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Legend [15926]
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Hamlin: Don’t expect any news sooner than tom
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Jan 3, 2023, 11:26 AM
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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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Heisman Winner [137390]
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Thanks Soywaker!***
Jan 3, 2023, 11:30 AM
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Legend [15926]
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Was thinking about you as I typed this friend
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Jan 3, 2023, 11:42 AM
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Happy New Year to you and yours
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All-Conference [445]
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Thank you!!***
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Jan 3, 2023, 11:39 AM
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CU Guru [1538]
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Re: Hamlin: Don’t expect any news sooner than tom
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Jan 3, 2023, 11:43 AM
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just to clarify, if what you are suggesting happened, it is likely he will have permanent brain damage?
And if so, does that potential grow the longer he is unresponsive while sedated?
thx
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Legend [15926]
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I’m suggesting that the longer he was pulseless, the higher
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Jan 3, 2023, 12:00 PM
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the likelihood he sustained brain damage and the worse it will be.
The brain is remarkable and we understand very little really, but what we do currently accept is that a brain without oxygen will result in irreversible brain damage
The longer he was unresponsive without a pulse = increased brain damage
The longer he’s unresponsive in the hospital with a pulse = does not change the damage done during his time pulseless but instead starts to illustrate the extent of the brain damage he suffered while not having a pulse
Ultimately, what he does matters more than the scans. We just use the scans to verify what we see clinically at bedside.
Make sense? If not, I’ll clarify more..
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CU Guru [1538]
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Re: I’m suggesting that the longer he was pulseless, the higher
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Jan 3, 2023, 12:35 PM
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yes it does. Thanks!
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CU Guru [1538]
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one other quick question involving cpr
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Jan 3, 2023, 12:42 PM
[ in reply to I’m suggesting that the longer he was pulseless, the higher ] |
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when performing CPR, I understand that oxygenated blood is still circulated through the body and to the brain, but how long is that affective when no new oxygen has been ingested?
I've heard stories of long duration CPR being performed and it has saved lives, but I don't understand how long that existing oxygen in the system (before arrest) can be used while performing cpr.
I know the lungs is where the O2 CO2 exchange occurs, but its interesting to understand how the brain would be able to use the existing O2 while not brining any new O2 in.
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Legend [15926]
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Good question
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Jan 3, 2023, 1:34 PM
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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.
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CU Guru [1538]
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Re: Good question
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Jan 3, 2023, 4:24 PM
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great explanation. Love learning new stuff like that.
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Associate AD [828]
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Re: I’m suggesting that the longer he was pulseless, the higher
Jan 3, 2023, 2:10 PM
[ in reply to I’m suggesting that the longer he was pulseless, the higher ] |
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Presumably educated take, there - thanks.
Obviously, this player was much healthier, but I have been fearing that the radio silence (as with Mike Leach) has been, if they weren't able to bring him back, they are trying to donate his organs.
Obviously, this is complete speculation and I only hope the young man can recover, but the above is what came to mind.
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Legend [15926]
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Whatever the local organ procurement group is has been contacted
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Jan 3, 2023, 3:03 PM
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Assuming he’s unresponsive
But
WAAAAAAAAY to early for organ donation and their involvement other than reviewing the case every 24-48h
You must allow time for homeostasis and normalize EVERYTHING. Easily days before that’s a thing.
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Legend [18359]
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Re: Hamlin: Don’t expect any news sooner than tom
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Jan 3, 2023, 12:01 PM
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Really hope he is ok that was terrifying to watch, also praying for Tee the things people were commenting on his IG last night was disgusting
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110%er [9015]
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Who is tom?***
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Jan 3, 2023, 12:01 PM
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All-In [27894]
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Re: Who is tom?***
Jan 3, 2023, 12:42 PM
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He started MySpace! Duh!
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CU Medallion [52879]
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Tom Morrow - my neighbor's third cousin's
Jan 3, 2023, 3:19 PM
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next door neighbor's uncle's friend.
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110%er [6113]
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always one on T net... lol. This is why I log on, as well
Jan 3, 2023, 1:59 PM
[ in reply to Who is tom?*** ] |
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as posts informative as soywaker. cheers
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Oculus Spirit [94363]
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Orange Blooded [4190]
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Re: Hamlin: Don’t expect any news sooner than tom
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Jan 3, 2023, 2:15 PM
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Thank you for the insight soy! Nice to know the process. Praying for his recovery.
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Legend [16891]
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Give education credit where due
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Jan 5, 2023, 11:59 AM
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Thanks, soywaker® for helping us understand and have a timeline to monitor reports. All's happened as if on cue...so thanks for the primer on how to watch his recovery unfold. May it continue. Keep the lessons coming (as necessary...and hopefully, very infrequently! )
Message was edited by: Salty55®
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Legend [15926]
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Great news!! Thrilled to read this in ESPN article
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Jan 5, 2023, 1:17 PM
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“The Bills released an update on Hamlin's status from his doctors Thursday morning, noting that he remains critically ill but appears to be neurologically intact“
Family saying that he’s squeezing hands is meh People read into what they how to see
MDs saying he’s neuro intact implies he is following more complex commands like “show two fingers on left hand” for example
For him to be there this morn after they lightened or turned off the sedation is EXCELLENT
Really happy for the young man and all of us It feels communal for all of us on a since
I expect he’ll make a pretty full functional recovery for life, not sure his playing days aren’t over
Cheers
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