I've reacted to a lot of episodes of Grey's Anatomy on this channel, and am often compared to Dr. Derek Sheppard (because we ...

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Doctor Reacts To Grey&#39;s Anatomy | McDreamy&#39;s Car Accident

season 11 episode 21 mcdreamy says good night let's watch it together [Music] okay first mistake he's making here you need to call for help my phone's not working because there's very limited things you can do on the road without any tools you need to call for help and get emergency transport to get them to a hospital where they could actually be taken care of hey i can't open the door ma'am hey hey what's your name sarah sarah who's winnie my daughter hey you winnie i think i'm dead well you're not dead i can feel a pulse in your wrist and you can't be dead if your heart's still beating i see i'm a doctor and i'm telling you everyone know you're dead feel your pulse maybe that's a little dark thing to say to a child listen getting you out it's gonna hurt a lot i don't know if it's shock or if it's that my leg hurts so badly that i almost can't recognize it almost feels normal so maybe um it will be so bad getting me out sounds like you're just looking at your head how does he know that he's just like feeling around over there and he's like yeah dislocated there yeah no special test eh i gotta get you out of this car down on the ground and then pop it back in the socket how does he know it's dislocated versus like a full-on fracture that's displaced he just has miraculous hands that have x-ray field the dislocation is cut off the blood supply to your leg if i don't do something you could lose it so that's the only time you would do a reduction in the field like this if you see that the vascular supply meaning the blood flow that is going to the lower limb is obstructed because of the uh dislocation that can happen in this case yeah he should try and put it back so that he restores blood flow otherwise literally the rest of her leg starts dying into crossing whenever you do a reduction of dislocation initially worst pain ever afterwards feels kind of good oh does it hurt anymore i'm not supposed to be here i have to go excited you're probably in shock okay you have a lot of adrenaline going through you right now there might be something wrong with you that you don't feel right now so i need you to slow down that is very accurate in fact paramedics are trained to tell folks who've been in car accidents to calm down because it's very easy to say i'm fine i'm fine i don't need to go get emergency care because you are on adrenaline you don't feel your internal injuries and you could potentially be bleeding out and it's also so important to know the mechanism of the injury like the fact that this was such a high steep car accident already puts her at a high risk of severe fractures vertebral fractures internal bleeding i just need to undo a button so i can look at your stomach he's going to see like bruising or he's going to see a giant laceration with intestines gotta hand it to you doc go and have yourself a drink you earned it oh and that's why you don't stop in the middle of the road blunt force trauma to the head chest and abdomen persistent hypotension after two liters of saline post is ready at 1 30. okay so that's important information so after giving him two liters of fluids to try and bump up his blood pressure it's still persistently low which means that he's in a dangerous spot ideally they want to give him more fluids more blood products if that fails you have to start him on pressers in order to keep his blood pressure up to give sufficient blood flow to the vital organs also they said his blood uh his pulse is 130 which means that it's fast tachycardic reason being is when the blood pressure is low the heart tries to compensate by beating faster in order to like fake increase the pressure can you hear me yes yes i can hear you loss of verbal skills possible bleeding in the brain peoples are equal and reactive good sign still should get a ct got a flail chest in the right i need a 36 french tube now uh so they said he has a flail chest that means he has significant rib fractures like complete fractures on one side maybe even a pneumothorax because what happens is when you have a complete disconnect of your chest like that your breathing happens paradoxically um on the side where you have your injury this is gonna hurt but we have to do it they're basically putting in a chest tube to drain it uh his chest of blood because he's bleeding internally which will allow his lungs and potentially his heart to expand uh when they are beating and filling up with either air or blood respectively you also sometimes if you have a pneumothorax a collapsed lung when you equalize the pressure you allow the lung to expand as well he fixed her leg he helped charlie and he put a lot of insides back and he saved us he saved you all of us he's a doctor he's a doctor so you should treat him differently than you would any other patient what we've got you it is all gonna be okay this isn't right [Music] you should have taken me to get a head ct any time you have blunt force trauma to the head with a serious accident again mechanism of injury semi truck hitting you at a fast rate of speed get cts we over order cts in emergency rooms for things that don't really matter yet when people have a really high-speed car accident people like should we get a head tt yes you need to figure out if there's bleeding internally because your management completely changes we have to work fast people i'm stable guys i'm stable take me to get the head ct the way you decide if stable is you look at their vitals if his blood pressure is not tanking you know that the patient is stable enough to go get a head ct and if there's bleeding in the brain you want to save the brain because without the brain there is no body uh he's got a great deal in the back meredith would leave it let's leave it check the four quadrants and she double check the retro hepatic space the retro hepatic space is a very commonly known one that you learn in uh your surgery rotations where you can lose a lot of blood and not even know it he's still hypotensive hylum is intact he's not bleeding in his chest this makes no sense we're missing something for t-e-e not that that's not what you're missing a tea is a trans-esophageal echocardiogram where essentially you put an ultrasound probe into the esophagus in order to better visualize the heart he had a headlock check his pupils who's right people's blown antisecoria can happen when you are having bleeding into the brain paige neurosurgery right freaking now the hell are you people screwed up now us you're on call for trauma what took you so long who the hell are you your response time was supposed to be 20 minutes wouldn't have made a difference you guys had ordered a head seat you would call me sooner you were supposed to be here in 20 minutes not an hour and a half we had a chance he had a freaking chance get out of my or what that type of blame game can happen in a hospital setting where there's big egos uh i mean obviously both are in the wrong does it matter who's more wrong no the only thing that should matter is the patient and trying to do the best that they could now it's too late the call to not get a head ct was a bad call we're not a trauma center or a teaching hub you did the best you could i mean ahead ct like if they made a mistake with some kind of protocol i get it because they're not a trauma center that makes sense but not getting a head ct is just incredible to me like that's the first thing you would do in a car accident of that nature remember the mechanism of injury there in fact there's like a canadian head ct protocol and one of the the points is the mechanism of injury and it's like if it's a high-speed accident boom you get the head ct like i still even remember that from med school i also don't quite understand how they were certain that he had abdominal bleeding over like how do they know he wasn't bleeding into his brain versus his abdomen like it seemed like they just guessed that because if you're doing anything you're pan scanning the patient you're scanning the head you're scanning the lungs i mean the chest and the abdomen you're doing it all at once mr shepherd there's some things you need to know some things we need to discuss difficult things i'm a doctor you've waited the requisite number of hours and now you can officially declare him dead so the icu needs a bed those must be the papers essentially the icu wants to clear the patient out if there's no improvements being made and while that is part of what goes into medical decision making obviously when it comes to triage but also it's in the patient's best interest to not be further tortured if there's no potential chance of recovery a stop all curative intervention discontinue all routine monitoring remove all the catheters drains and tubes and any and all treatments that might provide comfort to the patient terminate all life-sustaining measures well see that's not exactly true when we fill out a pulsed form we actually can put orders in that would put a patient on comfort care so we would put orders in to make sure the patient is comfortable giving them high sedation giving them pain control mucus control cough control hiccup control there's all sorts of things that we need to think about for a patient who's at the end of their lives and we do that with our comfort care order set when we choose to say that aggressively treating someone causes them more harm than actual benefit we're not saying discontinue everything we're discontinuing certain things that we feel like harm the patient and we continue certain things or begin things that we think would benefit the patient meaning that the goal is no longer to make the patient live longer but to make the patient as comfortable as possible oh no mcdreamy's gonna die one of the mistakes i've seen residents make is when they are putting a patient on comfort care and they're discontinuing the ventilator and all these things they forget to turn off the alarms because remember the alarms just notify you when a patient's crashing and it's very discomforting for a family to watch their loved one go peacefully but then the alarm's going off like crazy that the patient's dying so you got to turn those off as well [Music] and they didn't turn off the alarms [Music] mcdreamy one of the hardest conversations in medicine is the end-of-life conversation and this is supposed to happen not just with someone who's terminally ill someone who's just been in a car accident it's supposed to happen with your primary care doctor so you could have a plan because without a plan so many things can go wrong what's to happen what are their wishes who's going to be the power of attorney what do they want from their care medically speaking and an important aspect of that is understanding that there's never a surefire correct answer because patients a lot of times will ask of me as a doctor should i do this should i take them off life support do they have a chance to get better a lot of times you have to give the most accurate answer but it's not a 100 accurate answer a lot of folks are not comfortable with that but the unfortunate reality is that's life every decision cannot be a hundred percent and ultimately it's your choice that has to be decided upon based on the wishes of what the patient wanted here's the difference between real doctors and tv doctors click here to check that out great video i share some epic patient stories and as always stay happy and healthy unlike big dreamy [Music]

Dr.

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