for the safety

of the hospital personnel around them.

Let go!

And here's another dangerous patient in Thor.

How dare you attack the Son of Odin!

[Male Doctor] I need some help!

[Thor grunting]

[Female Doctor] Call security!

Sometimes we do have to do what's called

chemical restraint,

[Thor grunting]

that's given intramuscular

injection of something like Haldol,

which is an anti-psychotic medication.

You are no match

for the mighty. [face squeaks on glass]

Pretty accurate.

Bullet wounds, Game Night.

Step one, sterile gloves, check.

Step two, disinfect wound,

Why, yeah, that's gonna sting isn't it?

I wouldn't necessarily recommend using wine

as a disinfectant for an emergency backdoor surgery,

but I guess between the acidity and the alcohol content,

maybe it could work.

Nice and small baby, Yep, yep.

[toy squeaks]

That's not small, that's really big!

In my opinion, the bigger the incision, the better it is,

you're more likely to be able to see stuff,

and any time you're struggling,

just make the incision a little bigger.

It's a bullet, not a grapefruit.

So the entire premise here, that you have to remove

a bullet just to take a bullet out is not exactly accurate.

Shh, quiet, I know what I'm doing.

There's plenty of people walking around out there

with bullets stuck in their bodies in various locationss

that aren't really causing any harm at all.

[Woman] Max, did you get shot twice?

She must have skipped step zero,

which is make sure you can't also find the exit wound.

That's the exit wound.

Oh, it came out.

[Max] Yep, nothing to remove.

You wanna see a guy who knows what he's doing,

check out Sugar, in No Country For Old Men.

He's doing it in a nice, clean, sterile setting

in his bathroom.

Here, he's mixing some Betadine into some normal saline

as a cleansing solution,

he even has this pro tip down,

which is make yourself a little squeezy bottle

by stabbing holes in the top of the bottle.

Closing a laceration on a desert island, Lost.

Do you have a second, I could use a little help here.

Help with what?

With this, look I'd do it myself, I'm a doctor,

but I just can't reach it. You want me to sew that up?

Honestly, if I were Jack,

I would just leave that wound open for fear of infection,

but listen, if you're gonna close it, he's not wrong.

Did you ever patch a pair of jeans?

The sewing technique is actually kind of similar

to hand sewing.

For the wound.

And here are again, using alcohol to disinfect a wound,

again, I think vodka would be my personal choice,

both for its smoothness and its flavor.

Tension pneumothorax, Mad Max.

[Woman] She's collapsing her lungs, one breath at time.

So sorry.

[patient gasps]

Oh my god, that is not how you fix a tension pneumothorax.

This is more commonly known as a collapsed lung.

Every time a patient takes a breath,

air escapes from the lung but is trapped inside the thorax.

She's pumping air into her chest cavity,

she's collapsing her lungs.

The classical, standard, and safest way to treat

a tension pneumothorax is with thoracostomy drainage

or needle drainage in the first and second

intercostal spaces in the mid midclavicular line.

If you stab lower, like where Mad Max stabs,

you are just as likely to hit

something like the spleen or the colon

because the diaphragm is moving up and down.

[Max] I know, I know.

Safest way is in the chest,

where there's really nothing else.

I am so sorry.

Now where they get tension pneumothorax right

is here, in Three Kings.

[Man] There it is, the chest, it's crushing his lung.

[man groaning] [air hissing]

I pretty much love everything about this clip.

I actually think this animation is very good.

Here, it demonstrates the injury to the surface

of the lung that's allowing air to escape into the thorax.

[air hissing]

Here they demonstrate pretty solid placement of their

needle thoracostomy, it's exactly as described,

second intercostal space midclavicular line.

This is even a little fancier,

they have a three-way stopcock that will allow them

to let the air out intermittently.

[air hissing]

And it's also a great representation

that the patient will feel almost immediately better.

That feel better? Mm hmm.

How not to do a physical exam on a trauma patient,

Twilight.

Bella, looks like you took quite a spill, how do you feel?

Good.

You might experience some post-traumatic stress or

disorientation but your vitals look good,

no signs of any head trauma.

He's talking about her vitals,

meaning her heart rate or her blood pressure,

meanwhile he's doing a pretend neurological exam

by flashing the flashlight in her eyes,

that's not how we do it.

You might experience some post-traumatic stress.

PTSD is not really a diagnosis we make

right then and there in the ER,

it's something that sort of develops later on

in a patient's course.

I think you'll be just fine.

While good looking, this guy is pretty lazy,

he's doing a very minimal, superficial,

check of this patient who apparently just suffered

some big traumatic accident.

Sounds like you were very lucky.

Brain death, Grey's Anatomy.

Those must be the papers, the papers you want me

to sign to decide what to do with my husband

now that he's dead but not really dead.

He's dead, he is legally dead.

As a clarification, her husband,

Dr. Shepherd, has just been declared brain dead.

The definition of brain death is

a legal definition of death.

The brain stem is no longer functioning,

there is no chance of meaningful recovery.

Do I pull the plug?

The phrase, pulling the plug, really bothers me

because it implies we are

stopping taking care of this patient.

Terminate all life-sustaining measures.

When in reality, brain dead is

a legal definition of death.

Stop all curative intervention,

remove all the catheters, drains and tubes.

So I gotta say, Shonda Rhimes

broke my little heart with this clip.

I think this is a really terrible representation

of brain death as described by Meredith Gray,

who herself is supposed to be a doctor.

I'm a surgeon, just like my husband was,

I know how this works.

And should understand this complex

and very difficult concept.

You wanna talk about killing my husband?

Ma'am.

Give me the papers!

Surgical knot tying, The Good Doctor.

[Surgeon] Need a ligating suture on the splenic artery

while I make the cut,

can you do that for me before this young lady

bleeds out on us, Murphy?

[Murphy] Yes.

[uplifting music]

So they're doing a trauma splenectomy here,

this is one of the quickest, most straightforward

operations in the book, I don't know

why they're so surprised that he knows how to do it.

[uplifting music]

It's a pinch, a scoop and a staple fire.

It should not involve everybody stopping to stare,

really, nothing to write home about.

[Surgeon] Okay, lets move on to the bowel perf.

If you look at this monitor, this is actually

a great representation of what a

real patient monitor would look like.

[Surgeon] Yes!

That top line is your heart rate tracing 130

because the patient is hemorrhaging.

Middle line is the patient's sat,

that third line is what's called the

end-tidal CO2, that is the amount of carbon dioxide

that the patient's body is producing at that moment,

and those last numbers are the blood pressure, 84 over 40.

Maybe not good doctor, but good monitor.

[uplifting music]

An understaffed emergency room, Wrongfully Accused.

Because of cutbacks, you are the only person on duty.

Ah, ha! [cartoonish bouncing sounds]

He's pregnant.

Balance and rotate the organ.

You better take a look at this.

Uh, no thank you.

Honestly, it sometimes feels like our hospital

is this busy and this crazy

and we're all swamped as much as this,

but I think this is probably a little bit of a stretch.

[Man] It's El Nino!

[Woman] Killer bees, an ocean liner hit an iceberg!

Multidisciplinary discussions, Grey's Anatomy.

[multiple people yelling]

Why is the patient in there and all of you are in here?

No one can agree where to start.

There are definitely conversations

that take place between general surgery,

orthopedics, neurosurgery, anesthesia,

Dr. Torres is worried about the limbs,

Dr. Bailey is worried about abdominal crush injury.

But ultimately, all these people do have to come together

and decide what's gonna kill the patient first.

Working together on this?

No! Okay, everybody stand down!

That's the treatment plan that we should pursue.

We work as a team, or that man dies.

Scary 1970s cerebral angiogram, The Exorcist.

[machine clatter]

[woman gasping]

[machines whirring]

So this is an old-school representation

of how they used to do cerebral angiograms,

which is a picture of the blood vessels in the brain.

In this scene, you can see them putting a needle

into the patient's carotid artery,

you can tell its the artery 'cause

there's blood spurting out, [woman gasping]

threading a wire in, threading a catheter,

and then injecting dye and taking x-rays.

This dye is a type of contrast,

usually with some iodine in it so

that it'll show up on x-rays.

Cerebral angiograms are used to diagnose

problems with the blood vessels in the brain,

such as aneurysms or arteriovenous malformations.

There's nothing there, no vascular displacement at all.

I'm not sure what it has to do with demonic possession,

but I'm sure they were just exploring

all entities at this point.

We still think the temporal lobe.

Oh, what are you talking about?

[Narrator] Conclusion.

Listen, I get it, Hollywood has to take

some shortcuts for dramatic effect or comedic effect.

But it's also important to recognize a

difference between fantasy and reality.

All right, great! Great.

It's a wrap!

[crew applauding] Great.