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- Keith R. Stamm
- Disclaimer:I assume no responsibility for the accuracy of any information on this Blog. Im the only Republican ever re-elected to a city wide office. Information on this Blog may not be copied without written permission.
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While doing research for a novel that I've been working on for six years and I came across a piece of information that absolutely stunned me. I was discussing emergency room procedures with Darla Neff--an emergency room nurse--and we eventually got around to the "defibrillator."
You seen it in action hundreds of times on television. The doctor or nurse grabs these paddles, slaps them on a patient and jolts the patient to get their heart started when the patient goes flatline. Except . . .
That's not how a defibrillator works!!
According to Darla, a defibrilator "de-fibrillates." When the heart is fibrillating, it is fluttering. The heart monitor looks like a series of "V"s. The defibrillator jolts the heart back into a normal rhythm so it can actually pump blood to the body. If a person is flatline, Darla says that the defibrillator won't do any good!
This piece of information was absolutely amazing to me. How many times have we seen this on television? I've seen it so many times that I think I could operate the machine. Darla tells me that if you have a person who is flatline, you either have to do chest compressions or use an external pacemaker or use drugs.
I mentioned this little tidbit in one of my "This Week At NitCentral" updates and promptly received the following comments from Robert J. Woolley, a medical doctor, "You're completely correct about defibrillators. What's a little scary is that I've watched a fair number of my fellow doctors (not just TV docs!) shock a flatline heart, which, as your consultant pointed out, does no good. I suspect that this is not because of television portrayals, but because the image of jump-starting cars is so deeply ingrained. The correct procedure is to administer epinephrine and/or atropine, and hope that these produce an irregular rhythm that you can then shock back to a regular one."
Then Lee Lorenz came up with a great idea. He suggested that I start a file to see how many instances we can find of incorrect usage of a defibrillator. Since I had just seen several on an avalanche of American Gothic episodes, I thought this would be fun!
Here's the rules for submission: The scene must show a heart that is flatline on a monitor. While the heart is flatline, the scene must show someone attempting to shock the heart back to life using the defibrillator. When you submit, please include the name of the series, the name of the episode (if possible, if not just include a line saying what the episode was about), a short description of the scene and, if possible, the date you saw it. I won't have time to double-check them so let's try to be accurate out there!
ADDITION TO THE RULES (April 27, 1997): Some have said that it is possible that the monitor might not be calibrated correctly and therefor show a flatline when in fact there's fibrillations. So . . . we will make this allowance. If the code blue team administers a drug intercardially (sticks it in their heart) before they shock the patient the first time, we'll let that one pass. (As was done in a recent X-File episode, "Synchrony.") This also means that with this additional rule, some of the defib-flubs a listed here may actually not be defib-flubs if they were sent in prior to April 27, 1997 because members of the Nitpickers Guild didn't know to check for the injection! (Always need to cover our bases!)
I'll start us off with the ones I saw in the last six episodes of American Gothic.
American Gothic: To Hell and Back (7/3/96). A woman goes flatline. The monitor shows it and the nurse substatiates it. The doctor calls for the paddles. The scene cuts away. When we come back, the doctor is using chest compressions. Then, the crash cart rolls in. The doctor start hallucinating and the nurse steps in with the paddles to administer the jolt. (This one is a bit twitchy since it is possible that a drug was administered when we weren't look but the doctor appears to be busy doing chest compressions.)
American Gothic: Learning to Crawl (7/4/96). At the beginning of the episode, Caleb is electrocuted. After the opening credits, Caleb sees Merlyn and realizes he's dead. In the background you can hear a nurse say, "still flatline, doctor." The doctor yells, "Clear," and hits Caleb's body with the paddles.
American Gothic: The Buck Stops Here (7/10/96). Two-thirds of the way through the episode, Lucas Buck has a siezure. The doctor hits him with the defibrillator. The monitor shows flatline. The doctor hits him again.
The Outer Limits: Mind Over Matter (7/9/96). "The story involved Mark Hamill as a scientist using cyberspace to keep his new love alive. She goes flatline while hooked up, and they use a defibrilator on her lifeless body." Lee Lorenz of Fenton, MI
Short Circuit II: "The robot is dead. They defib the robot. (Since he was alive, he must have a heart--at least, I think that this was their logic.) It was bizarre, to say the least." Laura Jacquez Valentine of Pittsburgh, PA
Renegade: Val's Song (7/26/96). "In the first scene, Valerie Prentice is in a hospital bed on life support. The camera cuts to the heart monitor, which goes flat and emits the famous high-pitched whine associated with it. Then the nurses rush in and, without administering any heart starting drugs, put the pads to her a few times before giving up. Oddly enough, they got it right without even trying." Josef Hughson of Ft. Leavenworth, KS
Flatliners: "Sorry about this one, but it has been awhile since I've seen the movie and don't currently have a copy. But don't they use a defribulator each time to bring the person back from the 'dead'?" E. Haughton Dansforth of Tempe, AZ
Eraser: "The actor who plays Eldon the painter on Murphy Brown is helping the Eraser (Arnold) break into some secret HQ by pretending to have some sort of seizure. In the HQ's emergency ward, he pulls out the plug on the heart monitor they have put on him, and he appears to go flatline. Seeing the flatline, the attendants grab the paddles and start shocking him. Even though he is flopping around and screaming, they keep looking at the flatline on the monitor and repeatedly shock him." Steve Mack of Berkeley, CA
ER: Fire In The Belly "This nit breaks every rule of submission, but I thought I'd give it a shot anyway. Dr. Benton is doing an appendectomy when all of a sudden you here the high-pitched squel of a flatline. They never show the monitor, but Benton begins to do chest compressions (which seems to support the flatline theory). Anyway, Benton's doing chest compressions and although they never show the heart being shocked you very clearly, without a doubt, see a nurse pull a pair of paddles out before the scene cuts." Matt McDonough of Virginia Beach, VA (Note from Phil: Well . . . ER is suppose to have medical consultants. If the doctor called for epinephrine and/or atropine then the paddles would make sense. I don't know. This one's twitchy.)
Touched By an Angel: Interview With an Angel (8/10/96) "I'm not sure if this counts or not, but a doctor had just performed a heart transplant on a man. The moniter was flatline, and the doctor held electrodes or something on his heart, said "Clear" and there was a shocking sound. Of course, nothing happened. (Also, my stepfather is an EMT-I (Emergency Medical Technician-Intermediate) and I asked him about defibrillators. He confirmed the fact that you can't use paddles on a flatline heart. He's surprised that something intelligent is on the Net. ;)" JoAnna Walsvik (Note from Phil: We aim to please!)
Taken from Sunday's entry in "This Week At NitCentral" (9/15/96) . . .
**********************
In the continuing saga of the general populace's misunderstanding of defibrillators, Cliff Cerce alerted me to a series of news reports that spoke of a new, compact, computerized defibrillator receiving federal approval. (Note that the spokesperson for Heart Stream, Inc. does sound like he knows what he is talking about but the news media obviously doesn't! I've emphasized the appropriate passages.)
TRANSCRIBED FROM AN ABC RADIO NEWSBREAK ON 9/12/96
The smallest, lightest and cheapest device to restart stopped hearts now has federal approval and cardiologists hope that will make defibrillators as common as first-aid kits.
"This is a device that's been designed for fire departments, for ambulance service personnel, uh, for the police departments of many communities which will make it practical, uh, for them to carry this equipment and deliver this therapy in those first critical minutes," John Harris of Heart Stream Incorporated, the Seattle developer of the portable defibrillator.
More than 300,000 Americans die from cardiac arrest each year. Experts say a third of them might have been saved if they got an electrical shock to restart their heart right away.
TRANSCRIBED FROM THE LOCAL NEWS REPORT BROADCAST ON KY3 - THE NBC AFFILIATE IN SPRINGFIELD MO.
It's cheap, it's small and it could save your life. The nation's smallest device to restart stopped hearts now has federal approval. Cardiologists hope the FDA approval will make defibrillators as common as fire extinguishers. The new small defibs could become standard gear for security guards, police, even flight attendants. They are the size of a book and weigh just four pounds. They cost three to four thousand dollars.
Also, Cliff Cerce advised that Tom Brokaw actually used the term "jump-start" when referring to the service that these devices performed.
I asked Robert J. Wooley about this. His reponse follows. (I had commented that it sounded like the reporters simply didn't know what they were talking about!)
"I think you're exactly right--the reporter missed that day of physiology class. Again I maintain that it is the prevalent image of jump-starting a car that has caused all the misunderstanding by false analogy."
In my message to Robert, I also worried that having defibrillators as common as first aid kits might lead to Nellie jolting Bert every time he slumped over on the couch! Robert responded, "These automatic things are actually an improvement in that they will *not* deliver a shock to a flatline heart, or one with a regular beat. They must sense fibrillation before they will defibrillate. This makes it less likely that an uninformed operator will try the jump-start theory of cardiology. I haven't seen the new tiny ones, but the standard size automatic ones that some fire and police departments now carry are tres cool. You just slap two electrodes on the chest and it does the rest. Before it delivers the shock it loudly warns bystanders, in a Robby the Robot voice, "STAND BACK! STAND BACK! STAND BACK!"
And so it goes, and so on, our technology saves us in spite of our ignorance! (There's a scary thought. I used to create expert system technology. Granted it was only in the field of music notation but what happens if there is a manufacturing error in the chip sets for one of these computerized defibrillators? Will the hapless patient start doing a bad version of the Macarena? Sorry, sorry. That was totally uncalled for.)
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Emergency: "Almost every episode of would qualify for this. They certainly used the defibrillator often enough (something like 2 out of every 3 episodes). I can't give any specifics, because it's been years since the program was on the air. (Also, you have listed Short Circuit II but in this case, they were using the defibrillator to attempt to rechage his batteries)" Troy Risher of Vista, CA
A further note from Robert J. Woolley: "This is only tangentially related to your specific request for defibrillator misuse on TV, but I think you'll find it interesting anyway. A recent article in the New England Journal of Medicine checked out how realistic the use of CPR is on medically-oriented TV shows. But the really interesting part is the reponse of one of the medical writers for 'ER', who was invited to write an editorial about this research. What is interesting is his frank admission that realism gets sacrificed to what is dramatic and will pull in viewers. Of course, we all *knew* that, but to have the industry admit it publicly is unusual, I think."
(Note from Phil: Robert did send along the article and it was interesting but a bit too long for inclusion here.)
New York Undercover: Season Premiere, "At the end of last season, Det. Nina Moreno was in critical condition after taking a bullet for her fellow cop and boyfriend Det. Eddie Torres. The show faded out with her going into flatline (the monitor made that high-pitched whine and then we saw it) and the paddles came out, but it appeared that she had died. Then, last week, in this season's premiere, the same scene was repeated, and the paddles came out again and the crash cart came out and ... her heart started beating again! Ta-dah!" Daniel B. Case
Mad TV: (not the most reliable source at the best of times) Rerun September 14, 1996 "There was a scene with two woman doctors who spoke in 'girl' cliches. At the end, the patient is flatline. After the defibrillator didn't work (no surprises there), one of them yells 'Get your funky *** up,' or something like that, and then the heart starts going again." Murray J.D. Leeder
The Outer Limits: Afterlife (9/30/96) "The doctor-lady, named Ellen, I believe, is talking with somebody, when all of a sudden the sargeant [who has been infected with alien DNA] in the containment chamber goes flatline. The shot switches to the monitor of the flatline heart. Ellen rushes in with what I can only assume were her nurses, and begins to give him adrenaline. When this doesn't work, She whips out the defibrilator, with the steady tone still audible in the background." Ryan Hunter
Reanimator: "In the first scene after the opening credits of the movie, they clearly show asystole (flatline) on the monitor, yet shock the female patient anyway. In the same movie in the last scene another women is also flatlined, but is defibrilated." Scott Fleischer of Gainesville, FL (Note from Phil: By the way, Scott is a pre-med student at the University of Florida and has worked in emergency rooms for 5 years.)
Bride of the Reanimator: "[In this movie as well,] a women just slumps into cardiac arrest shown on the monitor and the first thing the doctor calls for are the paddles." Scott Fleischer of Gainesville, FL
Scott Fleischer comments, "The other nitpicky flub you can look into is the sound the defibrilator seems to make on TV. In real life there is little or no sound. The other thing to laugh at is how the patient always pops up or flails their arms like they are being hit with a severe amount of joules (unit of electrical energy). I could go on about how many times I've seen it done wrong."
Outer Limits: Mind Over Matter (10/4/96) "At the end of an episode, a woman dies. Some calls out 'Flatline!' and we hear what I believe is supposed to be the sound of a defibrillator. The camera cuts to the woman and we see her get another jolt from the paddles. In the seconds that follow, we are told that the woman's heart stopped, she gets another jolt. We see the flat line on the monitor." (Note from Phil: Lee Lorenz had already spotted this one but this description has a bit more detail.)
ER: Don't Ask, Don't Tell (10/10/96) "Blatant Defrib last night on E.R. Lawrence Tierny (who played Elaine's dad on 'Seinfeld,' and was in 'Resevoir Dogs') went flatline, and sure enough, they jump-started him three or four times. Didn't see anyone inject him first, either. And as always, the ever-reliable defrib worked!" Bob Canada
Sliders: The Dream Masters (Date Unknown) "Wade is having a very bad dream and goes into arrest about halfway through the show. Her heart stops and there is the familiar monotone sound of the flatline. The doctor tells someone to something to 100, and that something looks like a defibrulater. Then they use the paddles on her." John Latchem and Joe Hughson both submitted this one on the same day!
DS9: Nor the Battle to the Strong (Date Unknown) "Well, this isn't a nit, but I like to give the creators of a show credit when they do something RIGHT! In last week's DS9 episode, where Jake and Bashir are performing emergency field medicine, early on in the episode, Bashir is faced with a woman who IS fibrillating, NOT flatlined and he defibs her with a nifty Trek paddle. I was thrilled, but of course, we all know that Trek is SOO accurate with its science. (snort, snort)" Matt Nelson
New York Undercover: (Title Unknown) (10/31/96) "A young rap star is in a hospital recovering from a bullet wound when, suddenly, we see the monitor go flatline and the paddles come out and are used." Dan Case
CNN: "I was searching through their website, and came upon this URL: 'http://www.cnn.com/HEALTH/9611/19/airplane.heart/' It mentions that American Airlines will carry defibrillators on their planes, 'to "jump start a stopped heart"'" David McGrath
LEVI JEANS: "Okay, this isn't a TV show, it's a commercial, so you might be able to see it. The commercial is for Levi's jeans. There's a guy on an operating table surrounded by doctors. He's pretty beat up. He starts to sing a bad 80's song (think British, I can't remember the name of it), and the doctors start to sing. They ignore this person and he goes flatline, and they use a defib to start his heart. There you go!" Eric Brasure (Note from Phil: I love this commercial! It's for wide-legged jeans. I believe the song is "Tainted Love" and it's older than the 80's--I think!)
ER: Hell and High Water (11/28/96) "A young girl who had been hit by a car was having internal bleeding while in surgery to repair a laceration on her face. She was taken to the ER and Dr. Benton was doing a thorocotomy when Dr. Greene came in and traded places with him. The girl then went flatline. There were a few shots of the monitor clearly illustrating this. At that time, Dr. Greene called for the internal paddles and proceeded to shock her several times." Jim Cadwell of Minneapolis, MN (Note from Phil: Under the new rules, this may or may not qualify. I'd be surprised if someone didn't call for a shot before they used the paddles. After all, they do have a doctor on writing staff!)
Chicago Hope: Women on the Verge (Date Unknown): Boy is having a bypass operation. Boy's heart stops, monitor shows flatline. Surgeon "Kate Austin" uses defibrillator. Monitor still shows flatline. Surgeon(doubtless repressing the urge to say "Duh!") injects something into his heart. Monitor still shows flatline. Surgeon uses the defibrillator again. Boy's heart starts. I think this can be explained if a very weak fibrillation that can be treated with electrical shock still shows up as a flat line. The injection probably started the heart up. My father is very sceptical about defibrillators being useless for "dead" people, and when I saw Austin injecting the heart I tried to tell him this was the correct way to do it." Gareth Wilson of Christchurch, New Zealand (Note from Phil: This thing of defibrillators starting a heart is so deeply ingrained in us from seeing it on television that it's really hard to convince people that it's not true!)
Diagnosis Murder: (Episode Title Unknown) (1/16/97) "Dr. Sloan (Van Dyke) tries to save his friend when he starts fibrillating. The scene showed the monitor flatlining (as required for submission), and then Sloan applied the machine. Fun to watch once you know it's a WHIRL :)" Michael Teplitsky
The Abyss: "I'm not sure if it shows the flatline on a monitor, but how about this one. The movie shows the use of a defibrillator on Lindsey Brigman (played by Mary Elizabeth Mastrantonio) after she willingly drowns herself so that she and her ex (Ed Harris) can both possibly get back to Deepcore. Not only had she been drowned for some time when they used the defibrillator on her, but she was lying in about 3 inches of saltwater, the same water everyone around was standing in. Not sure if that makes a difference, but it sure seems dangerous to me." A. Neal Crandell of Louisville Kentucky
ER: (4/24/97) "Tonight on ER, Dr. Green told a troop of Brownies (Girl Scouts) that the 'paddles' were used to restart someone's heart. But, I feel I must add that he DID say that they were also used to steady irregular heartbeats." Michael Apple
(Note from Phil: And now for a truly interesting tidbit of information . . .)
"In your Defibrillator Files, someone said that the writers of ER would have the doctors using a crash cart on flatline patients because it looks dramatic. Well, it's not only on television that they do this. When my father died last year, they 'shocked' him for fifteen minutes after his heart stopped. My sister, a longtime registered nurse, later said 'They just do that for the family.' In other words, some doctors will use the crash cart in hopeless situations just so the family can see a dramatic lifesaving attempt, even though they know it doesn't do any good." John Reese (4/25/97)
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