Can You Commit Suicide With an AED?

Recently, my husband and I have been binge watching through all five seasons of breaking-bad-s5-400x600-compressedv1Breaking Bad. In the last season, a gentleman decided to kill himself using an AED.

AED stands for Automatic External Defibrillator. It is a quick rescue device used mostly by non-medical people for cardiac arrest. It is designed to recognize lethal heart arrhythmias and deliver a shock (electricity) if the patient is in one. The AED will not always fire. In fact, there are really only two arrhythmias it is designed to treat.

The question becomes, can you use an AED to commit suicide? An AED has two large, white patches connected to the device. In the show, the gentleman places one patch on his chest, pulls off the other patch and places the exposed wires in his mouth. After this, he turns on the device and discharges it, thereby killing himself.

aedThis scenario is highly improbable and here’s why:

1. Both patches must be in place for the defibrillator to analyze the patient’s rhythm. If they’re not, the machine will not progress any further.

2. Let’s say the AED would read the rhythm (one patch on the chest and exposed wire in the mouth)— it won’t deliver electricity for a normal rhythm (which this gentleman likely has because he’s alert and conscious.)

3. Let’s say the AED did fire for his normal heart rhythm— would he die? There is a slight chance that he might die, but only if the AED fired during a very sensitive time in the electrical cycle of his heart which has a very low probability.

All in all, I don’t find this method of suicide possible. Sorry, Breaking Bad, though I did love the series.

Author Beware: Use of Electricity

Authors, television producers and scriptwriters are fascinated by the use of electricity. This is probably one of the most commonly abused medical scenarios in that it is rarely used correctly.

One of my most popular posts here at Redwood’s was a post titled Shock Me To Death that highlights how electricity (or defibrillation) should be used.

I was reading a debut novel by a medical doctor and found many grievous errors around the use of electricity. Which distresses me because he also said he had a cardiologist review the manuscript. Seriously, I kind of want to know who that doctor is and what kind of training he had.

There was the usual error of shocking a flatlined patient or asystole. Remember, in order for electricity to work, there has to be some present. If a patient is flatlined, there is no disorganized cardiac rhythm to reset and so defibrillation is contraindicated in those patient scenarios.

Next error in this manuscript was cracking the sternum down the middle during compressions. For one, the sternum is extremely hard to fracture. It’s designed to protect some very important organs. If the sternum is even slightly fractured, we know there have been extreme forces placed on that patient. So, to have mere hands fracture a sternum all the way down the middle is ludicrous. Remember, they saw this open for open heart surgery. Breaking ribs is very probably during CPR, but not the whole length of your sternum . . . sorry.

Last, and most creatively (as I’d never seen this error before), was the amount of electricity used in an ICD device (an implanted cardiac defibrillator.) ICD’s are devices that are used to convert patients from lethal arrhythmias like v-fib and v-tach. They are not pacemakers– which stimulate the heart to beat.

Whenever electrodes are placed near the heart, the amount of electricity used is very small. Think about it. When we shock you from the outside of your body, the electrical current has a lot of tissue to pass through to get to your heart. This is why we use more. When defebrillating someone– it’s in joules.

A pacemaker uses a lot less energy. Outside pacemaker use milliamps.

And here is the very interesting quote from a published novel:

“Cardiologists shock patients all the time under controlled conditions, remotely dumping up to 700V (volts) of juice directly in to the heart via the ICD.”

Wow. That’s just . . . overkill.

Just how lethal is 700 volts applied directly to the heart?

This site explains that 110V can kill you.

It’s so egregious an error that I’m not quite sure what this author was thinking. It pains me more that he is an actual medical doctor. I even double checked the published manuscript (as I’d read a galley proof before) and the error was still present.

I think he needs a new cardiologist.

Medical Critique: CBS Drama Hostages 1/2

As you know, I’m critically watching some of the new Fall TV shows for medical accuracy. I’ve already posted about the CBS drama Hostages. You can find that here.

This week, I’m going to knock it down but then offer it a helping hand back up. Episode 5 is going to be the brief knock down.

If you haven’t watched all the episodes you have been thusly warned that there will be spoilers in this post.

If you’re not familiar with the show, the President needs an operation and his surgeon, played by Toni Collette, and her family have been taken hostage to force her hand to assassinate him or her family will be killed.

In episode five, the family plots to escape. They end up getting split up. The husband at home. The children on a bus to Canada and Ellen (Toni’s character) almost getting on the bus until she sees video of her husband being shot in the gut.

And, of course, even though he’s a cheating slime ball she goes home to save his life.

Issue One: One of the ways a person who has been shot and is bleeding dies is of exsanguination– meaning all their blood leaks out. The reason significant blood loss kills you is that your body is no longer delivering oxygen and you go into shock/circulatory collapse. What you really need is BLOOD to save your life. Without it– nothing the medical team can do will pull you out from the drain you’re swiftly traveling down. When our trusty surgeon arrives home she finds her husband unconscious and not breathing . . . no pulse.

She starts CPR– yea!! Then asks Mr. Hostage taker to get her medical bag from which she happens to have a hospital grade defebrillator.

Issue Two: There are only a few shockable rhythms. I’ve blogged about the use of electricity here. A likely rhythm for the patient to be in strictly from blood loss is what we call PEA or pulseless electrical activity. There is actually two parts of good heart activity. The electrical component and mechanical component. You need both working appropriately to propel your blood forward and keep you alive. You can actually have normal electrical activity and yet the heart is not mechanically beating– thus the term pulseless electrical activity.

In the case of this character’s husband– his heart likely has normal electrical activity but since he’s lost so much blood– it doesn’t have blood filling the chambers and so doesn’t have anything to pump out. Hence the lack of a pulse.

I’m guessing this husband’s injuries would lead to this set-up. Normal electrical activity with no pulse. So he doesn’t need electricity. He needs BLOOD.

Issue Three: I don’t know any physician anywhere that has a hospital grade defibrillator for their private use. Or would know how to work it . . . quickly. Now, this isn’t a backhanded slap to my physician co-workers. They know how to do their job very well. This just isn’t necessarily in their skill set. Nurses usually set-up the defribillator. The physician orders the desired amount of electricity.

I’ve taught advanced resusitation courses for two decades and I can tell you, across the board, every type of physician struggles to get it programmed. These classes are not a requirement for EVERY physician to take either.

So– wrong treatment with too much ease of use.

What would have been more believable would have been for her to have an AED (automatic external defibrillator) in the home. These are designed for lay people to use and some people do actually have them for home use. They basically diagnose the shockable rhythms and provide electricity if indicated. It’s what many first responders are carrying to even high school settings. They are very user friendly.

Check out my post on Thursday where I’ll continue my discussion of this particular episode.