way gonna get this thing started. We're gonna do this. Yeah. Yeah, we're gonna do it. You know why we're gonna do it? Because this this this this viscous Hey, ladies and gentlemen, boys and girls, it's time for another exciting. This one had a bit. I'm with my closest dearest friends. I'm here with Josh. Hi, George. Hello from the sister show shot. Bam!

Yeah, we don't have to do that. You can. I'm just I'm just get another shameless, shameless plug within company. Dave Mason. Hello And just Mason. Are you two in any way related? No.

No, we're just married. Yeah, that would be weird if we were really

Oh, in Australia. They do that. But not in America. America. If a man and a woman married an Australian, come in America. If they get divorced, they still brother and sister. Ask me that. That's a loaded question. Just Mason isn't here, Doc. I'm an e r Doc. Josh is a not produces sound designer. Dave is a producer to sound artist. Something's not qualified to be anywhere near a patient. Rhea World people and we'll be the doctors

will play the part of doctors. You play the part of not doctors

that this will be fun. That's easy. Just has a story for us that involves medicine.

Okay. Are you guys ready for this?

Yeah. What are we talking about today,

by the way? Well, I want to set this up with a story, so let's go back in your minds. I want you to picture that it is July of 18 81.

Josh, could you do some real time? Salazar todo taking anyone? They only have carriages. I did not do that.

Well, the things that they had in 18 81 they had the first street light ever on. And Billy the kid remember Billy the Kid? He's an outlaw. But you know what else happened? In 18 81 President James Garfield was in office and he had just gotten into the office of the presidency. He'd been there for about four months and President Garfield is going on vacation. He's going to the New Jersey Shore and he's getting ready to leave New Jersey, New Jersey. It's President Garfield. I don't

believe this story about a lot of stuff. My agree. Settle back, eh? It's Garfield.

It was 18 81 I think the New Jersey Shore was different than what did

they sound like in 18 81? It's a good question. Old timey radio jersey Shar are That's what they sounded like. Everything

was in C B radio back

there. It was all in. C e didn't have radio, but that's how they would sound.

There's no color gala. Okay, so that's where he's going. And he's getting ready to catch the train. He's standing on the platform of the train station and there's someone else who's lurking in the shadows on the platform of the train station. Steps out from the shadows. And who is it? It's a man named Charles Guiteau. Charles Guiteau was psychotic. He also thought that he was supposed to be the minister to France. And he was really, really angry at President Garfield for not making him the minister to France. And so because of this, he felt divine inspiration that he was supposed to kill the president.

Quick question. Yes, Did did they know each other and like he got turned down the position or was it totally delusional? He thought he should be the minister

of France. They may have met before this, but they did not know each other. So back then the White House was sort of like, you know, you could walk in and say I want to talk to the president and they would generally kind of like you do that in a minute, right? So he showed up to meet the president to basically apply for this job. I don't know what their interaction consisted of, but it's not like they were buddies, right? He just had this delusion fixed in his brain that he should have this job. And now he was pissed, and he shows up on the train station platform with a gun and he steps out from the shadows and he fires three shots at President Garfield. This strikes him in the arm twice and once in the back, and the bullet goes into his back right next to his spine. All of these bystanders on the train station platform,

they run to his aid. And this is this is rumor. I don't know how much fact there is here, but it's rumored that there were doctors who came to his aid on the platform, and immediately they start probing the wound you just start with what? Digging right in with their fingers,

their fingers. They spend all day like picking their noses and like working in the garden and they come in, they're

greasing their hair.

Oh, there's someone needs help. I thought they were white gloves back then, and canes and pop

hats, so they use their gross gloved finger. Either way, this is obviously not sanitary. So keep in mind, this is the 18 eighties. Things air a little different. There's no ers. There's no ambulances. There's no E r doctors. And there's this prevailing theory of my asthma. Have you heard of my as Yes, yes, it's me. Asthma. What happens when

you can't breathe? Now that's when you think they're the diseases carried through smell.

Yeah, that's right. So people didn't really believe in germ theory of disease, even though this was around at the time, like this concept came about in the 15 hundreds. But no one really embraced it yet, So people thought that disease was spread by foul odors in the air, and so no one really thought this was a problem. To basically stick your hand into someone's wound and tried to fish a bullet out, which, for some reason, they believed would magically cure him. So they're Waas someone named Joseph Lister. You've heard of blistering? Yes. Okay, So Joseph Lister,

he's a British surgeon, and he, like, really embraced this idea that there are these things called germs and germs or bad germs or what makes you sick. And so we need to sanitize things like our hands and our surgical

tools. Ways total black Steve like, Oh, there's Joseph Lister again. Guess what. Hey, Joe. Yes? We have a look at my hand. Got juice,

huh? Come on, guys. So, anyway, his theory hadn't caught on because a lot of Americans didn't believe him. American doctors apparently were very foolish, and they didn't believe in germs yet. So President Garfield has a personal doctor. They bring him to his personal doctor and get this. His doctor's name is Dr Dr Bliss.

You repeat yourself. It's Dr

Foster Bliss. First name, Dr Last name Bliss.

That's a lot of pressure. Way named your doctor.

I want to be an artist. No, that's not what we did it. Okay, so Garfield starts getting more sick later as the day is going on he starts showing signs of shock. Dr. Bliss doctor Dr Bliss starts to get worried about him, and you know he's manifesting these signs that today we very easily recognize a shock. Right? The heart rate goes up that we call a taxi cardia. He's breathing fast. Respiratory rate's going up, and today we just, you know, we'd say, Hey, that's shock. Maybe you're developing sepsis. We need to treat you. We need to give you antibiotics And you know, all sorts of things that we would do differently,

eh? So so when you when you say shock, that always sounds like it's Ah, it's a psychological thing, right? But but But what's the? Well, somebody showed him three times. He was pretty shocked, but But the whole idea about like, Oh, he's getting better. Oh, that's just you recognize that? A shock? What does that mean? Physiologically like Like what's going on in your body when physicians talk about shock,

they're talking about this state where you can't perfusion your body. Your blood is not getting enough out from the heart to perf use the body correctly so you can have shock from bleeding too much. So all the blood is on the ground. It's not in your body. You can't refuse and send oxygen and nutrients to your tissue. So you get sicker and sicker and sicker. You can get it from infection. Septic shock, will you? Cerveza de Leighton It's just not pumping effectively. It's not again circulating. So when we talk about shock, it's a state where you're not getting the blood to where it needs to go with all the nutrients that it needs. And if Shaq stays around for too long you're doing. But what's the So what's the bacteria do? Or the whatever the germs doing that's making it hard to get the blood all around like so does a whole bunch of things,

a cascade of things, so it makes your heart not be able to pump, probably because of all the toxins that they're out there. They make the blood vessels really dialect. So your blood pressure goes, Dan, that make your capital Aries leaky settle the fluid just sort of starts. Looking into the tissues becomes a very inefficient way to move blood around the body. It's a cascade of events, so it is basically they're eating stuff and then They're also excreting toxins, greeting toxins and sometimes themselves. Just the presence of the thing itself is produced some of these things. But in such a short amount of time, the biggest problem is all the blood everywhere, right? So that bullet might be dirty or that finger might be dirty.

But in this circumstance, in the first few minutes you're gonna die of hemorrhagic show. Right? Right. Okay. And days later, you might die of septic shock, finger shock. All the things get dirty. 30 finger shot. The show without X ray at this time, right? There's no X ray. There's no X ray back then. Not yet. It's being sort of developed right at this time.

Thomas Elderberry to Kari Curry. Very renting a gram curry. Those people, they haven't done it yet. So how's the retina, Graham? Yeah, Fucking what's his name? That's is known. All right, get in. Rankin, That can Franken, his chairman or Swiss. I don't remember.

Hello. My name is Vill Hem a munchkin And I was born in the German city of Lenin up in 18. 45 I died in the city of mention of a two car Munich 1920 sweet and six years later, 1929 the town of them. Seif took over the town of Len Epsom. How many looked me up on Wikipedia. It looks like I'm from the town of I'm shocked, but I'm not. I'm from the town of Lenin, for God's sakes.

So how do they find the bullet at this time? So back then, there was this guy called Alexander Graham Bell. Maybe you've heard of him. Who? Alexander Graham Bell. Hello? Unions things. Hello. That's the guy. So Alexander Graham Bell has invented this thing called the induction balance, which is like a metal detector. Which sort of you get in the middle and it goes Or some sound like that. And so they were using this on him. This guy called Dr Bliss, But Dr Bliss had this machine, this induction machine, and he was scanning where the bullet went in on the right side and he didn't work. They didn't find the bullet. There's two reasons in history that maybe the that he didn't find a book. One was a doctor blistered and scan the other side of his body because he was absolutely certain in your with a bullet Waas.

That's some serious arrogance. Poopsie

and two Garfield was on this bed, which had metal springs all over, so that probably produced a lot of internal it. Guys. Okay, so they didn't find the bullet we're looking for. Let's do it in this bathtub filled with water. So let's fast forward. So what's happening now is that every day that doctor coming in, they're sticking things into this word. They try to get out, and this goes on for a long time. What's amazing is Garfield lives for quite a long time, Mrs Day 67 this is back at the White House like they picked

him up. He's still at the White House,

not at the hospital at the White House, but, you know, at the White House, in the kitchen or somewhere like in the room. So on day 67 after so 67 days later, after he's been shot, they've decided that they need to move him to the New Jersey shore's because of the clean air. To get rid of the miasma right? That's before the hair spray. Day 80. This is September 19th 18 81. Let me describe what's happening to him now. His fever's a continuing. They're getting higher and higher. He's having hallucinations, his limbs a turning cold. His pulse is getting weak. What do you think this is Going? Death infection. And soon after he dies 80 days after the initial.

Yeah, he

lived a long time. Pretty good. So he's quite quite quite a trouper. He was in office for

only four months when he was shocked.

So he's actually? Well, no. So he's gonna be

president for, like, six months. Basically,

that was so Garfield live for 80 days after he got shot. So he didn't die of hemorrhagic shock. He didn't die because the bullet exploded his heart or Garfield actually died from a fallacy at the time. And the fallacy was, you must go and get that bullet out. And so he had all these people sticking their dirty fingers into this wound to get the bullet out because they didn't believe in the June theory of disease. And so he really died from the medical care at the time, which was Go get the bullet. And don't wash your hands

when you do. Oh, I think it's It's still a myth. that's perpetuated all the time and movies and TV, right? Like I just saw this in a movie like a big blockbuster movie where someone got shot and like they're in surgery and it's all intense in there. They're going in and looking for the bullet. And as soon as they like extracted and they pull it away from this spine like, yeah, the patient wakes up music. Fine. It's like, No, that's how

it is. Like the hero will die if you don't get out the bullet. Once the bullets out, they can continue on their journey and kick some more ass first aid kit. Get some tweezers. What are you going to do? It's not what I'm gonna do. It's what you're gonna d'oh. But that's a different Let's a different problem. But there's one problem of sticking dirty fingers in there, which I that that makes sense to me. But I don't understand why you don't get the bullet out right. Like I don't

understand why we don't do that.

Why would you get the bullet out now? Now? They confined it right. You have X rays and we don't get the bullet it.

Why do we owe ticket out. Okay, so right. These are good questions. Okay, So when do we actually take the bullet out? It's not very common that we're going to go fishing around and digging around for a bullet.

Okay, Most times you're gonna leave the bullet

in most the time the bullet stays in. There are a few times when you would take the bullet out, but these are exceptions and not the rule. So if you're like coming to the yard like I got shot in the arm and it, let's say it went in, You know, the front, your arm. And instead of coming out the back your arm, it's just like right under the skin. It's right there, and I touch it. I'm like, Oh, yeah, there's bullet right under your skin. I'll probably take that out like it's right there.

You make a tiny little cut. You could pop it out right? That's probably pretty easy. But other than that, you know, it really, really has to be a compelling reason like if the bullet is is a bullet in my But can you get it out? That's a compelling reason. Don't try that line with me. but I don't understand what? So does anybody get the bullet out?

Or is it just in the in the e. R. That's

really the only time I'm gonna take the bullet out. Otherwise, it's just really special circumstances, like if there's a bullet in a joint, then someone will operate like a surgeon will take them to the operating room and remove it. Or if there's a bullet in your eyeball, you know, like it's got to be in a place. Or maybe they're operating anyway because you're in hemorrhagic shock and they're going to try to control the bleeding. And while there they happen to be doing everything they're doing, they're like, Look, the bullet,

We should just take it out. Okay, so on this is crazy on this note, then in movies, and I think there's a general idea that if the bullet is in you, it's bad. But if it goes through you with an open wound in the back, that's better. Is that true? Like like the bullet goes out of you instead of staying in you? Uh, no, the doesn't. It depends where the bullet went. It goes into your head and get out quick has really fast, Really small. Exactly.

It depends where the bullet went. So you always see this of the booze like it totally depends where it went so it can stay in you and be a big problem. It could go through you and not be a big problem, and vice versa. I'm being a bullet through your head is bad. Yeah, regardless of the obvious places, a bullet goes and kills you, like goes in the shoulder. There's no exit wound. Got to get the bullet out or there is an exit wound. You're gonna live. So no, the criteria for getting the man itself is executive just said it depends like it's easy to get and it's right there. Or if it's next to a structure, because thes things move over time.

So if it's right near your spinal cord, then you might want to get that out because it might sort of migrate and do some problems later, but only under specific circumstances. So it's not like the movies, so so But okay, so there's there's a gene. What happens when you go to the e. R. And after that, like after you know, you you don't take the bullet out in the e r. And then what? I mean, do you just say, Well, I'll just

leave it in there. Yeah. You live with the bullet there? Yeah. You get your fuel. It's made out of lead. It's capes. Well, okay, so are you. What are you worried about? Lead poisoning?

Sure. That's

one thing. Yeah, well, it turns out that that is actually really rare. You know, he'd probably be shocked and horrified to know how many people in America are walking around with bullets in them. And very few of them actually end up getting lead poisoning. Some of them do. There's a There's a slight increase chance that those people are gonna have higher lead levels, but not by enough that it's gonna cause a toxic syndrome. Maybe there are case reports, but this is really rare. Lots of people are walking around full of

bullets. That's tens of thousands of people walking around with bullets in them. I just don't understand why you wouldn't get that out. Like what? So what is your body do with it? It's in there. And it's next year. Liver and just sitting there must create like a little cocoon around your body count good at five, bruising things off. So yeah, it does exactly what accounts seem. Little fibrous tissue, and it just sort of wolves It often it sits there. And the reason you don't go on get it is because it's not a zero sum game. Like, if you've got a bullet deep in you and you're a stable, then we know that it's just gonna wall itself off and to go and get it means we have to cut through a lot of healthy tissue to try and find it and dig around.

And the thought is that in most cases we would do more harm trying to take it out than just leaving it in there. We just go to the m r I machine turn on some things that can't do any home. So when a wound gets infected Okay, um, this bullet wound gets infected and you get this, like, puss and nasty stuff in it. What is puss? What is this white pudding

thing? Funny. You say that because get coca.

It's made mostly out of tapioca, a little chunky. Well, they put that on which they they get the puss and makes a little bit vanilla in it, and they put the little mochi balls in there, and then you mix it around. You get top

when residents train on like simulation mannequins. How to drain out abscesses. We really do use vanilla pudding. No, really, A

certain brands. Apparently Sara like,

smells a lot better than Real Puss, by the

way. So what is it? It's like from my understanding pusses. A collection of white blood cells? Yes, the carnage, isn't

it the carnage? Carnage?

Yeah, leftover remnants of the battle of the Battle that your immune system is fighting with the bad

guys, right? Yes, yes, it's dead cells of all sorts. It's dead immune cells. It's dead bacteria cells. That's mostly what it is. Yeah, the carnage, the carnage yourselves. Yeah, and when there's when there's like a big pocket of puss than that really needs to be incised and drained out like it's really hard for the body to kind of fix my

body's producing Puss. Why is it bad to be in my body? What's your buddies? He sees your body produces a hole that's going to have a question about that there's a guy who never pooped and he lived for No, I had a huge Colin. Yeah, I think we should talk about poop on another show because I have a lot of questions about that. But as far as Puss is concerned, how come the thing my body is producing? But it's It's more than the thing your body is producing. It's the byproduct of the fight, So your body is the good thing is the white cells that have come to fight the fight. But the byproduct of that when the body is being overwhelmed, is that there's a lot of dead white cells and a lot of dead bacteria love. It's a big battle. This is when the battle is huge and there's a lot of collection and it's got a drain. And somewhere so it gets.

This is actually a time when you would take the bullet. It let's say you got shot and then a week lady with the big swollen arm and its person just opens it in the past comes and coming up. That would be a time when you got probably should get that bullet out because that's acting as a knight us of infection. A night ISS and I D U s from the Latin nest is a breeding place where bacteria, parasites and other agents of a disease, lodge and development and often under those circumstances is that that is a response of the body trying to push it out. So, you know, if we had a number of patients that I looked after over the years like that had been shot, come back a week later, a daylight at one guy 20 years later with an infected a lump and i India and the puss comes out. And then Tink comes the world like,

good job body pushed it out. It took 20 years. But you did it. You did

it slow. Yeah, so they're crazy. I'll never forget. He got shot in the back, but he came in with a sort of an abscess on his front of his shoulder. And I said, Did was there a pimple or anything that, like Nana, like, Okay, we'll open this up and get to pass up. So I opened it up and sure enough the past comes out and then out falls a bullet and like, did you get shot here is like OMG. I got shot in the back on that side about 20 years ago. They left the bullet on Mike and migrated. Migrated some,

however, to the front of his shoulder. Or maybe it was always there, and it just got infect. Wow,

incredible journey. So do you guys want to know what would happen today? Let's say like, this is a scenario. Today, someone gets shot. What are the steps that happened? Protocol? Yes. Okay, so usually there'd be a flurry of 911 calls. And, um, the first people on scene are probably either gonna be There's some emergency responders, right? Maybe police, but the ambulance will show up with the like,

e, m t and paramedic, and they'll do an initial assessment right there in the field. They will try to control any bleeding, but really, the goal is to get them to an e. R as fast as possible, because that is what saves lives. Getting them to the resource is where we can do aton of stuff. That's what saves lives. So you show up at the e. R. And ah, what happens at that point is we do a rapid trauma assessment. So, you know, first we want to make sure that you are breathing and that you have a pulls.

Is this done outside before you've gone

into the yard? No. This is like you roll him in. We put a right onto our gurney in the trauma

bay. Is this the moment I would see you sitting on top of the person giving him, like, compressions,

like yelling and get that door open shot. I'm not having cardiac arrest. Get off me way. Generally don't do chest compressions.

And Hale says a broken sternum now and

penetrating trauma. So anyway, yeah, that come into the year, we do a rapid assessment. We basically trying to stop something from bleeding. So if you're, like, bleeding out of your arm, you know, let's turn to get your arm and try to stop the bleeding, and Ah, and then a bunch of diagnostic studies happened once we kind of stabilize you would give you blood if you need blood, right? And then we figure out whether or not you need surgery. That's sort of the really rapid summary of what happens.

So Okay, I got another question. When you get shot obviously. Well, not obviously. But like, do you? I mean, these days, bullets. They're different than the round balls. They were shooting back in the 1803 American Revolution. Yeah, but But like this clothing, ever get caught, like get pushed into the body with the with the bullet. And do you have to get that out?

Or do you just just say yeah, body of former cocoon on seeing 20? That is the bullet. Ever bring foreign Matter in with it? Yeah. Were you ever wearing flannel 10 years ago when I got shot back? So sometimes they both just fly right through that stuff, and I pick up a few little threads, but that's all. But the ones that get infected probably is exactly that. The bullet itself is probably reasonably clean and sterile. It this beads is flying through the air. It's pretty hot, Yeah, but it's when it picks up a little of your clothing or some other foreign material. It went through your you know,

your butt and then endure gets or something like that. So they're probably the ones that get evicted. Now we know what happens today. Let's go back and review what happened with Garfield, So he got shot. If that happens today, lots of people with cell phones would call 911 if you're there. David Europe. The scene. What would you do for Garfield? Has got a couple of holes in him. He's bleeding. What would you do? I would call 911 Okay, so you called 911 But you're standing right next to me. Is this something?

Today I would start like making a tourniquet and cutting off some blood somewhere Could have been a simple thought. For first of all, we've talked about this, but stopped bleeding by shoving a shirt into the whole first thing is seen safety. Oh, we don't talk about this before. If somebody's been shut like that, Is this the beginning of a gang warfare? Is there going to be lots more bullets? The police would really like you to not get involved in this custom. There's gonna be you as a victim. So you've gotta be very careful about diving in to save the person, right? So make sure that this scene is safe for you to go and help. And that's true with correct. Since it's true.

A lot of these things take your own pulse. You're you might have this impulse to go help but stop. Is there scenes safe? Can I go and help if you get there? The simplest thing you could do for somebody that's bleeding to death is not torture case everything, but just what up your T shirt or whatever, and just put a lot of pressure on there to stop the bleeding. How much pressure should you put on there and hod

until it stops bleeding?

Like if there's something that squirting ext. You press firmly until that stops

and you don't even want to check. Don't take your hand off of your shirt, your makeshift tourniquet off to check to see if it stopped bleeding. Just put constant firm pressure on whatever is bleeding. Don't check it. Don't stop until emergency personnel are there.

Okay, all bleeding's bad, but is the squirt bleeding worse than just kind off? Easy flowing, bleeding

or Yeah, but you're right. Both are bad, but if there's like a sport like projectile bleed, that's probably arterial. And if it's like a pooling slower bleed, that's Venus, you can you can still absolutely die from the pressure on both. Yes, but pressure on both. Yep. Same treatment as faras what we do in the field.

So let me recap. First of all, call 911 then make sure the scene is safe. If you believe the scene is safe, then you can go and help in pretty much. The only thing you can do as a lay person at the scene generally is to put pressure on wounds to reduce the amount of bleeding. The ambience will pick him up to a quick assessment, drive them to the hospital. No fingers, air going in that wound. He'll go to the operating room. He'll get some imaging and he'll do fine and live forever in vacation on the Jersey Shore and then pop that huge pimple on his shoulder outcomes that comes that bullet. That's crazy. Don't get involved and let the safe and pressure and call 911 Thank you. Good summary. Shar farm. Next just Mason,

Dave Mason and just Cause and I'm Mel Herbert. This won't hurt a bit. Is a production of Bulletproof Incorporated produced by C. C. Herbert Ville Connor. The information you here on this one hood a bit should not be taken as actual medical advice. If you have actual medical questions that actual medical things, you should see an actual medical practitioner even though we are actually doctors were not your actual doctor. So be sensible. Keep it real. And this this this this this this viscous Yeah.