Balancing on the tightrope of life and death, we delve into the ethical quandaries of critical care. Listen to Dr. Long's and Dr. Hill’s insights into the moral complexities medical professionals face, especially when personal beliefs intersect with broader ethical standards. Through a case involving severe brain damage to a 19-year-old woman in a car accident, we explore the intricate decisions around using ECMO for life support and organ preservation, emphasizing the profound importance of clear communication between medical teams and families. This segment is a deep dive into what it means to make life-or-death decisions in the face of uncertain outcomes.

Finally, be moved by the heartwarming story of a 28-year-old postpartum woman whose life was saved by an expertly coordinated medical team following a catastrophic heart event. Learn about the life-saving significance of teamwork in emergency medical procedures and the advanced care that turned a potential tragedy into a tale of survival and hope. Through these gripping narratives, we highlight the essential balance of medical innovation and ethical reflection, showcasing stories of resilience and the life-changing impact of modern trauma care.

To learn more about these life saving strategies and techniques, look for Dr. Long’s upcoming book, Flatline to Lifeline.

Follow us on Twitter @DrLongPodcast
Producer: Esther McDonald
Director & Technical Support: Lindsey Kealey, Host of The PAWsitive Choices Podcast

© Flatline to Lifeline 2024

In this episode we share a case study of a young woman who survived a devastating car crash, thanks to Dr. Long’s use of cardiopulmonary bypass . We explore the differences between various types of burns and the extreme impacts of chemical and electrical injuries. This episode covers it all, offering a deep dive into the severity of third-degree burns and the critical role of specialized surgeons in emergency trauma care. We discuss the evolution of medical practices like burr holes for brain pressure relief. It's an engaging exploration of how experience and expertise can make the difference between life and death.

Dr. Long shares invaluable insights on the importance of mentorship and interdisciplinary learning in medicine, embodied by mentors like Joe Utley and the never-quit spirit they inspire. As we wrap up, we highlight the remarkable advancements in medical equipment and strategies that redefine patient outcomes, setting the stage for Dr. Long’s upcoming book, "Flatline to Lifeline." Tune in to discover how today’s medical heroes are transforming the seemingly impossible into lifesaving reality.

Medical Clarifications:
Nitric Oxide was given into the pulmonary artery through the Swan-Ganz catheter. Nitrous Oxide (N2O) is known as laughing gas. Nitric oxide (NO) is also a gas. Therapeutically, it can be added to inhaled other gases like Oxygen by mask or a ventilator to dilate small arteries of the lungs and decrease pulmonary hypertension. An anesthetic machine can deliver multiple gases to a patient.

To learn more about these life saving strategies and techniques, look for Dr. Long’s upcoming book, Flatline to Lifeline.

Follow us on Twitter @DrLongPodcast
Producer: Esther McDonald
Director & Technical Support: Lindsey Kealey, Host of The PAWsitive Choices Podcast

© Flatline to Lifeline 2024

Prepare to be inspired by the innovations of Dr. Bill Long and Dr. John Hill, the "Cardiac Cowboys," who have revolutionized trauma care. You'll gain deep insights into their use of the portable cardiopulmonary bypass (CPB) machine, a game-changer in emergency medicine that has saved countless lives. Hear the gripping tale of a 34-year-old patient from rural Walla Walla, Washington, who survived a life-threatening shotgun blast thanks to this groundbreaking technology.

Learn about the challenges Dr. Long and Dr. Hill faced, the nationwide expansion of their innovations, and the remarkable case of the Walla Walla patient whose heart and lungs were severely damaged by a shotgun blast. This narrative underscores the power of swift medical response, teamwork, and the unwavering confidence needed to tackle seemingly insurmountable medical emergencies.

This episode also dives into the complex cardiac surgery and rehabilitation process, revealing the meticulous steps taken to manage severe trauma and infections. From the insertion of an intra-aortic balloon pump to innovative bypass cannula techniques, discover how the patient ultimately stabilized and returned to a functional life. We delve into the collaborative efforts between specialized trauma surgeons and rural hospitals, highlighting the profound human resilience and dedicated partnerships that make these life-saving advancements possible. Join us for an unforgettable journey of innovation, survival, and the relentless commitment to patient care.

You can view the medical image referred to in the episode here.

To learn more about these life saving strategies and techniques, look for Dr. Long’s upcoming book, Flatline to Lifeline.

Follow us on Twitter @DrLongPodcast
Producer: Esther McDonald
Director & Technical Support: Lindsey Kealey, Host of The PAWsitive Choices Podcast

© Flatline to Lifeline 2024

What if the key to saving lives in critical moments lies in the blend of mechanical precision and human compassion? Join us as we uncover the extraordinary journey of Dr. Bill Long and Dr. John Hill, two trailblazers in trauma care whose partnership began in the fast-paced world of Southern California.

Discover how the evolution of cardiopulmonary bypass technology has revolutionized cardiac surgery over the past 70 years, and how early experiences in trauma care paved the way for remarkable advancements. We explore the dynamic relationship between Bill and John, who began their residency together in San Diego and later transformed Portland's trauma system. Their narrative, filled with personal anecdotes and professional milestones, highlights the essential role of mentorship, teamwork, and family support in achieving medical excellence.

Witness the ingenuity behind the development of portable cardiac bypass systems and their life-saving applications in emergency situations. The episode culminates in a heartwarming encounter with a surviving patient, showcasing the ultimate reward of relentless dedication and innovation in trauma care. Don't miss this inspiring tale of two doctors whose commitment to their craft continues to push the boundaries of what's possible in medicine.

To learn more about these life saving strategies and techniques, look for Dr. Long’s upcoming book, Flatline to Lifeline.

Follow us on Twitter @DrLongPodcast
Producer: Esther McDonald
Director & Technical Support: Lindsey Kealey, Host of The PAWsitive Choices Podcast

© Flatline to Lifeline 2024

Join us on this enlightening episode of Flatline to Lifeline as Dr. Bill Long unpacks the complexities of fluid dynamics in medicine. We'll draw intriguing parallels between the cardiovascular system and electrical circuits, making sense of blood flow and pressure gradients. Understand how these fundamental principles are applied in surgical settings, particularly in the function of the intra-aortic balloon pump, and how naval physics concepts clarify these ideas. This segment will also equip you with a deeper understanding of how mathematical principles are applied to save lives in real-world medical scenarios.

Finally, we delve into the rich history of the cardiopulmonary bypass machine, from John Gibbon's pioneering work to the life-saving invention of heparin. We'll emphasize the importance of collaboration and communication among medical teams. Get ready to learn how these groundbreaking innovations are redefining the future of trauma care and ultimately saving lives.

Medical Clarification:
A note about survival rates from cardiac arrests in hospitals: 90% survival is possible in well organized medical centers with cardiologists on staff. 70% is more likely without those resources being immediately available

To learn more about these life saving strategies and techniques, look for Dr. Long’s upcoming book, Flatline to Lifeline.

Follow us on Twitter @DrLongPodcast
Producer: Esther McDonald
Director & Technical Support: Lindsey Kealey, Host of The PAWsitive Choices Podcast

© Flatline to Lifeline 2024

In a small Oregon coastal fishing port, a 60 y.o. male fell from a ladder on a pier trying to get into his boat. He fell 6 feet breaking his sternum, causing a cardiac arrest. The fall was witnessed by 3 men who hoisted him to the top of the pier, where EMTs awaited him. The man wasn’t breathing, had no pulses, and was unconscious.

Local EMTs did cardiac life support, including endotracheal intubation and defibrillating him multiple times for recurring ventricular fibrillation. They began CPR and transported the patient to the local hospital which was not a trauma center.

In the ER, the emergency physician (EP) tried using Advanced Cardiac Life Support (ACLS) drugs, providing the patient with a pulse and low blood pressure, but the patient kept fibrillating. The ECG tracing was compatible with an acute anterior lateral myocardial infarction.

The EP noticed the patient had a median sternotomy incision on his chest. A review of the hospital medical records revealed this patient had a single bypass vein graft to the left anterior descending coronary artery (LAD), aka the widowmaker). The EP assumed the fall may have damaged the vein graft causing it to clot, causing the patient’s current symptoms.

The patient was too unstable to transfer by either land or air ambulance. He called our trauma center, and asked if we could help him stabilize this patient. A cardiothoracic (CT) surgeon taking trauma call realized that this patient would need some mechanical cardiac support if the patient had a chance for survival.

The CT/trauma surgeon mobilized the MSTT and our perfusionist to help load the portable IntraAortic Balloon Pump (IABP), a mechanical device that helps to augment blood flow into the coronary arteries, into the BK 117 Critical Care helicopter to fly to this hospital. During this time, the patient required at least 4 more electrical defibrillations.

Upon arrival at the referring hospital, the MSTT team with the IABP went straight to the hospital’s emergency department where the team inserted the IABP long balloon catheter into the common femoral artery and advanced the balloon end of the cannula as far as the origin of descending thoracic aorta, and initiated balloon pumping.

The patient's vital signs (blood pressure and heart rhythm) improved and he developed a palpable peripheral pulse. We transferred the patient and the IABP to Emanuel where we took the patient directly to the Cardiac Catheterization Laboratory where an interventional cardiologist awaited us with his team. Coronary and vein graft angiograms revealed a clot midway down the length of the vein graft. He gave Streptokinase, an anticoagulant, via the vein graft to lyse the clot and restore circulation to the LAD. This was successful.

In our combined Trauma & Cardiac Surgical ICU he recovered over the next 5 days, after which we removed the IABP cannula. Meanwhile he regained consciousness and responded to simple commands, and was moving all 4 limbs to command.

We sent him home on oral anticoagulants. 3 months later, on follow up in our trauma clinic, his echocardiogram ejection fraction had returned to normal. According to his family, his mentation and activity had returned to normal.

Medical Clarifications:

This was the first time we used a mechanical cardiac support (IABP) to transport a patient successfully from any hospital.

The IABP doesn’t cure the causes of shock that cause heart failure; it buys the heart time to recover from the shock episode.

To learn more about these life saving strategies and techniques, look for Dr. Long’s upcoming book, Flatline to Lifeline.

Follow us on Twitter @DrLongPodcast
Producer: Esther McDonald
Director & Technical Support: Lindsey Kealey, Host of The PAWsitive Choices Podcast

© Flatline to Lifeline 2024

Case study of a 22 y.o. male driver of car, head on collision on an interstate highway, blunt chest trauma, rupture of pericardium with herniation of heart into left pleural cavity

The accident occurred not far from The Dalles, an Oregon town on the Columbia River about a 1 ½ hour drive from Portland. EMTs extricated him from the vehicle, “needled his left chest” to release a tension pneumothorax, and transported him to the nearest hospital, Mid Columbia Medical Center (MDMC), in The Dalles about 10 minutes away.

On patient arrival at the hospital, the surgeon on call inserted a left chest tube and re-expanded the patient’s left lung. The surgeon noticed the patient’s neck veins were distended, his facial skin was slightly cyanotic, and blood pressure was falling as the heart rate as rising: signs that the patient might have pericardial tamponade.

The surgeon did a left anterior thoracotomy to examine the pericardium for blood. Upon opening the left chest, he saw that the patient’s left and right ventricle had herniated through a 7 cm. long tear in the pericardium just anterior to the left phrenic nerve. The torn pericardial edges wrapped around the patient’s atrioventricular groove, essentially compressing the venous return to the patient’s right and left atrium, causing the symptoms mimicking a pericardial tamponade. The surgeon had never seen a pericardial rupture with biventricular herniation in his entire medical and surgical career. Multiple attempts to push the heart back into the pericardial sac only caused ventricular tachycardia. He realized that the patient was too unstable to transport to Emanuel and called for help from Emanuel.

We mobilized the MSTT and asked the trauma OR nurse to bring cardiac sutures and 12 inch long Allis tissue forceps. We arrived in the operating room at MCMC and scrubbed in. We used long Allis tissue forceps to grasp the edges of the pericardial tear anteriorly and posteriorly and pulled on the pericardial edges to create a “yawning” gap, allowing the beating heart to fall back into the pericardial sac; the patient’s blood pressure and heart rate stabilized. We sutured the tear in the pericardium and closed the patient’s left anterior thoracotomy. We asked the surgeon if he wanted to continue taking care of this patient, as the patient was now stable, but he declined.

We transported the patient to Emanuel, admitted him to our combined trauma and heart surgery ICU, and extubated him the following day. We discharged him from hospital a week later. We followed him in our trauma clinic for two visits, then referred him back to the surgeon in The Dalles.

Medical Clarification:

Blunt trauma pericardial rupture with herniation is extremely rare (estimated 0.4%). Most patients with this pathology die before arriving in the hospital.

Click here to view an image of an Intra-aortic Balloon Pump.

To learn more about these life saving strategies and techniques, look for Dr. Long’s upcoming book, Flatline to Lifeline.

Follow us on Twitter @DrLongPodcast
Producer: Esther McDonald
Director & Technical Support: Lindsey Kealey, Host of The PAWsitive Choices Podcast

© Flatline to Lifeline 2024

Penetrating Trauma (.22 rifle bullet at close range) with injury to left common iliac artery & vein with initial stabilization by emergency physician in a very rural hospital in Lakeview, Oregon

Josh, a 16 y.o. boy, was going to hunt squirrels with his .22 rifle. He drove his car to a ranch outside of Lakeview, Oregon, a small rural town where Lakeview District Hospital has a 24-bed capacity and provided emergency medical services with nurses and a family physician on call. On this particular hunting day, Josh parked his car at the gate of the road leading to a ranch house about ½ mile away. As he pulled the rifle barrel from the trunk of his car, the rifle discharged. The bullet entered the left lower quadrant of his abdomen, almost severing his left common iliac artery and vein. He collapsed at the scene. The rancher’s wife noted an empty car and went to investigate. She found Josh lying on the ground holding his abdomen and blood oozing between his fingers. She called 911 immediately.

The ambulance arrived on the scene about 15 minutes later, and the crew took Josh to the Lake District Hospital’s emergency room, where Dr. Bob Bomengen, an Emergency Physician was on call. Bob saw that Josh was in extremis from prolonged hemorrhagic shock, and he needed an operation to control the bleeding. Lake District Hospital had a limited blood bank, so Bob requested donors from the citizens of Lakeview to come and donate whole fresh blood to replace the blood that had been lost and to help correct the coagulopathy associated with prolonged shock. The townspeople responded and donated their blood which hospital emergency staff transfused into the patient and the patient stabilized.

Meanwhile, Bob asked for help by asking the hospital operator to call Ken Tuttle to come and assist in the damage assessment and to repair the bullet penetrated left iliac blood vessels. Ken Tuttle, MD, a general surgeon who trained at Stanford University Medical Center, was based in Klamath Falls, Oregon (96 miles away from Lakeview or a drive of 1 hour and 49 minutes). He also asked the operator to call Emanuel Hospital to come with vascular grafts and sutures to restore blood flow to the now ischemic left leg.

Jon Hill took the call at Emanuel. He activated the Mobile Surgical Transport Team (MSTT) and Life Flight to provide helicopter transport. Meanwhile, Ken Tuttle went from his home to Merle West Medical Center to get vascular instruments to take with him in his car. He called the Oregon State Police (OSP) to give him a police escort on the two-lane highway connecting Klamath Falls with Lakeview. By the time the OSP arrived at Merle West, Ken had started driving to Lakeview. He drove at “flank speed” hoping to arrive in time to save a life and a limb for Josh. Ken arrived at Lakeview District Hospital and went straight to the operating room to join Bob Bomengen.

The MSTT and Jon Hill arrived to help the situation. Jon assisted Ken in sewing the Gortex vascular graft to span the gap in the resected common iliac artery. These anastomoses did not leak. Peripheral arterial pulses were restored after intra-arterial clots were removed with embolectomy catheters. The patient came back in the ONG helicopter with Jon and the MSTT.

On arrival at the Emanuel helipad, the MSTT took Josh straight to the trauma OR where Jon performed lower leg fasciotomies for compartment syndrome, caused by the prolonged ischemia. The patient also began to get a return of muscle function and sensation in his leg. We transferred him to RIO for gradual mobilization of his leg and walking with assistance. Six months after this episode, he was back to normal activity. 16 years later, a phone call to the Lakeview District Hospital Clinic confirmed that Josh was living a normal life.

Follow us on Twitter @DrLongPodcast

© Flatline to Lifeline 2024