InPulp Fiction, John Travolta and Samuel L. Jackson are trying to save Uma Thurman from a drug overdose by injecting her with adrenaline. Instead, they should have given her an injection of a medication called Narcan to reverse the effect of the heroin. Adrenaline (epinephrine) is often given during cardiac arrest but only through a vein. Sorry, not as dramatic but definitely less painful.
In the movies and in the dictionary, “shock” can mean to strike with great surprise and emotional disturbance. In medicine, “shock” is a major medical emergency. When doctors talk about shock we are referring to the failure of the circulatory system to maintain adequate blood flow. This requires rapid treatment, otherwise it can lead to death.
There are a number of different causes of medical shock, including bleeding (hypovolemic shock), inability of the heart to pump enough blood (cardiogenic shock), severe infection (septic shock), and life-threatening allergic reactions (anaphylactic shock). People suffering from shock have low blood pressure, difficulty breathing, a weak rapid pulse, cold and clammy skin, decreased urination, and confusion.
So, the shock that we so often see on-screen should be more appropriately called freaked out.
If real life were a soap opera, then the answer to this question would always be yes. Unfortunately, coma is a very serious problem and although people do wake up, the longer they remain in this state, the less likely they are to return to consciousness. This is a very delicate question because doctors can’t really predict which patients will wake up and which will not.
If you look carefully in the original movieComa, you will see Tom Selleck, that’s right, Magnum, P.I., in a state of suspended animation. Recent movies likeWhile You Were Sleeping, Kill Bill, andTalk to Her also used coma in their stories. The medical story of coma isn’t as glamorous as Hollywood portrays.
To begin, there are several different categories of coma, or disorder of consciousness. Consciousness can generally be divided into two main components, arousal and awareness. Coma is defined as a state of unresponsiveness from which an individual has not yet been aroused. Patients in a coma are neither awake nor aware of their surroundings. On average, coma doesn’t usually last very long. After several weeks, most patients either regain some level of consciousness and if not are classified as being in a persistent vegetative state. Persistent vegetative state is characterized by complete lack of awareness of self or one’s environment. These patients can appear awake and even have their eyes open but are totally unaware of their surroundings.
Another category of consciousness is the minimally conscious state, an intermediate stage of consciousness, which indicates that a patient is somewhere in between a persistent vegetative state and normal consciousness. These patients can show intermittent signs of awareness.
The “locked-in” syndrome is a rare condition that must be distinguished from disorders of consciousness. It is characterized by complete paralysis of the voluntary muscles in all parts of the body except for those that control eye movement. These patients can think and reason but are unable to speak or move.
It certainly would be dramatic if we had our gunshot trauma patients take a swig of whiskey and bite on their belt as we removed the bullet with a knife that had been sterilized by heating over a fire. I also would love to ride a white horse to work every day but that doesn’t happen either.
In old Westerns, there is an urgency involved with removing a bullet, as if this is the life-saving maneuver. In reality, doctors are not concerned with the presence of the bullet but rather the damage that it does on its way in or out. We often see patients who get an X ray for another reason only to find a bullet from a previous injury.
There are some special situations when we worry about leaving a bullet in a person’s body. When bullets or fragments are near large blood vessels, nerves (especially the spinal cord), or in a joint, then they can migrate and cause damage. In these cases, bullets are usually removed.
People have also asked whether or not you can get lead poisoning from bullets that are left in the body. In general, lead fragments in soft tissue become surrounded by fibrous tissue and are therefore essentially inert. If a bullet is in a joint, there can be a problem with lead poisoning. A study in Los Angeles in 2002 looked at more than four hundred patients who had bullets retained in their bodies. They found increased levels of lead in a small percentage of patients. Bullets or shotgun pellets are 50 to 100 percent lead and people are more likely to have problems with lead poisoning if there are multiple bullets or multiple fragments in the body. Sorry to disappoint you spaghetti Western aficionados, but the old whiskey-and-leather routine is just for show.
Action heroes like Arnold Schwarzenegger often find themselves faced with an interrogator who uses a truth serum to get the hero to reveal his secrets. In the movies, our heroes are able to resist these potions and hide the truth. Hiding the truth seems to also prepare action heroes for a successful career in politics.
They seem pure fiction, but truth serums do exist. Barbiturates such as sodium amytal and sodium pentothal were first used as truth serums in the early twentieth century. These drugs inhibit control of the central nervous system and were used by physicians to help patients recover forgotten memories or repressed feelings. They are also used for patients with suspected conversion disorder, a condition in which psychological problems produce physical symptoms.
An “amytal interview” is performed by administering a small amount of this drug intravenously. The drug produces a state of drowsiness, slurred speech, and relaxation. This condition makes patients more susceptible to suggestion, allowing the potential to uncover repressed feelings or memories.
Today these interviews are seldom performed. The “truth serum” will not necessarily make you tell the truth. Patients may lose inhibition but will not lose all self-control. Therefore, they are still able to control their behavior and lie. Studies have shown that during these “amytal interviews,” patients often demonstrate a distorted sense of time, show memory disturbances, and have difficulty distinguishing between reality and fantasy, so the line between fact and fiction becomes even more blurred.
We’ve all seen it in the movies. The bad guy grabs someone from behind, places a rag over the victim’s nose and mouth, and instantly the person slumps to the floor.
This isn’t exactly how anesthesia is administered in a hospital, but many people wonder if this rag trick is possible, and if so, what is the chemical on the rag?
Chloroform and ether are the two possibilities. In the mid-1800s, both of these chemicals were being used as anesthetics. Chloroform is the more common substance discussed in these cinematic knockouts but actually doesn’t work as swiftly as portrayed. It usually takes several minutes to induce a state of unconsciousness with chloroform. Chloroform also causes a lot of side effects including nausea, vomiting, and skin irritation.