Medical Critique: CBS Drama Hostages 1/2

As you know, I'm critically watching some of the new Fall TV shows for medical accuracy. I've already posted about the CBS drama Hostages. You can find that here.

This week, I'm going to knock it down but then offer it a helping hand back up. Episode 5 is going to be the brief knock down.

If you haven't watched all the episodes you have been thusly warned that there will be spoilers in this post.

If you're not familiar with the show, the President needs an operation and his surgeon, played by Toni Collette, and her family have been taken hostage to force her hand to assassinate him or her family will be killed.

In episode five, the family plots to escape. They end up getting split up. The husband at home. The children on a bus to Canada and Ellen (Toni's character) almost getting on the bus until she sees video of her husband being shot in the gut.

And, of course, even though he's a cheating slime ball she goes home to save his life.

Issue One: One of the ways a person who has been shot and is bleeding dies is of exsanguination-- meaning all their blood leaks out. The reason significant blood loss kills you is that your body is no longer delivering oxygen and you go into shock/circulatory collapse. What you really need is BLOOD to save your life. Without it-- nothing the medical team can do will pull you out from the drain you're swiftly traveling down. When our trusty surgeon arrives home she finds her husband unconscious and not breathing . . . no pulse.

She starts CPR-- yea!! Then asks Mr. Hostage taker to get her medical bag from which she happens to have a hospital grade defebrillator.

Issue Two: There are only a few shockable rhythms. I've blogged about the use of electricity here. A likely rhythm for the patient to be in strictly from blood loss is what we call PEA or pulseless electrical activity. There is actually two parts of good heart activity. The electrical component and mechanical component. You need both working appropriately to propel your blood forward and keep you alive. You can actually have normal electrical activity and yet the heart is not mechanically beating-- thus the term pulseless electrical activity.

In the case of this character's husband-- his heart likely has normal electrical activity but since he's lost so much blood-- it doesn't have blood filling the chambers and so doesn't have anything to pump out. Hence the lack of a pulse.

I'm guessing this husband's injuries would lead to this set-up. Normal electrical activity with no pulse. So he doesn't need electricity. He needs BLOOD.

Issue Three: I don't know any physician anywhere that has a hospital grade defibrillator for their private use. Or would know how to work it . . . quickly. Now, this isn't a backhanded slap to my physician co-workers. They know how to do their job very well. This just isn't necessarily in their skill set. Nurses usually set-up the defribillator. The physician orders the desired amount of electricity.

I've taught advanced resusitation courses for two decades and I can tell you, across the board, every type of physician struggles to get it programmed. These classes are not a requirement for EVERY physician to take either.

So-- wrong treatment with too much ease of use.

What would have been more believable would have been for her to have an AED (automatic external defibrillator) in the home. These are designed for lay people to use and some people do actually have them for home use. They basically diagnose the shockable rhythms and provide electricity if indicated. It's what many first responders are carrying to even high school settings. They are very user friendly.

Check out my post on Thursday where I'll continue my discussion of this particular episode.