Damar Hamlin is headed home to Buffalo!

Mr Jums

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His brain had no oxygen for 9 minutes apparently. It's super sad, I feel horrible for him. His mom was there.
Do you mean because that's supposedly (or actually, don't know if it was confirmed) how long the CPR was? That's actually the whole point of CPR is you press on the chest and basically squish the heart so that it pumps blood throughout the body, for really the sole purpose of getting oxygen to all the organs. So while it definitely wasn't ideal levels of oxygenation, his brain was definitely getting something during that time. (And if I misunderstood you or there's information I don't have, my apologies!)
 

PedrosRedGlove

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I can't speak for that poster, but the second I saw Schefter in the studio I rolled my eyes- not because of what he was saying, but because he has a history of being tone deaf. And given that, it seemed like a poor choice on ESPN's part to put him on the air, regardless of how well or poorly he ended up doing.
Well that sounds like some bias. The second I saw Schefter, I noted that he was wide eyed like he had seen a ghost, and was borderline turning green. He seemed to entirely understand and appreciate the weight of the situation. And was vocal with the other two soon into the situation that the game should probably not continue before the league made the call.
 

fiskful of dollars

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Radsox's description of "perfect storm of badness" is exactly right.
About 10-20 cases/year. Really, really rare. These cases get a lot of publicity because these are young healthy athletes who die on the field without warning.
 

AlNipper49

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Do you mean because that's supposedly (or actually, don't know if it was confirmed) how long the CPR was? That's actually the whole point of CPR is you press on the chest and basically squish the heart so that it pumps blood throughout the body, for really the sole purpose of getting oxygen to all the organs. So while it definitely wasn't ideal levels of oxygenation, his brain was definitely getting something during that time. (And if I misunderstood you or there's information I don't have, my apologies!)
I think that is what I read, apologies for the quick post
 

mauf

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I agree.

I think SVP is doing a good job. I also think he's better equipped than most at the Worldwide Leader, in both brains and compassion. He's switching between small-scale details of this incident and big-picture implications pretty adroitly.

His conversation with Aikman was illuminating - he wanted Aikman to talk from his own experience, and a still very shaken Aikman (whom I have heard say he doesn't want his sons playing football) saying he had never seen anything like this.
It was pretty jarring watching it all with my 17-year old who plays. Found myself listening much more than talking. Which is one reason why I find myself respecting Schefter for shutting up and letting the man who actually played (McFarland) talk.
 

riboflav

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I know its not remotely the same. But its reminds to the Donald Sterling situation, in which the the NBA players were planning on walking out if Silver and the owners did not take appropriate action.

its sad that it has to be the players (and coaches)who yet again are the ones who have to put their foot down and say, in essence that no. “We will not continue, this is more than just a game to us.”


View: https://twitter.com/ezlazar/status/1610109692839182339
Even at the high school level it’s always the coaches standing up to the selfish administrators/decision-makers, unfortunately. Or at least in my experience
 

GB5

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His vitals being back to normal could be through life support machinery, no?
 

Fred in Lynn

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I think ESPN should go to pre-recorded shows because this isn’t their forte. I don’t know how you guys have been able to stick with it so long.

CNN has had Gupta and Reiner on, and they both seem to think that based on what has transpired, it was possibly a case of commotio cordis. It wouldn’t in that case necessary be a congenital condition. I’m sure those wiser than myself have chimed in or heard this also, but wasn’t going to scan the thread to verify.
 

glennhoffmania

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Well that sounds like some bias. The second I saw Schefter, I noted that he was wide eyed like he had seen a ghost, and was borderline turning green. He seemed to entirely understand and appreciate the weight of the situation. And was vocal with the other two soon into the situation that the game should probably not continue before the league made the call.
Yes, I'm biased because he's shown to be kind of clueless in the past. I don't randomly have some bias against him for no reason.
 

Marciano490

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I remember disliking Clark as a player - maybe just the laundry - but he’s doing an amazing job tonight.
 

riboflav

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Even at the high school level it’s always the coaches standing up to the selfish administrators/decision-makers, unfortunately. Or at least in my experience
Just to follow. My best example is forcing high school basketball teams in my area to compete indoors without masks pre-vaccine bc the administrators feared parent blowback. It took the coaches uniting to resist their efforts. Kids still weren’t even allowed back in schools but basketball must go on!
 

fiskful of dollars

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that’s great news right?
It's good his vital signs are stable. He's intubated (not good). The major concern in addition to any traumatic injury will be the possibility of an anoxic brain injury while he was being resuscitated. That can take minutes, or days or weeks to sort out. It's way too early to tell. Hopefully good CPR and rapid correction of (a likely) dysrhythmia prevented anoxia...or a stroke...or an MI...or multi-system organ failure. A LOT of really bad things happen to the body when the heart stops beating effectively. And they happen very quickly.
 

joe dokes

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Yeah the right thing to do was what they did, leave him on but let Suzy and Booger do most of the talking
And to be fair to him, the couple of times I saw schefter talk it was because kolber asked him a question. So it's kind of like they *all* realized that she could facilitate booger giving some insight.
 

strek1

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Was just texting wirth my teenage Grandson who's really pissed right now. He is a big NFL fan and was watching the game. He's quite upset after seeing this. Now he's pissed because he was browsing Instagram posts and there's a handful of idiots trying to blame this on Damar Hamlin being vaccinated. He doesn't understand why people always have to drag their politics into these situations. I told him those trolls are everywhere and are ready to inject their ignorance into any situation. Ignore them.
 

Jeff Frye's Face Mask

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His brain had no oxygen for 9 minutes apparently. It's super sad, I feel horrible for him. His mom was there.
A down time of 9 minutes is concerning. At this point, I would imagine he’s been (CT) scanned to rule out other potential causes highlighted by others and he’s probably had a formal echocardiogram as well as labs, etc etc. Given that he has not woken up, I would imagine they’re now going to control his temperature (basically prevent a fever) for the next 48 to 96 hours and monitor him (with additional testing based on his clinical course) and see how he does.

Disclosure (some of you already know what I do but just to be transparent) - I’m a PCCM physician who takes care of these types of patients way too much
 

Catcher Block

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I just read about SVP's heart-related scare almost exactly a year ago. This can't be easy for him with that added context, and he's doing a great job with this.
 

twoBshorty

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It's more than a little concerning that he's not breathing on his own, no? And apparently didn't do so when they got his pulse back? Christian Eriksen was only down for about 3 minutes total and came to pretty quickly after being shocked. He was conscious and breathing on his own when they wheeled him out on the gurney and was able to speak to correct one of the medics when he overheard his age stated wrong. This sounds more like Fabrice Muamba or worse, Abdelhak Nouri.
 

BigJay

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Didn't see it live, and way late to this but obviously the heart issue is the main concern, but the way his head hit the ground probably gave him a concussion too which won't help matters.
 

scott bankheadcase

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It's more than a little concerning that he's not breathing on his own, no? And apparently didn't do so when they got his pulse back? Christian Eriksen was only down for about 3 minutes total and came to pretty quickly after being shocked. He was conscious and breathing on his own when they wheeled him out on the gurney and was able to speak to correct one of the medics when he overheard his age stated wrong. This sounds more like Fabrice Muamba or worse, Abdelhak Nouri.
yeah unfortunately this is clearly worse than Eriksen.
 

OCST

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His brain had no oxygen for 9 minutes apparently. It's super sad, I feel horrible for him. His mom was there.
View: https://twitter.com/jordonr/status/1610116502845558784?s=46&t=FJjy1HCEXg89kgPAZ07y-g



Update on Damar:

His vitals are back to normal and they have put him to sleep to put a breathing tube down his throat. They are currently running tests.

We will provide updates as we have them.
Even if he "comes to" soon, his brain may have gone without the optimal level of oxygen for some period of time, his cardiac system has had this severe shock... the number of insults to his various systems, we may not know if he's "okay" for a while.

Edit: or see what the docs upthread say.
 

Petagine in a Bottle

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A down time of 9 minutes is concerning. At this point, I would imagine he’s been (CT) scanned to rule out other potential causes highlighted by others and he’s probably had a formal echocardiogram as well as labs, etc etc. Given that he has not woken up, I would imagine they’re now going to control his temperature (basically prevent a fever) for the next 48 to 96 hours and monitor him (with additional testing based on his clinical course) and see how he does.

Disclosure (some of you already know what I do but just to be transparent) - I’m a PCCM physician who takes care of these types of patients way too much
thank you and all the other experts for the info tonight, really appreciate it.
 

fiskful of dollars

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A down time of 9 minutes is concerning. At this point, I would imagine he’s been (CT) scanned to rule out other potential causes highlighted by others and he’s probably had a formal echocardiogram as well as labs, etc etc. Given that he has not woken up, I would imagine they’re now going to control his temperature (basically prevent a fever) for the next 48 to 96 hours and monitor him (with additional testing based on his clinical course) and see how he does.

Disclosure (some of you already know what I do but just to be transparent) - I’m a PCCM physician who takes care of these types of patients way too much
Yes, therapeutic hypothermia or CODE ICE is prob ongoing in the ICU.
 

patinorange

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8slim

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I think ESPN should go to pre-recorded shows because this isn’t their forte. I don’t know how you guys have been able to stick with it so long.

CNN has had Gupta and Reiner on, and they both seem to think that based on what has transpired, it was possibly a case of commotio cordis. It wouldn’t in that case necessary be a congenital condition. I’m sure those wiser than myself have chimed in or heard this also, but wasn’t going to scan the thread to verify.
ESPN is covering this quite well. People hate them, I get it, but they are the preeminent sports news organization. SVP, Ryan Clark and everyone involved with the current live telecast are reporting with grace and competence. The news nets are doing mostly speculation and meta commentary from what I see. I find that much worse.
 

Marciano490

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ESPN is covering this quite well. People hate them, I get it, but they are the preeminent sports news organization. SVP, Ryan Clark and everyone involved with the current live telecast are reporting with grace and competence.
Yeah, Clark and SVP are doing an incredible job. It’s incredible watching Clark in particular.
 

AlNipper49

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ESPN is covering this quite well. People hate them, I get it, but they are the preeminent sports news organization. SVP, Ryan Clark and everyone involved with the current live telecast are reporting with grace and competence. The news nets are doing mostly speculation and meta commentary. I find that much worse
I think ESPN is a piece of shit as well, but we've had this on for a bit and I'm pretty sure that I haven't seen a commercial. They're doing a great job imho.
 

GB5

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Jeff Frye: can you give us, even if dark, what statistically is the most likely outcome here in your experience?
 

InstaFace

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My dad brought up this good point re: heartbeats:

“He got hit just at thr wrong time, between heartbeats. There is a fraction of a second that if you get slammed right then you heart just stops”
Commotio cordis is the phenomenon where a sudden blunt impact triggers a fatal arrythmia- I think that's what the Little League event was.

https://www.ahajournals.org/doi/full/10.1161/circep.111.962712#d1e141
Yep this is probably the culprit, I would expect.

In layman's terms, in the rhythm of our regular heartbeat, there is a tiny millisecond of the process in which our hearts are vulnerable to something interrupting the normal electrical signals that indicate to the heart that it should do its next thing. To have it be a problem, we have to take a substantial impact, to the exact right spot in the chest, at that exact millisecond in our heartbeat. It's like the Death Star's exhaust shaft, except for our heart's continued proceedings - a miniscule, but potentially fatal, bug in the ol' software. If that all coincidentally happens, your heart is stopped, and you basically keel over as if you've been pole-axed. If you get immediate CPR and defib you're fine, if you don't you probably die.

That's a large part of why you're now required to have AEDs at little league and at most sporting events of moderate size (And why people getting certified to run such sporting events inevitably learn about it), because it's a freak occurrence but happens through a confluence of otherwise-unremarkable events in sports. Though rare, I've heard of it happening in ultimate frisbee, a non-contact sport. It happening to someone like Hamlin has nothing to do with the brutality of gridiron football, and everything to do with having really really bad luck.

edit: OK I had checked a few pages in before posting, but now I've made it up to the point in the thread where FOD posted. I'll leave this up as a basic statement of what (probably) happened, and will leave further elaboration to the pros.
 

OCST

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Call me crazy, but I find listening to SVP and Clark to be reassuring/soothing? This does hit a little close to home for me, as it does for some of you who've had similar experiences themselves or with family, and listening to them talk about it is helpful - facts + empathy is so much better than a vacuum.
 

chechusma

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Hey - another ER doc here and as usual, coming in after Fisk:
A blow to the chest can cause sudden, cardiac death. It’s called commotio cordis. Essentially, the trauma causes a brief electrical spike. If it happens during a particular point of the cardiac cycle, it can stop the heart immediately. It is much much more common in young children due to the increased compliance of the chest wall. Most cases that I’ve ever heard of occur with a strike to the sternum, usually a punch or a ball – like in baseball or lacrosse.
It’s extremely rare. Only about 10 to 20 cases a year are reported. I don’t think I’ve ever heard of a case in anyone over the age of 20 years of age. Every case I’ve heard of, or attended to, involved baseball. I would think shoulder pads would prevent the anterior chest from this type of injury. Modern pads cover the upper/mid sternum and anterior chest. Resuscitation was historically dismal, but that has improved with better recognition. There is some speculation that certain individuals are more predisposed given a possible underlying dysrhythmia. The variables that are necessary for this to occur include the shape of the projectile, the velocity and timing of the incident. Without going into the specifics of the cardiac electrical cycle and repolarization, the most common underlying dysrhythmias include long QT syndrome, and a condition called Brugada syndrome.

A blow to the chest does transmit electrical activity through the chest wall into the heart. If this occurs, it creates an electrical spike which (if timed to occur exactly) can cause a "R on T phenomena". The waves of the EKG are labelled PQRST (U). This causes ventricular fibrillation which must be immediately electrically corrected (defibrillation) or else the heart will stop. Whenever I’m at the bedside and a patient’s heart stops (rare, but it happens enough) the quickest way I have to get it restarted is a thump, essentially a punch into the chest of the patient. It is thought that a normal punch to the chest confers approximately 2-5 J of energy. A punch, hit, ball, etc is more like 20-40J. Enough to stop the heart if it happens at the precise wrong time. To be clear, this is an enormously rare event. Just an awful situation. Defibrillation will almost surely save him if that's the issue. I'm sure the med staff on the field know this stuff cold and the defibrillators are all right there.

Edit: Docsplaining, clarity
Excellent recap.
Just as a point of reference, the amount of joules used to “shock” a heart in fibrillation/arrest is 200-360J, so it’s actually (scarily) not a huge fraction to cause the rare arrhythmia (if commotio cordus is in fact the diagnosis, which I personally think is probably most likely - other causes of arrest after blunt chest trauma typically (a) require way more force (ie, aortic disruption) or (b) take a bit more time to cause arrest (tamponade, tension pneumothorax etc).

Aren't there meds or combinations of meds that in crease the interval, and increase the risk of this?
for long QTc syndrome (see below), yes. But not necessarily commotio cordis.

Is what was described before essentially a coma? Pulse, not breathing on own.
eh - “not breathing on your own” is always hard to get a read on, because as soon as one is intubated, they are sedated (and occasionally paralyzed, usually as part of the intubation but sometimes after) and “not breathing on their own”. Intubating patients used to be the first thing we did for arrest patients, but subsequently (and appropriately) it has become secondary to good chest compressions and defibrillation (if indicated). Intubation then becomes secondary and gets done either after return of spontaneous circulation (heart starts beating again) or, if tons of appropriately trained medical providers around, when it is convenient or during a lull in the action.

My guess is they suspend and resume tomorrow.

Upthread someone linked to a good story about the Muamba situation, that was also a long time in the ambulance. Basically one of the things is that you can do a lot of stuff in the ambulance, and don't want to be moving while you do it. Once you've done all the same things you'd be doing either way, you drive to the best hospital for the job.
Not sure what local EMS protocols are (and I am sure given the age/profile they would transport), but some EMS protocols (ie, NH) mandate staying on scene until ROSC (heart beats again). It’s really hard to do effective chest compressions (which are secondary in importance in terms of outcomes only to appropriate defibrillation) in the back of an ambulance, so I get the delay.

I’m not a doctor, and I didn’t stay at holiday inn express last night, but generally with a serious trauma the EMTs are in radio communication with the hospital regarding what to do. And at an NFL game, there’s already doctors there. So even if the prognosis was very bad, I doubt they would say, eh we’re just gonna call it here and not hurry. It’s more likely a decision was made with and by doctors that he could receive better care stationary in the ambulance than hauling ass to the hospital.
see above. EMS crews do use online (and offline) medical control, but they are well trained and likely would not need to use in this case, unless there was something really wonky where they needed to go outside of usual protocols.

There is speculation - but not objective evidence (the n of commotio is so, so low) that long QT syndrome and Brugada MAY be correlated with a higher incidence. Impossible to validate but it makes some physiologic sense.
I agree with the physiologic sense. Both of these have the longer appearing t wave upstroke on the EKGs, which seems like it would increase the (tiny) risk, marginally. Both of these conditions are associated with sudden cardiac death in young people (including athletes), but via different mechanisms that don’t require blunt chest trauma .

I'm not sure how rigorous the medical screening process is, but hopefully those would be seen on an EKG? I agree commotio cordis seems mostly likely, but the fact that they intubated even after ROSC makes me nervous
See above re: long QT and brugada. These will show up (to an extent HOCM, which is why Hank Gathers arrested) on an EKG, but commotio cordis can happen in people with normal EKGs, based purely on bad luck of timing and force and location of chest trauma.

As a possible (apocryphal) aside. My dad (also a doc) said that he was responsible for screening for Bruins players back in the day, and he said that Ray Borque had an abnormal EKG (left bundle branch block) which he should have not cleared, but he did. Again, no idea on the veracity of that claim, but I leave my dad his stories as he gets older.


For the doctors: I am guessing they need to verify cardiac function, and then they have to assess the impact of reduced oxygen to the brain for the period of time it was impacted right? That takes some time, I would guess, not being a doctor. Just to say, delay in an update is not surprising here.
Basically, yes. 9 minutes of CPR (“down time”, low flow to the brain), really isn’t that long though, and he had early effective CPR and early defibrillation. That really doesn’t seem bad to me. It can be hard to assess after when some one is I think aged and got a bunch of medications. I think the thing I would most want to know would be whether he had further arrhythmias or not, or if it was 10 minutes and done. I guess also whether there were any other blunt chest injuries.
 

Pablo's TB Lover

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Eh, regarding all the Schefter talk here tonight he is who we think he is. He's a breaking news guy who doesn't deal in detailed follow ups and doesn't seem to be the most empathetic guy. But he is part of the Monday night crew and was worth having on set at least due to his contacts and if anything "newsy" came up. It's the same when the NBA news-breaker Woj is on the ESPN studio team, I believe he may have been around the night of the Bucks walking out of their game in the bubble, but he didn't have too much to add to that broadcast for obvious reasons.

Clark was definitely the right empathetic guy to have on tonight however. Am not sure if he was even scheduled for this evening, but teaming him with SVP was perfect.
 

brandonchristensen

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I'd have thought they'd want to be in Cincy in case they could visit Hamlin in the hospital.
Yeah - though if he’s in the ICU, he’s likely there for awhile - and they wouldn’t be able to go visit anyway. Maybe the captains stayed. Hard to say, I think everyone is in a waking nightmare right now.
 

Marciano490

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Yep this is probably the culprit, I would expect.

In layman's terms, in the rhythm of our regular heartbeat, there is a tiny millisecond of the process in which our hearts are vulnerable to something interrupting the normal electrical signals that indicate to the heart that it should do its next thing. To have it be a problem, we have to take a substantial impact, to the exact right spot in the chest, at that exact millisecond in our heartbeat. It's like the Death Star's exhaust shaft, except for our heart's continued proceedings - a miniscule, but potentially fatal, bug in the ol' software. If that all coincidentally happens, your heart is stopped, and you basically keel over as if you've been pole-axed. If you get immediate CPR and defib you're fine, if you don't you probably die.

That's a large part of why you're now required to have AEDs at little league and at most sporting events of moderate size (And why people getting certified to run such sporting events inevitably learn about it), because it's a freak occurrence but happens through a confluence of otherwise-unremarkable events in sports. It happening to someone like Hamlin has nothing to do with the brutality of gridiron football, and everything to do with having really really bad luck.
All the experts and MDs can go to bed. Dr. Google is here.