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, what

are we talking about today? Yeah. What are we talking

about? Well, I think we should talk about a few ways that you, Dave, or anyone could save a person's life because I think

we wait, like in public. Yeah. Not

at your work. I'm not talking about, like, the guy who, you know, dove into the subway and covered the man who had passed out. Like, that's

what you talking about? Diving

for somebody. You know this story? No. Oh, my God. This is amazing. So there was a man waiting for the subway. He was staying there with his daughter and he saw another man have a seizure and fall down into the subway tracks. And without really even thinking about it, and he knew there was a train coming. He jumps down into the track and he tries to pull the other guy off to the side, and he starts to realize I'm not gonna make it like I can't make it. And so instead of trying to pull him off the track. He flattens the guy out and lays on top of him, and the train barely passes over both of them and the guy survives. And when the train leaves, he pulls the guy out, the guy wakes up and it's just this amazing hero story. Do you please

thoughts like, um, I'm sure I'd be so brave on the circumstances like that. I don't have those things. I have the thoughts like, I'm gonna embarrass my family and myself in shame because I'm not going to do that because I'm afraid my first thought is when I see something really horrible happened, I say, I really hope there's someone super brave in this.

Well, okay, we're not talking about these really amazing acts of bravery. We're talking about things that are that are kind of simple, that if you see someone who is in a lot of distress, that you could intervene on and potentially save a life, and there's not really there's not that many of them, you know, these are kind of rare opportunities, and if you know what to do in that moment, you could really save a life

like somebody's walking into Starbucks and you go stop right now. The coffee. He really isn't that good. There's been a little social programming here. You don't want to go in there. Is that what we took? Hero Hero?

That's well, I think we should start off with a story. And this is a story that comes from one of my coworkers, Dr Rene Ramirez, who works with me at UCSF Fresno, And he told me this story about his son Andrew, and Andrew's classmate, Mikayla. So they came over, and I interviewed them about what happened in their second grade class

party. This is absolutely adorable. So I was picking up the kids from school and it would. Sam used kindergarten, and she was kind of screaming while Andrew was talking because they both talk over each other, as is common. And Andrew's like, I have something to tell you. Dad and Sami saw Andrews a hero, Andrews hero, and usually when I picked them up, I always ask him. So how was your day? Would you guys do Who would you play with what you learn? So they're always ready to tell me what they did right? And Andrew's like I have something exciting to tell you today. And then he's like So my cost mate,

Micaela she was choking. And I did the Heimlich maneuver. And I was like, What? And Sami still yelling in the background? Andrews, a hero, Andrews, a hero. And I said, Well, hold on, hold on. What exactly

happened? I was eating a gummy men that my desk partner made me laugh so hard I try to swallow it. And then I was choking. And then Oh, and you came over and he gave me the Heimlich maneuver. So what did you see, Andrew? I saw Makayla choking on a gummy bear. She was pointing at her throat, and I knew something was wrong, and I quickly gave her the Heimlich maneuver. What's the Heimlich maneuver? You could ask my dad. Okay. All right. Dr. Ramirez, what's the Heimlich maneuver?

What is that like when you were an dry? How'd you explain it to

me? Remember? Okay, so you grab them by the belly button in, then you pull back and you're behind them, and they should spit it out. Did something come out of her mouth when you did the Heimlich maneuver? on me. There a gummy bear again. The gummy being read. No, it was Ah, didn't either. It was a white or yellow orange. A red Gummi there. So how did you know she was choking? What does that look like?

She was grabbing her neck, pointing at it, and she was about to turn pink. Well, I didn't turn P. Yeah, but you were built. Was that scary? Michaela? No. Wasn't really know. What were you thinking when that happened? I was just thinking maybe he'll save my life. Okay, Come over here and help me. So you saw Andrew And you thought that Andrew would do something to help? Yeah.

I was in such disbelief. I made him explain to me what the Heimlich maneuver was in the back of my mind. I was thinking, Oh, my gosh. Did this really happen? Is this little girl Okay, so I texted me, Kayla's mom, and ask her if she if she was okay. Number one And number two, Is it Was this true? Did it happen that way?

Andrew, where did you learn how to do the Heimlich maneuver? My dad taught me a year ago because I must scout and I. I was reading this comic about scouts in action, and I asked him how Dad, how can I say someone from choking? And he said, You can do the Heimlich maneuver and I asked him, What is it? And then he taught me how to practice.

I was just talking to the kids the other night. You know, they watch VeggieTales. Everyone's thrown on VeggieTales. There's an episode saying, What does it say, Guys, a little wet

flute? Hey, guys can do big things. I mean, little bits can do big things

to little guys can do big things, too. So that's a theme that we kind of told them kind of over the years, a song to it. There's a song todo

I'm big and you're little something Something done on on on on on.

And then it says little people can do big things too. So one of things I was talking to him about was, If you guys ever see an emergency, what's the first thing you guys were supposed to?

D'oh! You ask someone to call 911 and then while they're calling 911 if they're choking of them, the Heimlich maneuver. But if they're passing out, give him, um, see, Pierre. Also, if there's an emergency, she has stopped dropping full, uh, is a fire, that is Makayla. There you go. So you were doing a Valentine's theme party when all this happened. And you know,

Andrew, I would say that's a pretty heroic thing that you did. And so everyone that I've told this story always wants to know the answer to this question. Which is Does this mean that one day the two of you will get married? Oh, no, no. That's the appropriate reaction for a second grader. They didn't like that question.

I got

embarrassed. They were like these other side of the room.

That means he likes, sir. That's boy translation

right there. It's such an amazing story and so heroic and so sweet and charming. And then it got me thinking, Well, this is a fairly simple thing, and we should talk about this and other things that you could do that could maybe save someone's life, a simple intervention that you could possibly save someone's life.

So what is the Heimlich maneuver?

Well, I think Andrew explained it quite adorably. Well. The idea is if you're choking on something, whether it's a piece of food or foreign bodies, something's blocking your airway and you're unable to get it out. And so the idea is that someone puts their hands, you know, right below your rib cage. Right? Villiers, I foot process. Sorry. Is that the solar plexus? Yes. And then it's like a forceful squeezed like

a come from behind. Kind of came up in that solar plexus. Yes,

and it's a forceful emotion,

inward and like like you're going to stab a knife into you like your fist is rotated into you so you can get some, uh,

exactly. So it's a sudden increase in the in the pressure, and hopefully it kind of expels the foreign body out from

your airway, so this increases the pressure in your lungs. So if they foreign bodies in your lungs and potentially unpopulated lungs, it also increases the pressure within your potentially in your Suffolk us and your stomach. So if it's stuck there, maybe it can help it pop it, so do it fulfilling.

So try it. You're probably not gonna hurt them, although it's

how much force can you break something

cause Sure

you can. The CPR episode we talked about like you might be breaking ribs. Um, how how much force am I supposed to apply to the to the abdomen, I think. And I break anything. Absolutely so affirm amount. And that's probably why you do it a few times. You you do a little tug glow rehearsal. Maybe that's enough. The puppet and then you they're still doing a little harder. They're still doing a little hard, but you can absolutely hurt people. And so there is reports, just sort of gastric. So your stomach exploding? Yes, a rupture

gastric rupture. But that's really rare. I mean, the odds of that happening, I would I would definitely think here that the benefit outweighs the risk, you know, like

he's truly turkey. But it is a good point. You know, kids jerking around been idiots. Don't do this on each other. Don't do this for fun at a party person who's completely no, you can do damage with us. This is a procedure to save a life, but you can also hope it will. You can break ribs. It can't hurt. You can even give people Katic a rhythm is if you do it at the wrong time. So this is for somebody that is dying. But Step one, supposedly right now is back blows. You're just supposed to be bash people in the back. Boom,

boom, boom. The city can dislodge it and they'll cough it up themselves. That's step one. If that doesn't work, you would try a Heimlich maneuver. I feel more comfortable slapping someone on the back. Yeah, and while you're doing all this, you know Hey, you with the red shirt. Go call 911 because it could get worse. Like a better in a second. But what if it gets worse? You need an expert. You can let,

sir, like the first thing you get loud as you're running towards the person someone called 911 I'm going to save somebody. And I might screw this up royally and don't actually do it that way in a crowd like you point to somebody specifically that you see funds like you's in the red shirt. Call 911 right now because you think everyone thinks everyone else is gonna do is look at the freeway when there's a crash. I'm sure somebody's cold won't bother calling. Previously pointed somebody. Yeah, that's good. And then you point to another person like you. Go find out if there's an a d and bring it over here. You make sure the guy in the red shirt did call 91 and you get me a cup of coffee, Thirsty and I mean hot towels. I don't know why, but I need a hot towel. You boil water.

Wow, this guy really knows what he's doing. So any commands? I have a quick story. Last year we were at a conference. It was Mel. You were You were golfing at the time, but I was at lunch with Dave and Josh, Josh from Sha Bam Josh, one of our our sound designers. The three of us were having lunch, and we're right across the street from this really large emergency medicine conference where there's just, you know, probably 100 e r doctors and, ah, we're eating lunch. I take a bite of a French fry, and Josh tells a really funny joke right in this moment where I've got the French fry in my mouth and I gasped and a French Frank, it's lodged right in my Gladys

and Josh and I didn't notice because we were still running on the last job way were like playing off each other. And

here I am, crying and turning, like, just really likes This

just is really laughing at this joke. And then she starts elbowing me on the side, and I'm like, what grabs you like? And then Josh and I both looked at her like we don't know what the d'oh great!

And in that moment, the thought hits me. Here we are, about 100 meters from ah 100 e r doctors and I'm at lunch with these guys and they don't know What the hell did you what happened? I think it went down my bronchial

way away. Now, did you think just when you're having this episode, because I've heard stories on the Internet, people choking, there's nobody around and I give themselves their own Heimlich Well, like falling on the side of a take a chair, thrusting

them like poof. You know, this was such a brief, brief moment that my only thought was This is ironic

would not be, But I thought

that I thought would be Oh, another thing that doesn't get enough attention in a potential way. You could intervene and save someone's life is someone who is having an awful axis.

So that's, um, that's like peanut allergies, right? Or like getting stung by a bee.

Yeah, those air really common ones. But basically someone's exposed to some allergen and, you know their immune system just totally over, does it. They have this. And if lactic reaction and they can't breathe and what you could do to save them is administer an epinephrine auto injector, commonly called the EpiPen. But that's a trade name. Um, that is the one life saving intervention that that saves these people. And so someone who's in anaphylactic shock if they haven't EpiPen, maybe they can't

administer to themselves. They would have if they were this severely allergic to something they would have an EpiPen

on that I would hope so. But probably not necessarily. A lot of people don't carry it with them all the time. Even though they're supposed

thio, is it common enough? Were fixed in. I could yell out to someone have an epi pen, and someone

was throwing. You have a decent chance that someone will have an EpiPen. Yeah, I think there's a decent chance enough people have an awful axis that it's not that rare of an item. And so it's worth asking. And so basically what you do is you inject them right in the

thigh. What does it look like? Is it an actual long needle, or is it one of those? Like when you go, the doctor, they're like, we're gonna take some blood and they just you never see it like it just shoots a little fat. It's like a fete pin, and you basically just spoon. You push it hard against your thigh and at auto injects Oh, you don't have to press anything. You just have to stab, stab. And there's a whole bunch of YouTube videos of people who have epi pens have given up from the soldiers show. You had to use these fantastic.

But you know, speaking of Josh has come up twice now. In this episode, Joshua son Zachary has an AFL axis. He's allergic to peanuts. And so I actually talked to Zachary and Josh about what that's like, what the allergy feels like, what the EpiPen feels like. So let's take a Listen, I'm Zachary's Zachary,

do your full voice and don't do hopes. Okay? Doing Hulk Smash voice for now. Do normal with

Zachary. Okay, Zachary, I wanted to ask you some questions about your allergies and your EpiPen. I happy you have a allergy. They give me my EpiPen because my EpiPen is always stays. That's it's in my medicine box off with Benadryl. My inhaler. So when you get the epi, pen it, they have to do this it to your leg, and they have to keep it for 10 seconds. Yeah. Then what's that feel like? And see it hurt. Yeah.

How much has he had to do? The

sweet I touch someone's concealment. Peanuts

was a bag of peanuts, right?

Yeah, my I was hurting, and Annie got swollen. And then they had to take my auntie pen. And then the ambulance came. And then they pulled me to the doctor and there was a rally. A long time for the doctor. Did you feel it? You When you after you touched the peanuts? Yes. And what about Did you feel like any swelling inside your mouth? No. No. Did you have any problems breathing or were you breathing? Normal. I had problems breathing. I felt like I was about to throw up.

Does your tummy hurt if you get your peanuts? Yeah, like it hurts like their stuff that's about to come out of my mouth. And it just, like, hurt. Like that Kind of hurt. Do you ever get a rash? That's itchy E. No. So when you've had to give him the EpiPen shot, what was that like for you?

Uh, it was actually really scary, cause I was like, I have to stab my child in the leg. And but, you know, you're the doctor says you gotta do this. Otherwise he's gonna go into an awful axis. So, uh, you just take that over washing your child, suffocate, You know, you don't want take the chance. Right? So So you just stab it in there, and then you gotta hold it in there.

All right? You did such a good job, Zachary. Thank you.

Yes, I love that he Ah, he talks about the wait time for the doctor. Yes. Hey, the ambulance picked me up, and then I went to the doctor, and then I waited

even a six year old complains about wait times so

that that guy was really interesting Sex. Super cute. Um, what are you gonna die from from an if I Is it the suffocation

like that? That's a really good question. The thing that kills you are two things. One of them is basically, you can't breathe because you have so much swelling in your airway, and so you are unable to breathe, and then the other one is shock. So you get basically all this vase Oh, dilation all your vessels dilate and your blood pressure just tanks. It goes way down. So you're hypertensive, and that can put you into shock. And so that could be another reason to cause a cardiac or cardiopulmonary arrest.

And those vessels a dialect. And they also get really leaky. So a lot of the fluid leaks out of the vessels into your lungs and you get old Count Brady. She's like, So what is in this magical fluid that cures all allergic reactions to bees and peanuts and onions and everything? Everyone

got Well, when you have this, Anna flax is abnormal immune response. Your immune cells just release a ton of all these bio chemical products. Histamine is one of the major ones, and, like Mel said, it causes a lot of swelling and leaking of fluids and vase. Oh, dilation. And so what epinephrine does is it constricts the vessels that reduces swelling, and it increases the blood pressure. And it also causes your bronchial Sze to dilate. And so you can breathe again. And it's basically out of all the things that we give to someone who's having an awful Actiq reaction. There's a bunch of stuff we give that epinephrine is really the only one that saves lives. It's the medicine that is life saving in an awful axis.

It came from a mountain on mold or enoughto. It's magical. Just say it really is. It's comes from a purple plant, and if you crush it up, you're a Black Panther. It makes you strong. You ruin that

well, another thing that people talk about with epinephrine, auto injectors that if you see someone who's really in distress and and you're gonna administer the pen to them or the injector to them, you don't mess around with anything. You just take the pen and you go right through their genes or whatever pants. There you go, right into

their thought. 10 seconds is that Zach's 10 seconds? Let the medication get in. You can't just, like, stab a pullout. What if they're expensive? James? The I mean, come on. So is there a reason why it has to be the thigh? Or it could be anywhere? No, they really like it in the thigh because it's a big muscle. It's hard to miss that. You're trying to get in the muscle. There's a lot of good blood supply there.

If you do it like an arm or something, you might miss the muscle, Put it in the Fed. It gets absorbed a lots more slowly from fet. You're trying to find that big muscle with lots of blood supply. So to get absorbed into the blood and circulate around the body and save you, and sometimes you have to do to so some people and you do it once and I get a little bit better. But then I step get worse again. How do you know they're not getting better than like what? What is Oh, but by bad time, the ambulance is shown. That's why you called. Get the ambulance coming, but they'll often tell you likely they'll do it once and they will say, Like I've had this before and at last for five minutes,

But I need to have another one. So sometimes you don't be afraid of doing it again. If the person starts to get worse again especially they're telling you. Yeah, double dose me. Yeah.

So we talked about choking, and we've talked about Anna. Flax is Let's do Ah, let's do one more. I think we have time for another one. Um, what do you do if you see a person who is unresponsive? So whether maybe you're at a restaurant and you see someone pass out? Or maybe you see someone having a seizure and go unresponsive. Similar but two slightly different things. A

seizure that's really scary looking.

Well, let's start with just the unresponsive person. Not someone who sees in Paso. Someone who's passed out.

Yeah, they're

not joking. They're not swelling up. Woody, What should you D'oh

have? No, just call 911 I have no idea. Ask a family member they might know some history.

That's a really good first step. Is assigned someone the tasks, including help Yes and seen

safety. I love that scene, Sandy. Every time is it So did they pass out in the middle of the street where causes

whipping by gene thing and you get their little

save you and then you get hit by car. Or what if in a restaurant there on the ground seen safety, there could be soup or oil all over the floor. I go run to help them. I slipped, make a two people in on the floor, Seen safety. I actually just saw that at a hospital. And it's so true. So this lady dropped her salad and then she went to sort of go and clean it up at the same time another person look behind her and slipped away. Crash under the ground. And then it was like my job was to

seen safety. Nobody move. There's oil in the ground.

It's quite dangerous so that they came in critical. But it was such a silly thing. But you could see like that another person would come over another seen safety. Got it always. But how do you know they're really unconscious? Just head. I'd decide.

What should you D'oh As a non health care provider to intervene for this person. So you should go up to them and seen safety number one. And then when you approach them, if they're if you're yelling like hey, you know, Are you okay? What's your name? And they're not responding to you

because they speak Korean and you're speaking English.

Then you ask them in Korean, then, Yeah, Seven Mandarin Spanish

way. Talk about somebody who looks like they're have a good night's sleep and not just sitting there.

Why'd you responding

to me? These jokes are great. Different kinds of my best. Nick, wake up.

Audiences unresponsive. Well, the actual recommendation is basically to start chest compressions. CPR? Yes,

until they wake up until you stop. That's a good

thing. I mean, yeah, because that's essentially like a really, you know, vigorous sternal rub. We have sort of like a set of painful stimuli that we do, you know, as physicians. Assessing someone to see if they respond to anything

is that when you look I don't pin pricked fingers and stuff,

you know, that's a sensation test, but the really common ones are the sternal rub. And that is the knuckles, right in the sternum and give him a good hard press right there. Nail bed pressure. So you take, like, your knuckle or you take like, a pen and you press

it firmly down there, Neil.

But it's really painful. But the reason why I like that one is because you can do it really discreetly, you know? So I'm not standing in the room. Yeah, they don't want to see me, like, basically grabbed their skin and twisted. Horrible. Right. But we have deviated from the topic a little bit here that I think the take home point for this one is unresponsive person. You go up to them. Hey, wake up. Are you okay? And they're still unresponsive. Start chest compressions and get someone to call for help.

Well, let's talk about seizures, cause that's super frightening looking. And what is a bystander is supposed to do when someone's having a seizure? I heard you just sort of let him have it. Just make sure they're not gonna knock anything into home or they're not gonna knock into anything

or yeah, that's sort of the bottom line is to make sure that they're safe. So you want to try to get them safely to the ground and into a position where they're not gonna hurt themselves and they're not gonna choke. And so the best thing that you can dio is just sort of roll them a little bit on their side. And that way, if they have, you know, secretions in their mouth or if they vomit, it doesn't go down there. Airway. So you're actually helping protect their airway and their breathing just by simply turning them onto one side?

Um, this sounds stupid, but like in movies, they'll put something in their mouth. Is air you supposed to do that in every movie? Get a stick. You're taking a bullet out of your leg In the Old West, it's like the same stick, sometimes geezers to get sticking, their grinding, a bullet out of your leg, final whiskey and a stick.

No, I don't think

they're afraid of the tongue and worried about dear, the tongue biting and rolling back. Or so we don't do that anymore. So it is in every movie, and you don't shove something in there because you'll see that they will often be clench down. Your people are trying to shove a stick in there and they're tearing their lips and is like, just like Jason. Most of the reason you don't have to do too much is the overwhelming majority people with a seizure. It's very brief. It will seem like a long time. It's less than a minute, so at the most, you sort of roll them on their side. Call 911 and then it'll stop by itself but shoving things into their mouth. Very bad idea. You might lose a finger or two by doing that. You don't want

that. And could someone who's unresponsive be having a seizure? And they're just not convulsing? Yeah, absolutely. But we no one should make that assumption because if they are in cardiac arrest or if they're in, you know, dangerous heart rhythm and they need CPR. It's like much better to just air on the side of caution and give them CPR. Yes, there could be harmed from that. You could break ribs. You could cause some damage. But it's really much better to just air on the side of start CPR right away. That saves lives early. Bystander CPR saves lives, so if you're not sure and they're not. They're not convulsing. Maybe they're seizing. I don't know. They're just not responding.

I'd start CPR. So if I see somebody seizing, do I still call 911? Or is that just something they're gonna wait? Gonna be like? That just happens. I don't. Is that I would call 911 Okay. Even though it turns out that many people with epilepsy will have a seizure and then they will get better. And they could just sort of have a sandwich and go home. Let the pros you deal with. Just call 91 Because you don't know whether it's a new seizure of this. Something else going on. Just call. That's what they're

there for. You okay? We've talked about a lot this episode,

Man, I feel like there's more.

There's so

much seeing the family guy episode before we finish. Which one? Where, Uh, I don't remember the character's name, but there's a car accident and the guy gets out of the car and he goes, Don't worry. I know CPR. Any grabs the guy and throws him to the ground and start trying to do CPR on the screen.

Him stop stuff like

don't disappear on awake people. I just want to say if they're saying get off. Exactly.

I had a patient come in with chest pain once, and I was examining him, asking about it. Trust me. Pressed on his chest. Yeah, right there. That's where it hurts. Like specifically right here. Yeah, that hurts really bad. So what happened? Right there, he said, Well, I got a little chest pain, and then I was worried that,

you know, my heart was gonna stop, and so I punched myself in the chest to start CPR. Now it really hurts. Don't do self CPR, if you can. If you can do self cpr, you don't need

it. Well, we should definitely revisit this topic again, because I feel like I've got a lot more things that I see in public, and I want to know if I can intervene or not. So we have to do apart to at some point. So thanks to about gifts, Rene Ramirez, Andrew Ramirez, Michaela Ennis, Josh Curs and Zachary Coz and trail hosts have to just Mason, Dave Mason and I'm hoping this one hurt a bit is a production of fool Ibou Incorporated, produced by cc have it on Bill Connor. The information you here on this one had a bit should not be taken as actual medical advice. If you have actual medical questions about actual medical things, you should see an actual medical practitioner even though we are actually, doctors were not your actual doctor. So be sensible and keep it real. And this Oh, this this this this force, this viscous says this will

hurt a bit.

What's tragic is that Henry Heimlich died in 19 in 2016 and a nursing home he choked on a bagel. No, he did not know, actually, what evaded interest to get into the story?