WEBVTT - Selects: How Therapeutic Hypothermia Works 0:00:00.080 --> 0:00:03.440 M Hey everybody, it's Josh and for this week's select, 0:00:03.480 --> 0:00:08.240 I've chosen our two thousand fifteen episode on therapeutic hypothermia. 0:00:08.720 --> 0:00:11.080 It sounds weird and boring and it's a really super 0:00:11.119 --> 0:00:15.800 science EPP. But sometimes sometimes those can be the best ones. 0:00:16.400 --> 0:00:19.040 This topic is super interesting. It's a look at how 0:00:19.120 --> 0:00:22.520 science can stave off death and hopefully it's the direction 0:00:22.560 --> 0:00:25.680 that modern medicine is heading. Plus, if you get bored, 0:00:25.920 --> 0:00:28.400 you can thrill the hearing us. Try to say cellular 0:00:28.560 --> 0:00:32.760 level here or there. It's hilarious. Enjoy. I command you. 0:00:37.080 --> 0:00:39.879 Welcome to Stuff you Should Know, a production of I 0:00:40.000 --> 0:00:48.680 Heart Radio. Hey, and welcome to the podcast. I'm Josh Clark. 0:00:49.080 --> 0:00:54.400 There's Charles W. Eager Beaver, Chuckers Bryant ready to get 0:00:54.400 --> 0:00:59.760 its therapeutic hypothermia on. Yeah, baby, I'm chilling. Yeah, moving 0:00:59.760 --> 0:01:03.960 at a glacial paste today, right, I am um, I'm 0:01:03.960 --> 0:01:06.640 sorry for that. That was actually a poke at the 0:01:06.720 --> 0:01:10.200 author of this article. Yeah, that's uh. That stood out 0:01:10.240 --> 0:01:12.959 to me as well. I'm not telling you Jerry's over 0:01:13.000 --> 0:01:17.479 there and stuff you should know. No, I'm done. Um. Yeah, 0:01:17.520 --> 0:01:20.120 we were goofing off about this article and how stuff works. 0:01:20.120 --> 0:01:23.959 That there were way too many cold puns for my liking. 0:01:24.400 --> 0:01:27.600 There was a lot of puns, you know, a lot 0:01:28.000 --> 0:01:33.280 lots of them. Yeah, this article stinks of punt it reeks. 0:01:33.360 --> 0:01:38.080 So how you doing, man, how you feeling? I'm good? Uh, 0:01:37.880 --> 0:01:40.679 it seems there's a sickness going around the office. Yeah, 0:01:40.760 --> 0:01:43.160 which I thought we knew here in two thousand and 0:01:43.240 --> 0:01:45.480 fifteen that if you're sick, you don't come into work, 0:01:46.040 --> 0:01:48.920 especially when you have a liberal telecommune policy right like 0:01:48.960 --> 0:01:53.160 we do. I realized, Um, I realized that people need 0:01:53.160 --> 0:01:55.160 to come in and shoot video and recording all that. 0:01:55.240 --> 0:01:58.600 But come in, you do that, and you leave, and 0:01:58.640 --> 0:02:01.600 you wear like a plague doctor's mask the whole time 0:02:01.640 --> 0:02:03.920 you're here too. Yeah. I mean, I have a biohazard 0:02:03.960 --> 0:02:06.320 suit at my desk, but has a RiPP in it. 0:02:06.400 --> 0:02:10.160 Anyone can wear it, has a ripping. It's very small 0:02:10.200 --> 0:02:13.640 rental and cleaning fee. You're going to take a blood 0:02:13.639 --> 0:02:17.520 sample of mine wearing that thing. And it occurred to 0:02:17.560 --> 0:02:19.120 me as you were about to put it on, like 0:02:19.240 --> 0:02:20.840 I don't know where that thing has been, Like, that's 0:02:20.880 --> 0:02:24.000 a real biohazard suit and Chuck's going to use it 0:02:24.040 --> 0:02:28.400 to open my skin. Yeah, this sounds very odd. Um, 0:02:28.440 --> 0:02:31.240 we don't just do this in the office. We did 0:02:31.240 --> 0:02:33.680 our blood Types episode live here in Atlanta, and we 0:02:33.760 --> 0:02:37.360 actually took Josh's blood type on stage because you didn't 0:02:37.400 --> 0:02:41.240 know it. No, I when we recorded the version in 0:02:41.320 --> 0:02:44.120 the studio, I genuinely did not know it. Yeah, so 0:02:44.160 --> 0:02:46.000 I took your blood on stage. You trusted me. I 0:02:46.040 --> 0:02:48.840 did not wear the contaminated suit. No, you. You just 0:02:49.160 --> 0:02:53.200 used your dirty hands with no like rubber gloves or anything. 0:02:53.240 --> 0:02:56.080 Look at you. You're fine ish and you know your 0:02:56.080 --> 0:03:02.840 blood type now, which was a positive like Jarius, So 0:03:03.160 --> 0:03:06.079 we should release that whole live show. Is a just 0:03:06.120 --> 0:03:09.880 a special yeah little bonus. Yeah bonus. That was the 0:03:09.919 --> 0:03:12.040 word I was looking for. There's something special about it. 0:03:11.960 --> 0:03:14.480 It's just a bonus. That was special. Yeah, it's a 0:03:14.480 --> 0:03:19.240 good idea. Look for that soon people. So, uh, today, Chuck, 0:03:19.280 --> 0:03:23.520 we're talking about therapeutic hypothermia and I am very excited 0:03:23.560 --> 0:03:27.160 about this. This is my idea of this article. Yeah, Um, 0:03:27.160 --> 0:03:29.519 it's pretty neat. I don't remember. I guess I first 0:03:29.560 --> 0:03:31.679 heard of it from that Mosaic article that we both 0:03:31.680 --> 0:03:35.839 read to the big sleep awesome article. And uh, if 0:03:35.880 --> 0:03:38.640 you haven't figured out by now we have started to 0:03:38.960 --> 0:03:42.560 on the podcast page for each episode, put related links 0:03:42.800 --> 0:03:45.080 on there on our site stuff you should know dot com, 0:03:45.120 --> 0:03:47.320 so that articles on there. There's a bunch of other 0:03:47.360 --> 0:03:50.280 stuff on there too that will cover UM. But be 0:03:50.360 --> 0:03:52.720 sure to check out that mosaic article. It's very neat 0:03:53.680 --> 0:03:57.840 um and that article first introduced me to the concept 0:03:57.880 --> 0:04:03.480 of therapeutic hypothermia or medically induced hypothermia as another another 0:04:03.640 --> 0:04:07.920 term for it. I don't prefer target targeted temperature management. 0:04:07.960 --> 0:04:12.840 That sounds yeah corporate, Yeah, very corporate. You know the 0:04:13.080 --> 0:04:15.480 HMO term for it, like we'll we'll call it this 0:04:15.520 --> 0:04:17.520 because it'll less than the likelihood that we'll get sued 0:04:17.600 --> 0:04:21.000 or something exactly. Yes, yeah, I agree. But it's been 0:04:21.040 --> 0:04:24.880 around for a while, and the the idea that exposing 0:04:24.920 --> 0:04:29.560 people to lower temperatures to allow for better medical interventions, 0:04:29.600 --> 0:04:33.640 which is the whole basis of therapeutic hypothermia UM, has 0:04:33.640 --> 0:04:37.240 been around at least since the Napoleonic Wars. Yeah, it's 0:04:37.279 --> 0:04:39.480 pretty neat. I was interested to find that out. They 0:04:39.560 --> 0:04:43.200 noticed way back when in the eighteen hundreds early eighteen hundreds, 0:04:44.040 --> 0:04:49.120 uh that troops in battlefield trauma, wounded soldiers would the 0:04:49.160 --> 0:04:51.240 ones who were not kept warm and cozy by the 0:04:51.279 --> 0:04:53.320 fire or in their tents, right, they're just left out 0:04:53.360 --> 0:04:55.920 on the battlefield and the coals. Yeah, they actually fared better. 0:04:56.160 --> 0:04:59.160 And they were like, wait a minute, is uh And 0:04:59.200 --> 0:05:00.680 of course they had no idea at the time what 0:05:00.720 --> 0:05:02.680 was going on. No, they're like, did you notice that? Yes, 0:05:02.760 --> 0:05:06.280 I did notice that the heart well back to our brandy, Yeah, 0:05:06.279 --> 0:05:09.240 pretty much. But they did notice that the ones who 0:05:09.240 --> 0:05:11.120 were warm did a lot worse than the ones that 0:05:11.160 --> 0:05:13.560 were left out in the cold, which is super interesting. Yeah, 0:05:13.600 --> 0:05:17.920 But the the real investigation into what was going on 0:05:17.960 --> 0:05:20.719 there didn't start until the thirties with a guy named 0:05:20.800 --> 0:05:23.719 Dr temple Faye, and he was actually the first guy 0:05:23.760 --> 0:05:27.440 to write about using therapeutic hypothermia. I think in n 0:05:29.040 --> 0:05:31.000 was the first paper about it. But he was using 0:05:31.040 --> 0:05:34.160 it for a full decade or so before then, basically 0:05:34.200 --> 0:05:37.520 putting his patients in ice baths, opening the windows to 0:05:37.600 --> 0:05:41.360 their room during the winter, and um, just basically using 0:05:41.839 --> 0:05:45.200 any means he could to lower the temperature for I 0:05:45.240 --> 0:05:47.080 think I think he had he was using in a 0:05:47.160 --> 0:05:50.240 traumatic brain injury patients. Yeah, and I'm sure he did 0:05:50.279 --> 0:05:53.000 a lot of explaining along the way to family members 0:05:53.560 --> 0:05:55.560 that were like, hey, can you close the window and 0:05:55.640 --> 0:05:58.560 warm up my husband here? And that. He was like, 0:05:58.839 --> 0:06:01.520 all right, you wanted to I think back then too, 0:06:01.560 --> 0:06:03.800 he was like, it's the thirties and this guy is 0:06:03.800 --> 0:06:06.800 a traumatic brain injury. Really, there's nothing I can do 0:06:06.920 --> 0:06:10.599 to make it worse, the prospects worse, So why don't 0:06:10.600 --> 0:06:13.200 you just lighten up their family member? So there was 0:06:13.200 --> 0:06:17.839 another pioneer in the fifties named Dr Peter safar Um 0:06:17.960 --> 0:06:21.320 s A f A R. And he actually began experimenting 0:06:21.360 --> 0:06:24.159 around with this in the e er as well, trying 0:06:24.160 --> 0:06:27.240 to reduce tissue injury uh and brain image from a 0:06:27.320 --> 0:06:30.120 lack of blood flow. Uh. And this was mainly at 0:06:30.120 --> 0:06:33.960 the time in like stroke patients, cardiac arrest patients and 0:06:34.000 --> 0:06:35.960 what we'll talk more about it. There's all sorts of 0:06:36.720 --> 0:06:40.599 well not all sorts. There are several uses like cases 0:06:40.600 --> 0:06:44.640 where you would want to use this and UM ranging 0:06:44.680 --> 0:06:49.039 from cardiac arrest to like a gunshot wound to I think, 0:06:49.080 --> 0:06:53.920 what is the infant situation? Come again, it is called chuck. 0:06:54.160 --> 0:06:59.200 It's a type of encephalofy were ummic encephalofy. Yeah, where 0:06:59.240 --> 0:07:02.680 your natal basically the blood flow the lack of blood 0:07:02.680 --> 0:07:05.120 flow to the brains cut off for whatever reason, like 0:07:05.160 --> 0:07:07.560 maybe the umbilical cord gets rappidly on the baby's neck 0:07:07.680 --> 0:07:12.480 or what have you. Um, it leads to a swelling 0:07:12.720 --> 0:07:16.880 in the brain, and they started using it to medical 0:07:17.320 --> 0:07:20.840 the hypothermia to treat that. That's right, And that was 0:07:20.880 --> 0:07:23.480 in the fifties, right, Yeah, the fifties and sixties is 0:07:23.520 --> 0:07:26.880 when Dr Safar was doing his work. So this this 0:07:26.960 --> 0:07:29.440 is all kind of going on on the side and 0:07:29.640 --> 0:07:34.600 um experiments into hypothermia had kind of a bad name 0:07:35.200 --> 0:07:38.880 thanks to the Nazis, and a little bit also the 0:07:38.960 --> 0:07:42.600 Japanese and World War Two. But the Nazis, especially at 0:07:42.680 --> 0:07:46.040 Dock how the concentration camp or the death camp there 0:07:46.720 --> 0:07:53.320 um experimented using unwilling human subjects. Uh, they experimented on 0:07:53.360 --> 0:07:56.600 the effects of hypothermia in people's bodies. They did all 0:07:56.680 --> 0:08:01.080 manner of horrible, grizzly, gruesome stuff for they recorded the 0:08:01.240 --> 0:08:04.320 data and there was a long debate over the years 0:08:04.360 --> 0:08:07.920 over whether that data could be ethically used. And on 0:08:07.920 --> 0:08:11.320 one hand, people were saying, no, it's the Nazis. They 0:08:11.440 --> 0:08:15.200 used unwilling subjects. Is it amounted to torture in the 0:08:15.280 --> 0:08:18.640 name of science, and I just used air air quotes, right. 0:08:19.360 --> 0:08:21.520 And then other people said, well, wait a minute, these 0:08:21.560 --> 0:08:26.360 people died, um whether and we're whether they wanted to 0:08:26.480 --> 0:08:28.840 or not. They were made to be these test subjects 0:08:28.840 --> 0:08:30.880 and they gave their lives. We can honor them at 0:08:30.920 --> 0:08:33.720 least by using the data that was cold from it. Well, 0:08:33.760 --> 0:08:36.760 once they really dug into the data that the Nazis 0:08:36.800 --> 0:08:41.720 had accumulated, it was just like rank amateurs performing scientific experiments. 0:08:41.760 --> 0:08:46.680 They followed like almost no protocol. They did terrible record 0:08:46.800 --> 0:08:51.199 keeping of descriptions of subjects and things like that. So um, 0:08:51.240 --> 0:08:53.280 it's almost like you just have to toss it out 0:08:53.280 --> 0:08:58.000 because you just can't trust it scientifically the data. But 0:08:58.000 --> 0:09:03.560 but the idea that people were exposed forcibly to hypothermic 0:09:03.600 --> 0:09:06.640 conditions kind of gave hypothermia a bad name. So these 0:09:06.679 --> 0:09:10.080 guys experimenting with the stuff, it was fringe science for 0:09:10.080 --> 0:09:12.080 a while. Yeah, and then it started to come into 0:09:12.120 --> 0:09:15.360 the mainstream and then everybody said, well, wait a minute, 0:09:15.520 --> 0:09:18.240 hypothermia has all these bad side effects. Let's just table 0:09:18.280 --> 0:09:21.000 it for now. Yeah. In the in the fifties to 0:09:21.240 --> 0:09:23.520 NASA was doing a lot of work during the Space 0:09:23.600 --> 0:09:26.280 Race because the idea was and this is really sort 0:09:26.320 --> 0:09:31.680 of two parts. There's the the modern day uh cooling 0:09:32.040 --> 0:09:36.120 like that's not freezing somebody basically, and then we also 0:09:36.160 --> 0:09:38.640 have what's called suspended animation, which we'll get too later. 0:09:38.840 --> 0:09:41.360 Those are totally different things, totally different things, but they 0:09:41.400 --> 0:09:44.840 follow the same process initially, right yeah, um, well sort of, 0:09:44.920 --> 0:09:46.960 I mean the methods are different, but the same idea 0:09:47.040 --> 0:09:49.880 basically is to slow the body down, sown the heart rate, 0:09:49.920 --> 0:09:53.560 slow down everything, your metabolism. Yeah. Um. But NASA was 0:09:53.600 --> 0:09:56.000 doing this because they put a lot of money into 0:09:56.040 --> 0:09:58.720 it because they thought two things. One you could protect 0:09:58.720 --> 0:10:03.520 astronauts from cosmic rays and the other is basically straight 0:10:03.600 --> 0:10:08.000 up alien like we can freeze people on long journeys 0:10:08.000 --> 0:10:11.240 into space and then unfreezing when they get there, which 0:10:11.280 --> 0:10:13.439 is not just alien. That's a bunch of sci fi movies. 0:10:15.080 --> 0:10:19.040 But there was a doctor named James Lovelock back in 0:10:19.080 --> 0:10:23.040 the day who was um freezing hamsters until they froze 0:10:23.040 --> 0:10:27.480 and then basically until he couldn't hear heartbeat frozen, yeah, 0:10:27.520 --> 0:10:29.920 they were clinically dead. Yeah, and then they would he 0:10:29.920 --> 0:10:32.600 would put a little, uh, a little hot teaspoon against 0:10:32.600 --> 0:10:35.400 their belly and warm him back up, and he found 0:10:35.440 --> 0:10:37.480 that they were actually okay, and he was able to 0:10:37.480 --> 0:10:40.280 revive them some of them. Well sure, yeah, I'm sure 0:10:40.320 --> 0:10:42.320 there were losses along them, but I mean even one 0:10:42.720 --> 0:10:47.080 coming back to life and seeming normal again, it is 0:10:47.120 --> 0:10:51.480 pretty significant. It's a significant finding, Yeah, because basically the 0:10:51.520 --> 0:10:54.760 idea was planted all of a sudden that hypothermia can 0:10:54.880 --> 0:10:58.760 kill you or it can preserve you and keep you 0:10:58.800 --> 0:11:02.000 from dying in an extreme situation, right, which is kind 0:11:02.000 --> 0:11:07.080 of counterintuitive. Like you think of people who undergo hypothermia 0:11:07.480 --> 0:11:10.640 or you know, being exposed to extremely cold temperatures, they're dead. 0:11:10.920 --> 0:11:14.559 I mean, we've all seen the shining, we know the end. Yeah, 0:11:14.600 --> 0:11:16.880 But apparently there's a rule of thumb among the er 0:11:17.520 --> 0:11:21.800 physicians and staff that there's no such thing as a 0:11:21.800 --> 0:11:25.240 cold dead body. I thought it was measured twice cut once. 0:11:26.080 --> 0:11:30.320 It's a little different. That's for the surgeons. Um, No, 0:11:30.920 --> 0:11:33.760 there's no such thing as a as a cold dead body. 0:11:33.800 --> 0:11:37.880 You're only dead when you're warm and dead, right, Because well, 0:11:37.960 --> 0:11:40.360 there's been some some cases throughout the years. The one 0:11:40.400 --> 0:11:44.240 that spectacular one. Yeah, this lady um was she with 0:11:44.320 --> 0:11:48.120 Norwegian on a boggenhorn. Um, I don't even know what 0:11:48.240 --> 0:11:50.080 that is. It's not an oom out, it's a single 0:11:50.160 --> 0:11:55.000 circle above that A. That's a it's a very Norwegian. Yeah, 0:11:55.240 --> 0:11:59.280 death metal band name totally. Uh So she was skiing 0:11:59.600 --> 0:12:02.720 and um, actually I think she was Swedish, but she 0:12:02.800 --> 0:12:06.440 was on holiday skiing in Norway. Um fell headfirst into 0:12:06.440 --> 0:12:10.280 a frozen stream and was trapped under ice, submerged for 0:12:10.440 --> 0:12:15.920 eighty minutes, stopped breathing, heart stopped. Yeah. I mean she 0:12:16.000 --> 0:12:18.160 was well known. She didn't drown. They thought she drowned 0:12:19.120 --> 0:12:25.000 until they reheated her. Ten days they reheated her and 0:12:25.080 --> 0:12:28.559 she was fine, Like weeks and months later she fully recovered. 0:12:29.240 --> 0:12:33.160 And basically, if you're underwater warm water, you have a 0:12:33.160 --> 0:12:36.319 few minutes at most. But what they discovered was if 0:12:36.320 --> 0:12:41.160 you actually go into hypothermia, it can preserve your body. Um, 0:12:41.160 --> 0:12:45.160 which was amazing and a big breakthrough into like, hey, 0:12:45.200 --> 0:12:47.800 maybe we can use this right. Yeah, she was one 0:12:47.880 --> 0:12:50.280 of a few a handful of people and we'll talk 0:12:50.320 --> 0:12:55.520 about some others too, but um, that what researchers into 0:12:55.600 --> 0:12:58.560 hypothermia I've learned and why they figured out that they're 0:12:58.600 --> 0:13:00.840 you're not cold and dead you're just warm. And debt 0:13:01.640 --> 0:13:06.680 is that it's not the the the addition of cold 0:13:07.400 --> 0:13:10.840 or the exposure to cold that kills you. It's warming 0:13:10.840 --> 0:13:14.480 back up in the wrong way too rapidly under the 0:13:14.520 --> 0:13:19.160 wrong circumstances stances that that's what can kill you. Yeah, 0:13:19.160 --> 0:13:22.839 it seems like it's a very fine line between well, 0:13:22.840 --> 0:13:24.800 we'll talk about the process, but you have to do 0:13:24.840 --> 0:13:27.959 it just right on the cooling side and the warming 0:13:28.000 --> 0:13:31.160 side if you want to be successful right exactly. You know, 0:13:31.200 --> 0:13:33.720 it's they haven't quite figured it all out yet. This 0:13:33.760 --> 0:13:36.360 is in the very uh nascent stages. Still. It is 0:13:36.520 --> 0:13:40.240 ridiculously primitive and and to the point where it's kind 0:13:40.240 --> 0:13:42.920 of like if you're a doctor experimenting with this, you 0:13:42.920 --> 0:13:47.040 you would be like, there's a d chance that your 0:13:47.240 --> 0:13:52.120 dad is going to die under normal circumstances. We have 0:13:52.200 --> 0:13:55.319 this one radical technique we can try that might help. 0:13:55.920 --> 0:13:59.960 Can we try this? And that that that whether they 0:14:00.040 --> 0:14:04.280 had lives or dies after being given medical hypothermia, he's 0:14:04.280 --> 0:14:06.720 still going to end up as like the subject of 0:14:06.760 --> 0:14:10.080 a major paper that would be written, because that's where 0:14:10.080 --> 0:14:12.320 it's at right now. Yeah, And I read one doctor 0:14:12.400 --> 0:14:15.320 said that they they think they pretty much know, it's 0:14:15.520 --> 0:14:18.520 super possible and we'll work, he said, But it's the 0:14:18.520 --> 0:14:21.600 the doing of it that's just really really hard. Exactly. Yeah, 0:14:21.640 --> 0:14:24.920 I mean like it makes a complete sense intuitively, we 0:14:25.040 --> 0:14:28.680 understand like what it's doing. It's just yeah, the fine tuning, 0:14:28.720 --> 0:14:31.920 the nuance behind it that it's still kind of mysterious. 0:14:32.080 --> 0:14:35.360 The most brilliant doctors say, it's just really hard. He said, 0:14:35.400 --> 0:14:37.760 it's really dog gone hard to do. It kind of 0:14:37.760 --> 0:14:40.720 makes you go, yeah, you know, is that the quote? 0:14:41.280 --> 0:14:43.680 He know, his quote was, it's really dog gone hard. 0:14:43.920 --> 0:14:48.560 And then my quote was, but we'll talk about medical 0:14:48.640 --> 0:14:53.240 hypothermia and what it is specifically, uh, in just a 0:14:53.320 --> 0:15:17.560 minu alright, so therapeutic hypothermia. Hypothermia is basically when you 0:15:17.720 --> 0:15:23.840 lower the body temperature for various reasons to keep it alive. 0:15:24.120 --> 0:15:27.640 And right now, what they're mainly doing now, this isn't 0:15:27.680 --> 0:15:31.080 the second wave, which is freezing somebody. This is just 0:15:31.480 --> 0:15:36.440 cooling a body before and after surgery to help them 0:15:36.560 --> 0:15:41.120 increase their chances of survival. Basically, right, your your body. Um, 0:15:41.680 --> 0:15:44.960 and they're doing that now on this side, they're just 0:15:45.000 --> 0:15:48.080 not doing the other quite yet on humans. Yes, um, 0:15:48.120 --> 0:15:52.640 so under normal circumstances, your body maintains a normal core 0:15:52.720 --> 0:15:57.920 body temperature, normative temperature because what it's called, right, and um, 0:15:57.960 --> 0:16:01.880 that's somewhere between like nineties in nine point six degrees 0:16:02.400 --> 0:16:05.960 is a normal human core body temperature. And all of 0:16:06.000 --> 0:16:08.600 this is and dude, do you remember and like when 0:16:08.600 --> 0:16:11.800 I went on that crazy, weird metaphysical tangent and does 0:16:11.840 --> 0:16:16.440 the body replace itself? Somebody wrote in and said, check 0:16:16.480 --> 0:16:19.640 this article out, like here's a really great explanation of 0:16:20.240 --> 0:16:24.480 why things live, where life comes from. And it was this, um, 0:16:24.520 --> 0:16:29.040 this idea, it's a physics based idea of life and evolution. 0:16:29.320 --> 0:16:33.160 And it says that because of entropy, because of one 0:16:33.160 --> 0:16:36.640 of the laws of thermodynamics, that atoms will arrange themselves 0:16:36.640 --> 0:16:39.520 in a way that they can take in energy and 0:16:39.880 --> 0:16:43.520 dissipate heat in a really efficient manner. And so of 0:16:43.560 --> 0:16:46.840 course they're gonna atoms are eventually going to arrange themselves 0:16:46.880 --> 0:16:50.560 into life. It just makes total sense. Right, So, being 0:16:50.680 --> 0:16:54.280 living things like we are, we take in energy and 0:16:54.360 --> 0:16:58.240 we dissipate heat, and that's what forms our core body temperature. Right. 0:16:58.720 --> 0:17:03.040 With therapeutic hype of thermia, what you're doing is lowering 0:17:03.920 --> 0:17:08.440 the metabolic rate through the addition of cold, and so 0:17:08.520 --> 0:17:12.440 we put out less heat, and by doing that, we're 0:17:12.480 --> 0:17:17.080 also lowering our energy demand, so that that that little 0:17:17.119 --> 0:17:19.439 engine that's going all the time and our cells and 0:17:19.720 --> 0:17:23.399 our body in general gets slowed down. And it's not 0:17:23.480 --> 0:17:26.080 altered in any way except for the speed and the 0:17:26.240 --> 0:17:30.280 energy consumption. It's just slowed down. It's doing everything slower. 0:17:30.720 --> 0:17:34.119 And you can do that simply by lowering the temperature 0:17:34.560 --> 0:17:37.879 of the person. Yeah, and it's it's not just lower, 0:17:37.960 --> 0:17:42.639 it's um it doesn't need to be faster. Does that 0:17:42.680 --> 0:17:45.119 make sense, Like the heart beat slower because it doesn't 0:17:45.119 --> 0:17:48.120 need to beat any faster, not like your body is struggling. 0:17:48.160 --> 0:17:50.760 Your body is still doing fine. It's just reducing the 0:17:50.800 --> 0:17:54.879 demand for stuff like blood flow and neurotransmitter action and 0:17:54.880 --> 0:17:57.880 stuff like that exactly. And ultimately, what your heart does 0:17:58.000 --> 0:18:00.879 is pumps blood. And what your blood has this, among 0:18:00.920 --> 0:18:04.000 other things, oxygen, and your cells need oxygen to carry 0:18:04.000 --> 0:18:08.360 out these metabolic processes to burn energy, right, So if 0:18:08.400 --> 0:18:11.320 they need less, then your heart doesn't have to beat 0:18:11.359 --> 0:18:14.720 as much. It's like you said, it's just the normal processes, 0:18:14.720 --> 0:18:19.360 but on a much slower scale. Pretty awesome stuff. It is, 0:18:19.640 --> 0:18:22.720 and it's just through the application of colder temperatures. Oh yeah, 0:18:22.760 --> 0:18:25.040 and in this case UM, and we'll get to how 0:18:25.080 --> 0:18:26.920 to do it. But in this case you're not I 0:18:26.960 --> 0:18:29.600 mean you're literally cooling the body with like ice packs 0:18:29.680 --> 0:18:33.240 and cold blankets and stuff like that pre surgery and 0:18:33.280 --> 0:18:36.640 post surgery. It's not the suspended animation one that we'll 0:18:36.640 --> 0:18:40.080 get to when they're actually like pumping frozen saline through 0:18:40.080 --> 0:18:43.400 your pains. No, there are, but there are some UM 0:18:43.440 --> 0:18:49.479 techniques for medically induced hypothermia that do put in like 0:18:49.640 --> 0:18:53.600 chilled saline to chill your body down very quickly. But 0:18:53.680 --> 0:18:56.239 it's not like replacing your blood. Yeah yeah, yeah, I 0:18:56.240 --> 0:18:59.720 hear you. So there's a couple of applications at this point. 0:19:00.080 --> 0:19:04.320 End the cases are either involved intervention or prevention, and 0:19:04.440 --> 0:19:08.920 intervention is when they're trying to prevent further damage from 0:19:08.960 --> 0:19:12.640 an incident like a stroke or cardiac arrest or sort 0:19:12.640 --> 0:19:16.879 of the two main ones UM and then preventative wise, 0:19:17.040 --> 0:19:20.520 it's to extend operating time because back in the day 0:19:20.600 --> 0:19:24.119 you could not operate on UM. Well, back in the 0:19:24.200 --> 0:19:27.199 day you couldn't stop the heart to operate on it. No, 0:19:27.440 --> 0:19:30.000 which was I do remember we did like this day 0:19:30.040 --> 0:19:32.400 in history about the first guy to ever do open 0:19:32.440 --> 0:19:37.119 heart centuries of Black surgeon in Chicago the early twentieth century, 0:19:37.119 --> 0:19:41.000 I think, and he did an emergency open heart surgery 0:19:41.040 --> 0:19:46.919 with a beating heart. That guy was totally awesome, champion. UM. 0:19:47.320 --> 0:19:49.840 This was the case for a very long time, and 0:19:49.960 --> 0:19:53.320 you couldn't stop the heart. They finally invented a machine 0:19:54.080 --> 0:19:57.720 UM that basically does the work of the heart and 0:19:57.760 --> 0:20:01.600 the lungs, called the Heart Lung machine. Exactly where you're 0:20:01.640 --> 0:20:05.680 transferring blood through this machine and UM, it's removing c 0:20:05.880 --> 0:20:08.800 O two, it's adding oxygen, and it's pumping it back 0:20:08.840 --> 0:20:11.560 into the body while the heart and lungs are stopped. 0:20:12.400 --> 0:20:16.520 Revolutionized open heart surgery. There's problems with it. One of 0:20:16.520 --> 0:20:19.439 the problems is um when the blood comes back in 0:20:19.520 --> 0:20:22.600 the body, since it's been through this machine, it may 0:20:22.640 --> 0:20:27.040 have picked up some sort of foreign in bacteria, and 0:20:27.200 --> 0:20:30.240 the immune system sometimes mounts an attack on the blood. 0:20:30.560 --> 0:20:34.560 So this this machine poses its own problems. And alternatively, 0:20:34.680 --> 0:20:37.960 an alternative method for stopping the heart or slowing the 0:20:38.000 --> 0:20:43.639 heart is to use medically induced hypothermia. So that's an intervention, no, 0:20:43.800 --> 0:20:49.040 a prevention preventative use of medically induced hypothermia. But intervention 0:20:49.160 --> 0:20:50.960 is another way, like you said, and it can have 0:20:51.040 --> 0:20:55.480 to do a stroke or heart attacks or cardiac arrest. Right, 0:20:55.560 --> 0:20:59.439 aren't those two different things? I think so technically, but 0:20:59.520 --> 0:21:02.159 in some sort of cessation of the heart pumping blood. 0:21:02.520 --> 0:21:05.040 And the big problem with that it doesn't really matter 0:21:05.080 --> 0:21:07.800 whether your hand is getting blood for a while. The 0:21:07.920 --> 0:21:10.720 big problem that comes from a heart attack is your 0:21:10.760 --> 0:21:15.320 brain not getting blood for a while. Right, So here's 0:21:15.320 --> 0:21:18.360 what happens when blood stops flowing into your brain. Right, 0:21:19.080 --> 0:21:22.080 And we we covered this somehow in the How Dying 0:21:22.119 --> 0:21:26.399 Works episode. Yeah, the dying process. Okay, because it's not 0:21:26.480 --> 0:21:29.360 a it's not a black and white thing. Uh, you're 0:21:29.400 --> 0:21:32.000 not alive and then you're dead. It's comes in many 0:21:32.000 --> 0:21:35.640 many stages. And we talked about the stages of death. Yeah, 0:21:35.800 --> 0:21:39.600 so there's when what they've discovered is that, yeah, you're 0:21:39.600 --> 0:21:42.400 not like I'm alive and now I'm dead. Is what 0:21:42.440 --> 0:21:44.600 we covered in the How Dying Works episode? Right, Like 0:21:44.640 --> 0:21:46.800 dying in your sleep? I mentioned that the other day. 0:21:47.080 --> 0:21:49.080 How like nobody dies in their sleep. That's just a 0:21:49.200 --> 0:21:51.840 nice thing. That's a nice way to say they died 0:21:51.880 --> 0:21:57.560 in their bed. Yes, overnight, overnight, Yeah, exactly. Um so, yeah, 0:21:57.640 --> 0:22:01.200 there's with medically induced hypothermia, they've been able to extend 0:22:01.359 --> 0:22:04.680 that that time between when you appear to be dead 0:22:04.680 --> 0:22:07.920 and when you're actually dead, and by extending that time 0:22:07.960 --> 0:22:13.480 they can intervene UM better. And Yeah, even a little 0:22:13.480 --> 0:22:15.800 bit of time can go a long way. So one 0:22:15.800 --> 0:22:19.159 of the one of the things that medically induced hypothermia 0:22:19.200 --> 0:22:21.919 has been shown to really help is what's called return 0:22:21.960 --> 0:22:26.919 of spontaneous circulation after uh, you have a heart attack. 0:22:27.280 --> 0:22:29.880 The problem is is your heart and lungs can your 0:22:29.920 --> 0:22:33.440 cardio pulmonary system can start working again, but you might 0:22:33.480 --> 0:22:37.560 not regain consciousness. And in that case, that's a sign 0:22:37.640 --> 0:22:40.879 that your brain may be in trouble, your cognitive function, 0:22:40.920 --> 0:22:43.600 you may be suffering brain damage at that moment. Yeah, 0:22:43.600 --> 0:22:47.000 And isn't the stat one and ten cardiac arrest outside 0:22:47.000 --> 0:22:49.320 of a hospital has a like goes on to live 0:22:50.200 --> 0:22:54.320 like a without brain damage. Yeah, ten, only because you 0:22:54.320 --> 0:22:57.159 have a very small window and that window is usually 0:22:57.160 --> 0:22:59.120 longer than it takes to get to the hospital. Right, 0:22:59.160 --> 0:23:01.679 So if they bring you in and you are showing 0:23:01.760 --> 0:23:06.480 signs of um r OSC without return to consciousness, too um. 0:23:06.600 --> 0:23:10.360 They may induce medical medical hypothermia. And the reason why 0:23:10.440 --> 0:23:14.360 is the heart pumps blood, and blood contains things including 0:23:14.359 --> 0:23:19.280 oxygen right um. And one of the organs that uses 0:23:19.359 --> 0:23:22.800 probably the most oxygen of all, is the brain, and 0:23:22.840 --> 0:23:26.720 the brain uses its oxygen to um burn energy. Basically, 0:23:26.760 --> 0:23:30.640 it uses it to oxidize glucose. And when it does that, 0:23:30.720 --> 0:23:33.560 the reason it does is because you're neurons, your little 0:23:33.600 --> 0:23:36.720 neural cells that fire. The way they fire is because 0:23:36.720 --> 0:23:41.199 their chemical battery, their chemical battery with the stored potential charge, 0:23:41.560 --> 0:23:44.720 and they do that by keeping a lower concentration of 0:23:44.920 --> 0:23:49.320 electrolytes inside the cell than outside. So this difference creates 0:23:49.359 --> 0:23:52.600 the electrical charge that your neurons used to fire. Right 0:23:52.840 --> 0:23:56.080 on normal circumstances, that's all well and good, but when 0:23:56.359 --> 0:23:59.960 they stop, when they stop getting oxygen, they can switch 0:24:00.119 --> 0:24:02.720 to anaerobic mode for a little while, so they're still 0:24:02.800 --> 0:24:05.440 burning energy, but they're like, you need to start breathing again, 0:24:05.480 --> 0:24:08.600 because this is not very efficient. It's like the like 0:24:08.640 --> 0:24:13.119 when the emergency lights go on exactly exactly. So um. 0:24:13.160 --> 0:24:17.399