WEBVTT 00:00:07.880 --> 00:00:10.759 You're in the bay. Once you get over to the bed, 00:00:10.919 --> 00:00:13.560 we'll give you the story. Everything's going 00:00:13.560 --> 00:00:17.339 to happen super fast. Welcome to the emergency 00:00:17.339 --> 00:00:45.350 room. Okay, hey guys At the beginning of this 00:00:45.350 --> 00:00:48.409 podcast all the way close to like episode one 00:00:48.409 --> 00:00:54.929 maybe episode Whatever I came out and said whenever 00:00:54.929 --> 00:00:58.509 I have like weird cases that come into the ER 00:00:58.509 --> 00:01:02.770 that I'll be able to share them or would be willing 00:01:02.770 --> 00:01:07.030 to share them and This is one of those particular 00:01:07.030 --> 00:01:12.769 instances so It was my last shift at work the 00:01:12.769 --> 00:01:14.849 one that I just worked not like the last one 00:01:14.849 --> 00:01:18.010 as a terminal one but the last one as in like 00:01:18.010 --> 00:01:23.730 one before a few days off. I was running some 00:01:23.730 --> 00:01:28.049 labs to the lab and then when I get back I see 00:01:28.049 --> 00:01:33.769 one of the trauma residents like hauling ass 00:01:33.769 --> 00:01:36.790 from the trauma from the trauma side of the hospital. 00:01:37.820 --> 00:01:40.060 uh toward the medicine side and when he gets 00:01:40.060 --> 00:01:42.480 to the medicine side he makes like a hard left 00:01:42.480 --> 00:01:45.859 and Then I was like there right there seems like 00:01:45.859 --> 00:01:47.260 that's something that I would want to be part 00:01:47.260 --> 00:01:51.379 of So I like walk real fast too because you never 00:01:51.379 --> 00:01:54.500 run in the ER So if you are new nurse and you 00:01:54.500 --> 00:01:57.260 don't know anything Or you're wanting to get 00:01:57.260 --> 00:02:00.519 into the ER and you're new to it You never run 00:02:00.519 --> 00:02:05.540 in the ER like never don't ever ever ever run 00:02:06.060 --> 00:02:09.599 Is a cardinal sin and you just don't do it. So 00:02:09.599 --> 00:02:12.039 I walk real real fast, right? I'm walking real 00:02:12.039 --> 00:02:17.439 real fast and He goes into room 36 now room 36 00:02:17.439 --> 00:02:21.759 is one of our big rooms and it is one of our 00:02:21.759 --> 00:02:25.419 like real big critical rooms we have like Two 00:02:25.419 --> 00:02:29.560 real big critical rooms in our emergency department 00:02:29.560 --> 00:02:33.500 on the medicine side room 41 because as you're 00:02:33.500 --> 00:02:39.300 coming down The EMS hallway from where the ambulance 00:02:39.300 --> 00:02:42.780 bay is at it literally dead ends right into the 00:02:42.780 --> 00:02:45.219 room right into the room so they can really like 00:02:45.219 --> 00:02:48.139 someone could be on the Lucas device and literally 00:02:48.139 --> 00:02:51.500 just haul ass all the way to the room and be 00:02:51.500 --> 00:02:55.520 in a big room a big critical room without having 00:02:55.520 --> 00:02:59.520 to make a single turn and then room 36 literally 00:02:59.520 --> 00:03:03.099 sits right beside the CT scanner and that particular 00:03:03.099 --> 00:03:07.020 room. Also holds a bunch of stuff and so you 00:03:07.020 --> 00:03:10.819 can literally come out of CT You can have like 00:03:10.819 --> 00:03:13.979 a bad some bad news on your CT got a bleed you 00:03:13.979 --> 00:03:16.120 got something going on and so you literally just 00:03:16.120 --> 00:03:20.479 wheel right next door to the to their to the 00:03:20.479 --> 00:03:24.180 critical room and so we get into 36 and they're 00:03:24.180 --> 00:03:29.479 doing compressions on this dude and He is actively 00:03:29.479 --> 00:03:35.460 fighting The tech that is giving him compressions 00:03:35.460 --> 00:03:40.219 like his legs are kicking up in the in the air 00:03:40.219 --> 00:03:44.039 he's bringing his knees up trying to knee her 00:03:44.039 --> 00:03:49.259 and the attending the ER attending and he's actively 00:03:49.259 --> 00:03:55.360 fighting the resident that is trying to intubate 00:03:55.360 --> 00:03:58.780 and gain an airway along with the respiratory 00:03:58.780 --> 00:04:01.819 therapist now. I walk in and I'm like, yeah, 00:04:01.840 --> 00:04:03.960 what the hell is going on? You know, stop compressions 00:04:03.960 --> 00:04:06.740 homeboys like he's alive. He's awake. You know, 00:04:06.740 --> 00:04:08.280 you're doing compression on someone who's awake. 00:04:08.280 --> 00:04:11.500 That's going to hurt like hell. And so no sooner 00:04:11.500 --> 00:04:14.280 than I said that, they called for a pulse check. 00:04:14.960 --> 00:04:18.759 And so when they called for the pulse check homeboys 00:04:18.759 --> 00:04:21.060 stopped moving altogether. He quit breathing. 00:04:21.399 --> 00:04:25.259 He quit moving. He quit fighting. And then on 00:04:25.259 --> 00:04:30.110 the monitor was a systole. Or if you're from 00:04:30.110 --> 00:04:32.470 a weird part of the world that calls it a system, 00:04:32.870 --> 00:04:35.209 I don't know who you are, but it's kind of weird 00:04:35.209 --> 00:04:39.149 than a system, but I'm calling it a system. So 00:04:39.149 --> 00:04:41.610 the monitor read a system and I was like, what 00:04:41.610 --> 00:04:43.889 the hell, you know? And so they were doing their 00:04:43.889 --> 00:04:46.670 pulse check, you know, they were doing ultrasound 00:04:46.670 --> 00:04:50.610 for cardiac activity. So on the monitor was guess 00:04:50.610 --> 00:04:56.250 what? Cardiac standstill. And and so we resumed 00:04:56.250 --> 00:05:01.100 compressions. It was a witnessed arrest. So under 00:05:01.100 --> 00:05:06.259 any other under any other circumstances, he would 00:05:06.259 --> 00:05:09.439 have been a candidate for ECMO. If you don't 00:05:09.439 --> 00:05:11.939 know what ECMO is, it's a really, really neat 00:05:11.939 --> 00:05:15.339 thing where they have a machine that kind of 00:05:15.339 --> 00:05:18.399 breathes for you like literally almost like a 00:05:18.399 --> 00:05:20.459 dialysis machine, but it will pull the blood 00:05:20.459 --> 00:05:25.600 out, oxygenate it and give it right back to you 00:05:25.600 --> 00:05:29.129 without. you needing your lungs. And there's 00:05:29.129 --> 00:05:35.050 a hospital here in the Houston area that specializes 00:05:35.050 --> 00:05:39.149 in lung transplants or not just long organ transplants 00:05:39.149 --> 00:05:42.970 like a transplantation hospital. And they do 00:05:42.970 --> 00:05:46.610 ECMO all the time. And so like those people are 00:05:46.610 --> 00:05:49.610 very familiar with ECMO, but down in the dirty 00:05:49.610 --> 00:05:53.269 ER, you know, because these ECMO these ECMO people 00:05:53.269 --> 00:05:56.850 love to tell us how dirty the ER is. and we're 00:05:56.850 --> 00:06:02.230 like we know it's the ER and they do the ECMO 00:06:02.230 --> 00:06:06.230 anyways so he was under any other normal circumstances 00:06:06.230 --> 00:06:09.730 he would be considered a candidate for ECMO but 00:06:09.730 --> 00:06:16.069 he ingested some sort of toxic chemical to get 00:06:16.069 --> 00:06:20.209 high off of we don't know what it was or at least 00:06:20.209 --> 00:06:21.910 I don't know what it is because I never stayed 00:06:21.910 --> 00:06:23.649 around long enough to figure out what it was 00:06:23.649 --> 00:06:28.069 that he took But it was definitely chemical induced. 00:06:29.089 --> 00:06:31.629 And they said that they found some psychedelic 00:06:31.629 --> 00:06:33.870 gummies in his pocket. So he might have just 00:06:33.870 --> 00:06:38.290 taken an assload of those and put them in this 00:06:38.290 --> 00:06:43.970 wonky state now. Back to the story is after the 00:06:43.970 --> 00:06:47.910 pulse check was done. Another tech hopped on 00:06:47.910 --> 00:06:50.050 the chest and started doing chest compressions 00:06:50.050 --> 00:06:53.860 and homeboys started fighting her again. You 00:06:53.860 --> 00:06:56.319 know, he brought his legs up, trying to knee 00:06:56.319 --> 00:07:00.500 her, fighting the bag mask, trying to take his 00:07:00.500 --> 00:07:03.160 hands and rip her off his chest, you know, by 00:07:03.160 --> 00:07:05.879 stopping the compressions, everything of the 00:07:05.879 --> 00:07:08.000 matter. So I was like, this is like weird as 00:07:08.000 --> 00:07:11.680 hell, you know. And the pulse check came two 00:07:11.680 --> 00:07:15.480 minutes later and he actually had some cardiac 00:07:15.480 --> 00:07:19.319 activity on the monitor this time, but it was 00:07:19.319 --> 00:07:24.040 not a shockable rhythm. And so they called for 00:07:24.040 --> 00:07:27.639 a round of Epi and another round of CPR and then 00:07:27.639 --> 00:07:32.180 this time I got on the chest and As I am doing 00:07:32.180 --> 00:07:35.420 compressions on this dude, um, and I'm a pretty 00:07:35.420 --> 00:07:40.019 good sized fella Um as I've been told I like 00:07:40.019 --> 00:07:43.180 I know my way around the gym and I know a way 00:07:43.180 --> 00:07:46.160 my round I know my way around a buffet table 00:07:46.160 --> 00:07:49.180 and I like a chicken nugget or two, you know 00:07:49.180 --> 00:07:53.740 and so I'm doing chest compressions on this dude, 00:07:53.939 --> 00:07:59.319 and he sets up 90 degrees sets up. I don't know 00:07:59.319 --> 00:08:02.180 how I don't know what the fuck possessed him 00:08:02.180 --> 00:08:04.779 to sit all the way up. But homeboy was sitting 00:08:04.779 --> 00:08:07.779 all the way up. The respiratory therapist tried 00:08:07.779 --> 00:08:11.060 to grab him and yank him down. The intubation 00:08:11.060 --> 00:08:13.699 failed because every time we do compressions, 00:08:13.899 --> 00:08:16.459 homeboy wakes up. So I'm kind of like doing these 00:08:16.459 --> 00:08:19.540 kind of calf ass compressions. like you're trying 00:08:19.540 --> 00:08:24.660 to do compressions against a wall but you are 00:08:24.660 --> 00:08:27.839 not facing the wall you are kind of perpendicular 00:08:27.839 --> 00:08:32.919 to the wall and so as soon as he stood like as 00:08:32.919 --> 00:08:36.539 soon as he sat up as soon as he sat up and the 00:08:36.539 --> 00:08:39.960 profusion to him stopped he like passed out again 00:08:39.960 --> 00:08:44.480 on the bed you know we resume CPR again and he 00:08:44.480 --> 00:08:47.799 came back to life actively fighting, fighting 00:08:47.799 --> 00:08:51.039 me, fighting the emergency physician, fighting 00:08:51.039 --> 00:08:53.379 the respiratory therapist, moving his head left 00:08:53.379 --> 00:08:58.960 and right to not get bagged. And and it was just 00:08:58.960 --> 00:09:03.759 a weird ass situation. And so I say during the 00:09:03.759 --> 00:09:06.600 CPR, I'm like, this is the weirdest fucking code 00:09:06.600 --> 00:09:11.919 I've ever been in. And sure as shit, like the 00:09:12.900 --> 00:09:16.580 the emergency physician called for a pulse check, 00:09:17.080 --> 00:09:19.299 or it was actually time for a pulse check, not 00:09:19.299 --> 00:09:22.279 the physician calling for it, but the it was 00:09:22.279 --> 00:09:25.960 time for a pulse check. And so the ER physician 00:09:25.960 --> 00:09:29.039 literally with his hand on the femoral without 00:09:29.039 --> 00:09:33.200 a active pulse, and no activity on the cardiac 00:09:33.200 --> 00:09:38.259 monitor said, as we all are aware, this is a 00:09:38.259 --> 00:09:42.840 very interesting case. And I don't know if he 00:09:42.840 --> 00:09:45.879 was being facetious about my comment about this 00:09:45.879 --> 00:09:47.620 being the weirdest fucking code I've ever been 00:09:47.620 --> 00:09:53.620 in or what, but that's what he said. And so a 00:09:53.620 --> 00:09:57.519 long story short, man, the guy did not make it, 00:09:57.519 --> 00:10:02.159 but we were able to knock them down with some 00:10:02.159 --> 00:10:05.279 ketamine and rock. They were going to go with 00:10:05.279 --> 00:10:08.299 a tommy date, but they changed it to ketamine. 00:10:09.439 --> 00:10:13.200 And so we hit him with a hundred megs or his 00:10:13.200 --> 00:10:17.120 ketamine Mike's or Meg's I think his mix I think 00:10:17.120 --> 00:10:19.740 his big so either way we hit him with a hundred 00:10:19.740 --> 00:10:22.139 of some it was either Mike's Academy and our 00:10:22.139 --> 00:10:24.960 Meg's Academy And we hit him with a hundred of 00:10:24.960 --> 00:10:28.820 it And then we hit him with the with the rock 00:10:28.820 --> 00:10:31.940 and then we were able to intubate him but I will 00:10:31.940 --> 00:10:35.779 say man like After we gave him the ketamine and 00:10:35.779 --> 00:10:41.879 after we gave him the rock Usually well like 00:10:41.879 --> 00:10:45.759 when I'm in trauma, you know, and we give a tomodate 00:10:45.759 --> 00:10:50.059 and ketamine But a tomodate and rock usually 00:10:50.059 --> 00:10:52.379 like that knocks and knocks them down pretty 00:10:52.379 --> 00:10:55.679 good pretty fast, right? and they don't move 00:10:55.679 --> 00:10:58.279 or whatever but this particular instance we hit 00:10:58.279 --> 00:11:01.820 him with a hundred of ketamine and then the rock 00:11:01.820 --> 00:11:04.379 I think it was like a Don't let me get you wrong 00:11:04.379 --> 00:11:07.179 on the rock. I think it was like 100 maybe a 00:11:07.179 --> 00:11:09.289 hundred and a hundred. I'm not sure But we hit 00:11:09.289 --> 00:11:14.710 him with the with the rock and. And he was it 00:11:14.710 --> 00:11:16.549 took him a while, so it took him about a good 00:11:16.549 --> 00:11:19.750 30 seconds for the drugs to take hold and kind 00:11:19.750 --> 00:11:23.909 of pull him down. And then we started working 00:11:23.909 --> 00:11:26.149 on them and then we weren't like we didn't have 00:11:26.149 --> 00:11:31.889 an issue with him fighting us then. But he. He 00:11:31.889 --> 00:11:36.779 he didn't make it and. Yeah, man, like I was 00:11:36.779 --> 00:11:40.460 just one of the weirdest cases that I think I've 00:11:40.460 --> 00:11:43.820 ever been a part of, especially like kind of 00:11:43.820 --> 00:11:46.860 like during a code. And for you guys that are 00:11:46.860 --> 00:11:48.740 interested in knowing what this shit is called, 00:11:48.820 --> 00:11:51.299 because it is legitimately a thing, apparently, 00:11:52.019 --> 00:11:56.259 it is called cardio pulmonary resuscitation induced 00:11:56.259 --> 00:12:01.279 consciousness, or CPR, I see, see prick, right? 00:12:02.970 --> 00:12:06.690 So it is a legitimate thing. I did not know it 00:12:06.690 --> 00:12:10.950 was a thing But apparently it only happens less 00:12:10.950 --> 00:12:16.370 than 1 % of the time So out of a thousand cases 00:12:16.370 --> 00:12:19.830 that you or a thousand CPRs that you're a part 00:12:19.830 --> 00:12:28.330 of only one Maybe not even one you will see So 00:12:28.330 --> 00:12:31.330 just put that in kind of perspective on how rare 00:12:31.330 --> 00:12:35.039 this is It was definitely something new to me. 00:12:35.200 --> 00:12:38.340 He was a young guy too. He was like in his 30s, 00:12:38.340 --> 00:12:42.220 40s. So whatever he ingested, he ingested enough 00:12:42.220 --> 00:12:45.399 to kill him because we weren't able to get an 00:12:45.399 --> 00:12:48.220 organized rhythm back. We were able to deliver 00:12:48.220 --> 00:12:51.840 one shock and that was all we were able to get. 00:12:52.299 --> 00:12:56.279 There were no other rhythms for that. The follow 00:12:56.279 --> 00:12:58.620 up with the ECMO stuff. He was not a candidate 00:12:58.620 --> 00:13:03.830 for ECMO because of the the toxication that he 00:13:03.830 --> 00:13:10.190 was under or the ingestion of that toxic substance. 00:13:10.789 --> 00:13:16.629 So he wasn't a candidate for ECMO. And the cardiologist 00:13:16.629 --> 00:13:23.230 didn't have anything else to add. The ER team 00:13:23.230 --> 00:13:26.490 didn't have anything else to add. The only thing 00:13:26.490 --> 00:13:28.909 that I was going to suggest if we were to get 00:13:28.909 --> 00:13:32.370 another cardiac rhythm that was shockable was 00:13:32.370 --> 00:13:37.190 DSS or double shock sequencing. If you're not 00:13:37.190 --> 00:13:40.950 familiar with what that is, I'm not sure how 00:13:40.950 --> 00:13:45.509 prevalent it is, but apparently it yields about 00:13:45.509 --> 00:13:50.870 32 % greater results, greater outcomes than just 00:13:50.870 --> 00:13:55.450 a single shock sequence. And there's no there's 00:13:55.450 --> 00:14:00.190 no benefit for a triple shock sequence so my 00:14:00.190 --> 00:14:03.029 understanding of DSS or double shock sequencing 00:14:03.029 --> 00:14:08.230 is that you will have two defibrillators at the 00:14:08.230 --> 00:14:11.830 bedside and you charge them up to the same the 00:14:11.830 --> 00:14:15.370 same voltage right so for our case it was like 00:14:15.370 --> 00:14:19.789 two sixty two something we'll just say 360 because 00:14:19.789 --> 00:14:22.549 that's a good even high number so we charge them 00:14:22.549 --> 00:14:29.929 up to 360. And and what you would do is you have 00:14:29.929 --> 00:14:33.049 two pads, you have the pads placed, you know, 00:14:33.049 --> 00:14:35.490 at the same spot, just kind of beside each other. 00:14:35.909 --> 00:14:39.710 And then you will deliver a shock, one shock, 00:14:39.750 --> 00:14:42.529 and then immediately after you hit the button 00:14:42.529 --> 00:14:44.990 on one defibrillator, you hit the button on the 00:14:44.990 --> 00:14:48.370 other defibrillator. And so it delivers like 00:14:48.370 --> 00:14:52.639 almost two simultaneous shocks. that are really 00:14:52.639 --> 00:14:55.600 close together. And apparently, according to 00:14:55.600 --> 00:14:59.139 the AHA, the double shock sequence will yield 00:14:59.139 --> 00:15:03.559 you a 32 % greater chance of good outcomes or 00:15:03.559 --> 00:15:07.860 better outcomes. Now, how prevalent that is, 00:15:07.860 --> 00:15:11.720 I don't know. But that right there is something 00:15:11.720 --> 00:15:14.440 to kind of keep in your back pocket. You have 00:15:14.440 --> 00:15:19.340 this new idea of double shock sequence or double 00:15:19.340 --> 00:15:23.179 shock sequencing. Now, Surprisingly, I did not 00:15:23.179 --> 00:15:28.200 learn about DSS or double shock sequencing in 00:15:28.200 --> 00:15:33.940 nursing school or in TNCC or ACLS or PALS or 00:15:33.940 --> 00:15:38.220 any other formal formal education. I actually 00:15:38.220 --> 00:15:40.700 learned it from you guys heard me talk about 00:15:40.700 --> 00:15:43.580 this company before this compendium company. 00:15:44.279 --> 00:15:49.259 It is a company out of Germany and they make 00:15:49.259 --> 00:15:53.110 pocket guides. That are a legitimate pocket size 00:15:53.110 --> 00:15:55.809 they're not like a pocket drug guide that is 00:15:55.809 --> 00:15:58.509 a thousand pages thick but it just happens to 00:15:58.509 --> 00:16:02.950 be you know, like a four by eight size No, they're 00:16:02.950 --> 00:16:05.950 like legitimate pocket size. They're about four 00:16:05.950 --> 00:16:10.590 four by eight Four by eight and they have like 00:16:10.590 --> 00:16:13.350 two three hundred pages in them or maybe even 00:16:13.350 --> 00:16:15.549 just a hundred pages Like I have the OB one rub 00:16:15.549 --> 00:16:18.809 beside me right now And it's one of the thicker 00:16:18.809 --> 00:16:22.549 ones that they've come out with, and it has 350 00:16:22.549 --> 00:16:26.570 pages. And it's about like an inch and a half 00:16:26.570 --> 00:16:31.389 thick. So it's a very, very compact size. But 00:16:31.389 --> 00:16:33.450 yeah, this company, Compendium, I was reading 00:16:33.450 --> 00:16:37.029 through the cardiology Compendium pocket guide, 00:16:37.049 --> 00:16:41.610 and I ran across DSS, the double shock sequencing. 00:16:42.309 --> 00:16:45.049 And I thought that shit was weird. I was like, 00:16:45.049 --> 00:16:48.399 I never heard of such. So I got on the Google 00:16:48.399 --> 00:16:51.820 like everyone else does. And I did a Google search 00:16:51.820 --> 00:16:55.639 on the interwebs and I found out that a that 00:16:55.639 --> 00:16:58.340 double shock sequencing is a legitimate thing. 00:16:58.620 --> 00:17:03.860 And B, it is highly effective. Now, some other 00:17:03.860 --> 00:17:07.599 weird shit that they have in the companion guide 00:17:07.599 --> 00:17:12.859 is like five percent saline. Like if you thought 00:17:12.859 --> 00:17:18.500 three percent was a lot. There's five in ten 00:17:18.500 --> 00:17:22.019 now. What the hell are you ever going to do with 00:17:22.019 --> 00:17:26.359 ten percent saline? I have no fucking idea or 00:17:26.359 --> 00:17:29.440 even five percent, you know because we hardly 00:17:29.440 --> 00:17:33.599 ever use three percent You know, we're closer 00:17:33.599 --> 00:17:36.619 to using man at all than using three percent 00:17:36.619 --> 00:17:40.839 saline And I'm just assuming because of the rapid 00:17:40.839 --> 00:17:42.940 fluid shifts that you're gonna get with that 00:17:42.940 --> 00:17:45.180 because like that right there is ridiculous But 00:17:45.180 --> 00:17:47.980 can you imagine like five percent or ten percent? 00:17:48.259 --> 00:17:51.680 I guess going to be like pushing like Coconut 00:17:51.680 --> 00:17:54.880 oil to the IV like it has to be like thick thick 00:17:54.880 --> 00:18:00.279 thick But either way ma 'am That right there 00:18:00.279 --> 00:18:03.579 is just like the weirdest like the weird case 00:18:03.579 --> 00:18:08.359 of that I have as of recent Not all of my stories 00:18:08.359 --> 00:18:11.400 are trauma. I do work in medicine actually quite 00:18:11.400 --> 00:18:17.559 a bit more so than I do in trauma, but but I 00:18:17.559 --> 00:18:21.079 do like to share the weird stories that I get. 00:18:22.799 --> 00:18:26.799 I do see a lot because I'm at the busiest level 00:18:26.799 --> 00:18:30.200 one trauma center in the United States, according 00:18:30.200 --> 00:18:35.660 to Google. And we are like a 1300 bed hospital. 00:18:36.109 --> 00:18:40.150 And the ER might like the ER work and can easily 00:18:40.150 --> 00:18:48.710 hold Easily like 160 patients, you know 60 There's 00:18:48.710 --> 00:18:52.609 like 60 beds and then you have a hallway For 00:18:52.609 --> 00:18:55.190 each that brings you up to 120 and then some 00:18:55.190 --> 00:18:58.529 of those Some of those hallways can be extended 00:18:58.529 --> 00:19:04.109 out two three fourfold So easily like 160 patients 00:19:04.109 --> 00:19:11.589 and the ER alone Um, and then, um, you know, 00:19:11.769 --> 00:19:13.990 it just opens a door for some weird shit to kind 00:19:13.990 --> 00:19:17.190 of come in the door. And so that right there 00:19:17.190 --> 00:19:19.730 was like the weirdest case that I have as a recent, 00:19:19.730 --> 00:19:23.589 uh, this, uh, CPR induced consciousness or C 00:19:23.589 --> 00:19:30.049 prick. Um, so it's a thing. Um, don't stop your 00:19:30.049 --> 00:19:33.210 compressions for some boy down and keep the per 00:19:33.210 --> 00:19:38.440 compressions going. because yeah he's not like 00:19:38.440 --> 00:19:41.559 he might look awake he might seem awake but he 00:19:41.559 --> 00:19:45.660 is not awake so keep doing your thing alright 00:19:45.660 --> 00:19:47.480 guys that right there is the weirdest that was 00:19:47.480 --> 00:19:49.839 like the weirdest case that I have as of recent 00:19:49.839 --> 00:19:53.480 keep on listening to the learning material and 00:19:53.480 --> 00:19:56.400 as weird shit keeps as weird shit keeps popping 00:19:56.400 --> 00:20:00.019 up at the ER I'll be letting you guys know alright 00:20:00.019 --> 00:20:00.680 peace out