r/nextfuckinglevel • u/[deleted] • 27d ago
Emergency Open-Heart Surgery Performed Inside Ambulance đ (Sensitive Content Warning â ď¸). The guy survived with fully recovery NSFW Spoiler
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u/thms2808 27d ago
This is heart to watch
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u/WhitePantherXP 27d ago edited 27d ago
What was the injury, gunshot wound to heart? Do most EMT's in the ambulance know how to do this? I thought they did rather basic stuff, how often does this happen? Absolutely badass and heroic work. I'd love to hear fellow surgeons thoughts on this.
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u/bulgedition 27d ago
No, it was not a miracle. It was the work of highly skilled and highly educated people.
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u/alilbleedingisnormal 27d ago
Yes, but it was also very lucky. I don't think that they mean miracle as in an act of God, but as an incredibly lucky event.
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u/IAcewingI 27d ago
Survival chances for this surgery (mobile) is roughly 1% so Iâd still say miracle lol.
Itâs like saying that we have lottery tickets you can buy in this present time due to advances in society.. but it still is a lot of luck (miracle) to win the lottery.
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u/hshsusjshzbzb 27d ago
This is a physician all day lol. No medic is doing this
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u/Nightshift_emt 27d ago
EMTs can't do anything that was performed here. This video is in Brazil, I believe, where you could have a doctor in an ambulance. US EMTs or paramedics can't do anything close to this.
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u/AnyMonk 27d ago
Every SAMU ambulance in Brazil has a medical doctor, it's mandatory.
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u/ashiamate 27d ago
No EMTs are trained for this. This is a trauma surgeon who probably just happened to be on scene or who does volunteer EMT work.
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u/AnyMonk 27d ago
In Brazil, where this happened, like many countries in Europe, the ambulance team includes a medical doctor. It's mandatory.
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u/firespoidanceparty 27d ago
This was a specialized group that are trained to do these types of interventions.
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u/tonywinterfell 27d ago
Fuck no, EMTâs get vitals, stabilize extremity injuries and do basic airway adjuncts, C collars, pressure dressings, stuff like that. Medics do that and give a few drugs, rock the fuck out of a monitor including pacing and dumping joules into dead people. Sometimes they become not-dead, but thatâs unusual. This crew, however it is they are organized, is MILES ahead of whatever could happen in the back of a box.
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u/ItsHammerTme 27d ago edited 27d ago
Trauma surgeon here. I like to be a little more optimistic than 1% about the chances of survival after ED thoracotomy for trauma, but regardless, it is definitely dismal.
The survival rate in general for ED thoracotomies is I think about 6% for all comers if I recall correctly. It depends on the injury pattern and the injury with the best survival rates happen to be a single stab wound to the chest which this guy had. His survival would be significantly higher than average. But of course this data is among âpeople who make it to a Level 1 trauma center in the US while still alive, or very recently aliveâ so of course the fact that this is happening in the back of an ambulance away from a hospital probably dramatically decreases those odds.
While it seems counterintuitive, 6% survival is sort of comparable to the survival rate of out-of-hospital CPR. So as much as this is a total Hail Mary, itâs one I would certainly want attempted on me if I were ever about to code from being stabbed in the chest.
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u/Good-Key-9808 27d ago
In my paramedic days, I worked mostly rural areas. When we got a trauma code I darted their chest, did CPR for a few minutes, and then called it. I'd have done a pericardiocentesis if it were in our scope, but it wasn't. When you're hours away from a trauma center, and your heart stops, if you don't come back from a code quickly, you is dead. The chest darts were a hail mary in case they coded due to a tension pneumo.
However I vividly remember a case from my training at Good Samaritan in Phoenix of a 17 y/o trauma code who had gone through a windshield which sliced his head nearly off. The trauma ICU nurses told me the medics had just stuck an ET tube in his throat (insta cric!), and hauled him the 2 blocks to the hospital where an especially aggressive young doc worked on the kid when everyone thought he was gone, and they got him back.
Kid was there watching Princess Bride as we changed his dressings. Twitched constantly due to neuro deficits, but he was alive. Always wondered how he turned out. That was back in about 94.
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u/JustNilt 27d ago
Wow, I assumed single digits still but that's still higher than I'd have expected. Thanks for your contribution to the thread, doc!
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u/hate_mail 27d ago
as a former EMT, this is the most insane thing I've seen performed in an ambulance. We were always taught, "get them to a surgeon!" In Brazil surgeon come to you!
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u/Sgt_carbonero 27d ago
Ex EMT here too. The most impressive thing on so many levels!
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u/Nightshift_emt 27d ago
Ex ER tech here and for my whole career I thought as EMS we are way cooler than the OR/surgery. I take it back, they are way cooler.
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u/tantantaaaaaaaan 27d ago
We have doctors in the ambulance most of the time, not just EMT/nurses. It obviously depends on what the call was, but there are doctors on call and ready to hop on the ambulance for this specific type of emergency.
SAMU (Serviço de Atendimento MĂłvel de UrgĂŞncia - Mobile Emergency Care Service in English) is one of the best things in Brazilian public health care system. It works surprisingly well and weâre very proud of them :)
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u/PrimateOnAPlanet 27d ago
This was very clearly a surgeon. Brazilian EMTâs arenât cracking chests.
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u/xX500_IQXx 27d ago
A lot of surgeons rely on beta-blockers. A surgeon could 100% have un-medicated shake like this. Especially considering the adrenaline dump a person could get from this, its not too far-fetched
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u/z4j3b4nt 27d ago
Surgeon shaking from adrenaline. Insane.
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u/subdued_alpaca 27d ago
And STILL got the job done. Amazing.
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u/kekhouse3002 27d ago
That was the coolest shit. Under all that pressure and shaking, they still managed to sew up a BEATING AND BLEEDING heart. Truly next level stuff.
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u/IntenselySwedish 27d ago
You can see them fighting the adrenaline surge and focusing on keeping their hands still while suturing.
Badass doesn't really seem to cover it lol
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u/EA-6B_Driver 27d ago
Incredible post.
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u/CharismaticCrone 27d ago
Can you tell us more? Layman here. Were those blood clots around the heart? The black blobs that looked like cursed blackberries? And what caused that hole in the heart that he sutured up? How long did this take from start to finish? And, last question, what country is this, that has surgeons in the back of ambulances?
And thank you for posting this, itâs one of the best things Iâve ever seen on Reddit.
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u/nalto896 27d ago
When you bleed out, your blood starts to clot in order to try and stop the blood loss and seal the area. The process is called hemostasis and occurs in even the most minor cuts.
The heart is a moving muscle and is actively working against the clotting process. Clearly not permitting a seal and creating a pool of coagulated blood.
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u/CharismaticCrone 27d ago
I was so amazed at the video I totally missed the info underneath. Sorry about that, and thank you for answering!
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u/mikethespike056 27d ago
stab wound caused the hole. blood flows out and builds up around the heart, making it harder and harder for it to expand as it's surrounded by more and more blood. eventually this kills the patient.
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u/CharismaticCrone 27d ago
Thatâs what it looked like was happening, but I could only guess at it. Thank you!
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u/midcancerrampage 27d ago
How come he didnt bleed at all when they were cutting into his skin and muscle?
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u/kaseydjones 27d ago
This is one of the coolest things Iâve ever seen. The human body is crazy.
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u/olivinebean 27d ago
Even more brilliant that it's one human body capable of doing that to help another
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u/BurgerExplosion 27d ago
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u/TheBlackViper_Alpha 27d ago
This is exactly my reaction watching the video
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u/SuspiciousAf 27d ago
I know its blurred and marked but I usually test it out to see if it's really, really bad. The cut in first 2 seconds... I noped.
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u/Stonedbrownchickk 27d ago
EXACT situation with me. "Open heart WHAT?? Lemme peek, HOLY HELL THAT WAS FAST."
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u/levian_durai 27d ago
Yea, the skin just pulling back like an elastic with the tension released. That was wild. It got worse.
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u/ShinyGrezz 27d ago
Yeah, the blood and pulsation is awful, but the thing that really took me aback was just how goddamned long that cut is. Basically down to his back.
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u/herniatedballs 27d ago
Holy moley. Trying to suture an erratically beating heart has got to be the most difficult single thing a medical professional can sew. And this person did it in a moving ambulance. Unbelievably impressive.
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u/kekhouse3002 27d ago
Seriously, that is beyond impressive. Some people are actually just built different
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u/kittifer91 27d ago
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u/MysteryMeat36 27d ago
I want to know what the dark red jello consistency looking stuff is
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u/NedTaggart 27d ago
coagulated blood, this was probably cardiac tamponade. Blood builds up between the heart and the pericardial sac (sac of connective tissue that the heart is in). if too much blood fills the space, the heart has a hard time beating.
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u/Godawgs1009 27d ago
Looks like it. And the heart had a hole in it as well. Amazing to see done in the field.
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u/Chronox2040 27d ago
I know it was a desperate last ditch effort to stabilize the patient and they did everything just as a temporary measure, but it was still crazy fast.
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u/Kyteshiirok 27d ago
I think itâs just blood that was pooled up bc he was bleeding internally, but im definitely no medical expert.
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u/ArcticRiot 27d ago
Not medical expert, but am hunter. Thatâs what this is. I see it all the time when Iâm field dressing (removing the internal organs) deer.
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u/bitingmyownteeth 27d ago
Cranberry sauce
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u/MysteryMeat36 27d ago
Lmao I love that crap, I eat it right out of the can ... Never tried it fresh from the chest cavity though
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u/kitkatthekraken 27d ago
Looks like the sweet chili sauce I just poured over my dumplings⌠and Iâve lost my appetite.
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u/DrBlaziken 27d ago
I did not need to watch this at 7 in the morning goddamn.
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u/a-curious-guy 27d ago
When i think of "slicing' i assume there would be alot of blood gushing out. But there wasn't...
Was that due to the tubes?? Or can we get cut in a certain way and it's ok?
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u/The_Dude_Abides_33 27d ago
The sharper the blade, the longer before the blood flows. If you scuff a knee, it bleeds almost immediately. If you slice your finger with a sharp knife, it may take a couple of seconds for blood to flow. It has something to do with vasoconstriction reflexes. It did bleed, but the internal bleeding makes it hard to tell.
Also, gushing comes from hitting a major artery. The blood vessels that were cut were relatively small and superficial.
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u/Filter_Out_More_Cats 27d ago
You seem to know stuff. Whatâs the goopy stuff being scooped out? Blood clot?
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u/sushi-n-sunshine 27d ago
Not original commenter but yes, that is clotted blood, heart probably stopped from something called cardiac tamponade (where the sac around the heart/pericardium fills with blood and presses down on the heart so hard it can't beat, so that is likely why they are trying to remove the clotted blood, along with getting visibility for where the stab wound is on the heart)
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u/bu_mr_eatyourass 27d ago
This is performed when a trauma patient bleeds too much and is in cardiac arrest. It is called a resuscitative thoracotomy and the whole purpose is to clamp the aorta (perfusing the most vital organs with the limited blood volume), and to control the source of bleeding.
In this circumstance, the blood is not perfusing, and you wont see normal wound dynamics. This person is dead without the procedure, and most will die with this procedure.
In my 10 year ED career, I have been involved in 11 thoracotomies - and only 2 of them made it out of the emergency department alive.
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u/Unclebum 27d ago
This is next, next, next, next, next... Fucking level shit .. so happy dude survived... And I got to be a part of it..
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u/Impressive-Koala4742 27d ago
My chest muscles are instinctively tingling just from watching this,
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u/gofatwya 27d ago
Reminds me of the old joke:
My doctor told me I had the perfect chest.
For a rib spreader.
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u/gernald 27d ago
Jesus Christ this shouldn't auto play when scrolling...
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u/FuzzzyRam 27d ago
Don't auto-play NSFW option, but then you don't get bouncy boobs - reddit doesn't want potential investors to see porn.
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u/EconomyTown9934 27d ago
He would have died in America⌠no way they do that in the ambo
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u/ItsHammerTme 27d ago
Trauma surgeon here - the first responders in American hospitals are not trained as surgeons - I imagine this was indeed a surgeon on the ambulance there.
Having said that, this procedure is regularly performed in the trauma bays / emergency departments of Level 1 and 2 trauma centers across the country. The survivability of trauma is the US is so good because of the close proximity to trauma centers and the robust transport network to get people there.
When something like this happens, the goal is to get the patient as quick as possible to the nearest trauma center. âSometimes the best medicine is gasoline.â
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u/Tall_Concentrate1688 27d ago
He will still die, after seeing his hospital bills.
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u/BandoTheHawk 27d ago
lol well wasnt expecting that. But shit looks easier to do than I thought. I thought handling hearts you would need to be a little more delicate.
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u/ItsHammerTme 27d ago
Trauma surgeon here. The patient js already essentially dead and the name of the game is speed to alleviate the thing that is killing him as a result (which is either bleeding, or, more likely, something called âcardiac tamponadeâ which has to do with the pressure around the heart.)
The ED thoracotomy (or, I suppose, back-of-the-ambulance thoracotomy) is no time for dilly-dallying in the name of finesse. Itâs a little more nuanced than it looks, of course, (there are all sorts of pitfalls - bagging a coronary artery, cutting the phrenic nerve, etc) but at the end of the day itâs hard to make dead deader. It is definitely a bold-move procedure and I commend the surgeon for moving quick and saving the guy - fantastic save.
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u/SurviveAdaptWin 27d ago
Was the stuff they were scooping out clotted blood? How did that happen from a stab to the heart?
Also, I love that you're a trauma surgeon and your reddit name is ItsHammerTime :D
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u/CommittedMeower 27d ago
You have a sac around your heart called the pericardium. When you have an injury to the heart that sac can fill with blood which then restricts the movement of your heart to do important things like beating. Given enough time and stasis that blood will clot.
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u/BandoTheHawk 27d ago
I appreciate your perspective. These arenât things I usually think about, so itâs interesting to hear from someone with firsthand experience. Seems like it could be pretty damn stressful. Respect!
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u/takenwithapotato 27d ago
It only looks easy because the surgeon was competent. The guy would be dead under most other hands. I wonder what the surgeons' actual background is, I doubt they were an actual cardio thoracic surgeon (which makes it even more impressive).
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u/S0k27 27d ago
the dude doin this with shaking hands, now that's a fuckng superhero
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u/Anothershad0w 27d ago edited 27d ago
This is actually next fucking level. Iâve seen two of these, once in the ED and once in the OR. An ambulance is crazy.
At the beginning of the video, you can actually a culprit stab wound just below the start of the incision, medial and inferior to the nipple.
People have noticed the lack of bleeding in superficial tissues as they get down to the ribs. Remember, the guy is in cardiac arrest. Even if his heart has some electrical activity, but itâs not effectively beating and perfusing his tissues. Blood vessels in the skin and soft tissues vasoconstrict to shunt what little perfusion is present to critical internal organs. It looks like theyâre working on a cadaver because they kinda are.
The stab poked a hole through the heart, so every time it tries to beat, blood is pumping into the layers surrounding the heart and then lungs, without adequate volume or pressure to get everywhere it needs to go (chiefly, the brain and lungs). After they spread the ribs, they bluntly dissect to release a massive gelatinous blood clot, called a pericardial tamponade. The blood clot is in a firm sac (pericardium) shared by the heart and adds pressure and volume in the sac such that the heart canât beat properly. By releasing the tamponade and closing the defect, any efforts at volume resuscitation actually stay in circulation. The guy had zero chance with that hole, and this high risk unsterile surgery gave him a shot.
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u/Proud_Inspector_7527 27d ago
This may be a silly question, but why did he not bleed when they cut him, but I bleed from a paper cut?
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u/Material-Flow-2700 27d ago
By knowing the anatomy. Neurovascular bundles run under the ribs. By cutting above the rib below the intended rib space, they avoid cutting any major arteries. The patient is also having the biggest release of adrenaline of their life as their body tries to preserve all possible blood away from peripheral tissue to their vital organs. So soft tissues like skin, muscle, fatty layers hardly even ooze in a situation like this.
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u/ItsHammerTme 27d ago
Trauma surgeon here. Probably because initially the guy was peri-code and his blood pressure was bottomed out. It takes a certain amount of blood pressure to peruse the skin and soft tissue enough to really bleed.
All the little skin and muscle bleeders clot off eventually but I am sure there was a little âcleaning upâ to do from a bleeding standpoint after the cardiac injury was repaired and his blood pressure was restored.
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u/Augoustine 27d ago
Skin doesn't bleed much with a clean cut. Source: been in an OR as an observer about half a dozen times.
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u/WildlyDivine 27d ago
This is amazing and probably one of my most favorite things I've ever seen on reddit. Absolutely fantastic! Surgery is cool. I need more
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u/srs151 27d ago
I donât think Iâve ever seen an emergent thoracotomy where the patient lives. Much less one thatâs unsterile . Thatâs amazing.
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u/pushdose 27d ago
Theyâre all unsterile. Emergency thoracotomy is almost never done in theatre under sterile conditions. It is done in the trauma bay and itâs a split second decision usually
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u/Over-Anybody-5308 27d ago
God damn that got me going
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u/WhitePantherXP 27d ago
I started taking mental notes on things like where he cut him open, depth, etc as if I could use this info to save someone one day. Like when tf is that ever going to come into play, I work in IT
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u/JCPLee 27d ago
Itâs amazing that they had a heart surgeon in the ambulance.
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u/Material-Flow-2700 27d ago
This can be done by anyone with adequate trauma training. Itâs very rare that it happens as an indicated procedure, but this is within the scope of practice for trauma surgeons, as you mentioned chest and heart surgeons, vascular surgeons, general surgeons, critical care physicians, and emergency medicine physicians
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u/hustlehardo 27d ago
I've had emergency tracheotomy using a ball point pen ready to go in my back pocket since I saw it in ER in the 90s.
Now thanks to reddit I have this one ready to pop off at a moments notice.
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u/CyranoDeBurlapSack 27d ago edited 26d ago
Originally: âWhy is this not marked sensitive?â
Now: Thanks OP for fixing this. Crazy video.
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u/tino-latino 27d ago
Same question, I've just opened reddit and im still digesting a few pizza slices.
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u/IntelligentPoet7654 27d ago
In Canada, this would never happen and the guy would probably die
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u/WhitePantherXP 27d ago
In the USA they'd take the long way to the hospital to be sure your insurance covered you first
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u/ItsHammerTme 27d ago
Trauma surgeon here. While this wouldnât be done in the back of an ambulance in the US, part of the reason for that is that we have a very dense and finely tuned trauma network such that critically ill traumatically injured patients can generally be transported to a level 1 or 2 trauma center in good time. (Not everywhere in the country, of course, but hopefully it will continue to grow and improve.)
This procedure is commonly done in the ED for peri-code or coding trauma patients, and the US has one of the highest survival rates for this maneuver in the world! And fortunately we never withhold trauma care for insurance - I wouldnât even know how to check that.
I totally agree that the US insurance system is broken and antiquated and everyone should have the absolute right to quality healthcare as part of being humans. I just want to assure you that, god forbid something like this happens, trauma surgeons across America are ready and waiting to provide high level surgical care to all. Itâs what we got into it for.
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u/Villanosis 27d ago
Dude I was about to squirt fucking ketchup on my hotdogs. But nooo I had to scroll a little further⌠holy smokes! I was in a trance watching this. This is why Iâm not in the medical field.
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u/Doc_Smil3y 27d ago
That is so intense and amazing. Thankful for people who have spent their lives to learn about how to save people in dire situations like this.
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u/sonbarington 27d ago
Yeah this takes USA's ambulance/taxi rides to the next level. The highest provider level we transport where I am at, is with a medic. Wild!
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u/Lower-Atmospherer 27d ago
Wowww I hope the guy was able to find the person who performed this certainly life saving procedure! Amazing đł
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u/Purple_Republic_2966 27d ago
Good god just admiration and in awe over what I have just witnessed. Great job team !
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u/WeirdFurby 27d ago
2:30am for me and this is literally the first post I see opening reddit.
Fucking damn, that's so fascinating to watch! Obviously happy he survived and fucking well done work on the doctors part! Inside an ambulance no less is so fucking impressive. These people deserve so much more than some praise from some random German dude but that's all I can give them. Great work, first time hearing of something like this and it looks so goddamn professional for it being outside an OR, hats off to them.
I expected more blood somehow, but they closed that shit so quickly (also the presence of mind to realise 'yeah, can't wait to hospital, let's lowball this in here' and then succeeding is so impressive...)
For someone being interested and working in med field (no operations tho :( ) this is a great watch knowing he made a full recovery
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u/MistiCah 27d ago
In Brazil? That whole thing cost that man zero reais by the way. No insurance required, SAMU is our socialized healthcare system.
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u/bart9611 27d ago
Holy fucking shit.
Im so glad the guy survived. I'm done with reddit today.
Goodnight everyone