WEBVTT - How Therapeutic Hypothermia Works 0:00:00.560 --> 0:00:04.000 Welcome to Stuff you Should Know front House Stuff Works 0:00:04.040 --> 0:00:12.920 dot Com. Hey, and welcome to the podcast. I'm Josh Clark. 0:00:13.360 --> 0:00:18.640 There's Charles W. Eager Beaver, Chuckers, Brian ready to get 0:00:18.680 --> 0:00:24.200 its therapeutic hypothermia on. Yeah, baby, I'm chilling moving at 0:00:24.200 --> 0:00:28.560 a glacial pace today, right I am. Um, I'm sorry 0:00:28.600 --> 0:00:31.280 for that. That was actually a poke at the author 0:00:31.320 --> 0:00:34.559 of this article. Yeah, that's uh. That stood out to 0:00:34.600 --> 0:00:37.480 me as well. I'm not telling you. Jerry's over there 0:00:37.479 --> 0:00:41.879 and she's stuff you should know. No. Um, Yeah, we 0:00:41.880 --> 0:00:44.360 were gooking off about this article and how stuff works 0:00:44.360 --> 0:00:47.560 that there were a way too many cold puns for 0:00:47.680 --> 0:00:51.519 my liking. There's a lot of puns, you know, a 0:00:51.600 --> 0:00:56.840 lot lots of them. Yeah, this article stinks of pun reeks. 0:00:57.640 --> 0:01:02.360 So how you doing, man, How you feeling? I'm good. Uh. 0:01:02.120 --> 0:01:04.960 It seems there's a sickness going around the office. Yeah, 0:01:05.000 --> 0:01:07.440 which I thought we knew here in two thousand and 0:01:07.480 --> 0:01:09.760 fifteen that if you're sick, you don't come into work, 0:01:10.319 --> 0:01:13.160 especially when you have a liberal telecommune policy right like 0:01:13.240 --> 0:01:17.399 we do. I realized, um, I realized that people need 0:01:17.440 --> 0:01:19.240 to come in and shoot video and record and all 0:01:19.280 --> 0:01:22.039 that but come in, you do that, and you leave, 0:01:22.720 --> 0:01:25.680 and you wear like a plague doctor's mask the whole 0:01:25.680 --> 0:01:27.520 time you're here too. Yeah, I mean I have a 0:01:27.520 --> 0:01:30.400 bio hazard suit at my desk that has a RiPP 0:01:30.400 --> 0:01:33.720 in it. Anyone can wear it, has a rippen it, 0:01:33.920 --> 0:01:36.839 very small rental and cleaning the You're going to take 0:01:37.400 --> 0:01:41.240 a blood sample of mine wearing that thing. And it 0:01:41.280 --> 0:01:43.200 occurred to me as you were about to put it on, 0:01:43.280 --> 0:01:44.920 like I don't know where that thing has been, Like, 0:01:44.959 --> 0:01:47.840 that's a real bio hazard suit and Chuck's going to 0:01:48.000 --> 0:01:52.640 use it to open my skin. Yeah, this sounds very odd. Um, 0:01:52.680 --> 0:01:55.480 we don't just do this in the office. We did 0:01:55.520 --> 0:01:57.880 our blood Types episode live here in Atlanta, and we 0:01:58.000 --> 0:02:01.600 actually took Josh's blood type on stage because you didn't 0:02:01.640 --> 0:02:05.520 know it. No, I when we recorded the version in 0:02:05.560 --> 0:02:08.360 the studio, I genuinely did not know it. Yeah, so 0:02:08.400 --> 0:02:10.280 I took your blood on stage. You trusted me. I 0:02:10.280 --> 0:02:13.120 did not wear the contaminated suit. No, you you just 0:02:13.400 --> 0:02:17.480 used your dirty hands with no like rubber gloves or anything. 0:02:17.480 --> 0:02:20.320 Look at you. You're fine ish and you know your 0:02:20.320 --> 0:02:27.080 blood type now, which was a positive us guy, So 0:02:27.400 --> 0:02:30.320 we should release that whole live show is a just 0:02:30.400 --> 0:02:34.160 a special yeah, little bonus. Yeah, bonus. That was the 0:02:34.160 --> 0:02:36.280 word I was looking for. There's something special about it. 0:02:36.200 --> 0:02:38.720 It's just a bonus. It was special. Yeah, it's a 0:02:38.720 --> 0:02:43.520 good idea. Look for that soon, people. So today, Chuck, 0:02:43.560 --> 0:02:47.760 we're talking about therapeutic hypothermia and I am very excited 0:02:47.800 --> 0:02:51.399 about this. This is my idea of this article. Yeah, um, 0:02:51.440 --> 0:02:53.800 it's pretty neat. I don't remember. I guess I first 0:02:53.800 --> 0:02:55.919 heard of it from that Mosaic article that we both 0:02:55.960 --> 0:03:00.160 read to the big sleep Awesome article. And uh, if 0:03:00.200 --> 0:03:02.880 you haven't figured out by now, we have started to 0:03:03.200 --> 0:03:06.800 on the podcast page for each episode, put related links 0:03:07.040 --> 0:03:09.320 on there on our site stuff you should know dot com, 0:03:09.360 --> 0:03:11.560 so that articles on there. There's a bunch of other 0:03:11.639 --> 0:03:14.560 stuff on there too that will cover um. But be 0:03:14.639 --> 0:03:16.959 sure to check out that Mosaic article. It's very neat. 0:03:17.919 --> 0:03:22.120 Um and that article first introduced me to the concept 0:03:22.120 --> 0:03:27.760 of therapeutic hypothermia or medically induced hypothermia as another another 0:03:27.880 --> 0:03:32.200 term for it, I don't prefer target targeted temperature management. 0:03:32.240 --> 0:03:37.080 That sounds yeah corporate, Yeah, very corporate. You know the 0:03:37.320 --> 0:03:39.720 HMO term for it, Like, well, we'll call it this 0:03:39.760 --> 0:03:41.920 because it'll lessen the likelihood that we'll get sued or 0:03:41.960 --> 0:03:46.200 something exactly. Yes, um, But it's been around for a while, 0:03:46.720 --> 0:03:50.840 and the the idea that exposing people to lower temperatures 0:03:51.360 --> 0:03:54.520 to allow for better medical interventions, which is the whole 0:03:54.520 --> 0:03:59.000 basis of therapeutic hypothermia UM, has been around at least 0:03:59.040 --> 0:04:02.200 since the napoleon Onic Wars. Yeah, it's pretty neat. I 0:04:02.280 --> 0:04:05.120 was interested to find that out. They noticed way back 0:04:05.120 --> 0:04:09.400 when in the eighteen hundreds early eighteen hundreds that troops 0:04:09.720 --> 0:04:14.000 in battlefield trauma wounded soldiers would the ones who were 0:04:14.040 --> 0:04:16.040 not kept warm and cozy by the fire or in 0:04:16.080 --> 0:04:18.400 their tents, right, they're just left out on the battlefield 0:04:18.400 --> 0:04:20.760 and the cold. Yeah, they actually fared better. And they 0:04:20.760 --> 0:04:23.760 were like, wait a minute, is uh? And of course 0:04:23.800 --> 0:04:25.520 they had no idea at the time what was going on. No, 0:04:25.680 --> 0:04:27.599 They're like, did you notice that, Yes, I did notice 0:04:27.640 --> 0:04:31.080 that they're hardy back to our brand, Yeah, pretty much. 0:04:31.200 --> 0:04:33.919 But they did notice that the ones who were warm 0:04:34.120 --> 0:04:35.720 did a lot worse than the ones that were left 0:04:35.720 --> 0:04:37.960 out in the cold, which is super interesting. Yeah, But 0:04:38.200 --> 0:04:42.400 the the real investigation into what was going on there 0:04:42.440 --> 0:04:45.280 didn't start until the thirties. With a guy named Dr 0:04:45.360 --> 0:04:48.120 Temple Faye, and he was actually the first guy to 0:04:48.200 --> 0:04:53.400 write about using therapeutic hypothermia. I think in nineteen was 0:04:53.440 --> 0:04:55.440 the first paper about it, but he was using it 0:04:55.760 --> 0:04:58.760 for a full decade or so before then, basically putting 0:04:58.800 --> 0:05:01.800 his patients in ice ba ads, opening the windows to 0:05:01.839 --> 0:05:05.640 their room during the winter and um, just basically using 0:05:06.080 --> 0:05:09.480 any means he could to lower the temperature for I 0:05:09.480 --> 0:05:11.320 think I think he had he was using it on 0:05:11.400 --> 0:05:14.480 traumatic brain injury patients. Yeah, and I'm sure he did 0:05:14.520 --> 0:05:17.279 a lot of explaining along the way to family members 0:05:17.800 --> 0:05:19.880 that were like, hey, can you close the window and 0:05:19.880 --> 0:05:22.800 warm up my husband here? And that He was like, 0:05:23.080 --> 0:05:25.280 all right, you want him to die? I think back 0:05:25.279 --> 0:05:27.720 then too, he was like, it's the thirties and this 0:05:27.760 --> 0:05:30.719 guy is a traumatic brain injury. Really, there's nothing I 0:05:30.760 --> 0:05:34.240 can do to make it worse, the prospects worse, So 0:05:34.480 --> 0:05:37.000 why don't you just lighten up their family member? So 0:05:37.240 --> 0:05:40.320 there was another pioneer in the fifties named Dr Peter 0:05:40.560 --> 0:05:44.520 safar Um s A f a R. And he actually 0:05:44.600 --> 0:05:47.120 began experimenting around with this in the e er as well, 0:05:48.120 --> 0:05:51.360 trying to reduce tissue injury. Uh, and brain damage from 0:05:51.440 --> 0:05:54.200 a lack of blood flow. Uh. And this was mainly 0:05:54.240 --> 0:05:57.640 at the time in like stroke patients, cardiac arrest patients 0:05:58.120 --> 0:05:59.920 and what we'll talk more about it. There's all sorts 0:05:59.920 --> 0:06:04.280 of well not all sorts. There are several uses, like 0:06:04.440 --> 0:06:07.320 cases where you would want to use this and um, 0:06:08.560 --> 0:06:13.320 ranging from cardiac arrest to like a gunshot wound. To think, 0:06:13.360 --> 0:06:18.560 what is the infant situation. It is called chuck. It's 0:06:18.600 --> 0:06:25.920 a type of encephalofy where UM, basically the blood flow, 0:06:26.080 --> 0:06:28.400 the lack of blood flow to the brains cut off 0:06:28.400 --> 0:06:30.960 for whatever reason, like maybe the umbilical cord gets rappy 0:06:31.120 --> 0:06:33.919 on the baby's neck or what have you. Um, it 0:06:34.120 --> 0:06:39.440 leads to a swelling in the brain. And they started 0:06:39.520 --> 0:06:44.440 using it to medical hypothermia to treat that. That's right, 0:06:44.720 --> 0:06:47.039 And that was in the fifties, right, Yeah, the fifties 0:06:47.040 --> 0:06:49.800 and sixties is when Dr Safar was doing his work. 0:06:50.040 --> 0:06:52.320 So this this is all kind of going on on 0:06:52.360 --> 0:06:57.960 the side. And um experiments into hypothermia had kind of 0:06:58.000 --> 0:07:02.440 a bad name thanks to the Nazis and a little 0:07:02.440 --> 0:07:06.000 bit also the Japanese and World War two. But the Nazis, 0:07:06.200 --> 0:07:10.040 especially at Dachau, the concentration camp or the death camp. 0:07:10.080 --> 0:07:17.480 There um experimented using unwilling human subjects. Uh, they experimented 0:07:17.520 --> 0:07:20.880 on the effects of hypothermia people's bodies. They did all 0:07:20.920 --> 0:07:25.800 manner of horrible, grizzly, gruesome stuff, but they recorded the data. 0:07:26.000 --> 0:07:28.800 And there was a long debate over the years over 0:07:29.160 --> 0:07:32.680 whether that data could be ethically used. And on one hand, 0:07:32.760 --> 0:07:37.160 people were saying, no, it's the Nazis. They used unwilling subjects, 0:07:37.160 --> 0:07:40.560 as it amounted to torture in the name of science, 0:07:40.600 --> 0:07:43.880 and I just used air air quotes, right, And then 0:07:43.920 --> 0:07:46.520 other people said, well, wait a minute, these people died, 0:07:47.440 --> 0:07:50.960 um whether and we're whether they wanted to or not. 0:07:51.040 --> 0:07:53.320 They were made to be these test subjects and they 0:07:53.360 --> 0:07:55.800 gave their lives. We can honor them at least by 0:07:55.960 --> 0:07:58.240 using the data that was cold from it. Well, once 0:07:58.280 --> 0:08:01.840 they really dug into the data that the Nazis had accumulated, 0:08:01.880 --> 0:08:06.120 it was just like rank amateurs performing scientific experiments. They 0:08:06.160 --> 0:08:11.440 followed like almost no protocol. They did terrible record keeping 0:08:11.480 --> 0:08:15.440 of descriptions of subjects and things like that. So um, 0:08:15.480 --> 0:08:17.520 it's almost like you just have to toss it out 0:08:17.520 --> 0:08:22.200 because you just can't trust it scientifically. The data. But yeah, 0:08:22.240 --> 0:08:27.800 but the idea that people were exposed forcibly to hypothermic 0:08:27.840 --> 0:08:30.920 conditions kind of gave hypothermia a bad name. So these 0:08:30.920 --> 0:08:34.320 guys experimenting with this stuff, it was fringe science for 0:08:34.360 --> 0:08:36.440 a while, and then it started to come into the 0:08:36.440 --> 0:08:40.479 mainstream and then everybody said, well, wait a minute, hypothermia 0:08:40.520 --> 0:08:42.800 has all these bad side effects. Let's just table it 0:08:42.920 --> 0:08:45.840 for now. Yeah, and the in the fifties two, NASA 0:08:45.920 --> 0:08:48.080 was doing a lot of work during the space Race 0:08:48.080 --> 0:08:50.640 because the idea was and this is really sort of 0:08:51.200 --> 0:08:56.520 two parts. There's the the modern day uh cooling like 0:08:56.960 --> 0:09:00.520 that's not freezing somebody basically, and then you also have 0:09:00.640 --> 0:09:03.320 what's called suspended animation, which we'll get too later. Those 0:09:03.320 --> 0:09:05.920 are totally different things, totally different things, but they follow 0:09:05.960 --> 0:09:09.080 the same process initially, right Yeah, um, well sort of. 0:09:09.160 --> 0:09:11.240 I mean, the methods are different, but the same idea 0:09:11.280 --> 0:09:14.120 basically is to slow the body down, sown the heart rate, 0:09:14.200 --> 0:09:18.160 slow down everything. Yeah. Um, but NASA was doing this 0:09:18.200 --> 0:09:20.600 because they put a lot of money into it because 0:09:20.600 --> 0:09:23.920 they thought two things. One you could protect astronauts from 0:09:24.160 --> 0:09:28.000 a cosmic rays and the other is basically straight up 0:09:28.040 --> 0:09:32.760 alien like, we can freeze people on long journeys into space, 0:09:32.800 --> 0:09:35.760 and then unfreezing when they get there, which is not 0:09:35.800 --> 0:09:39.440 just alien that's a bunch of sci fi movies. But 0:09:40.880 --> 0:09:43.400 there was a doctor named James Lovelock back in the 0:09:43.480 --> 0:09:47.400 day who was um freezing hamsters until they froze and 0:09:47.400 --> 0:09:51.920 then basically until he couldn't hear heartbeat. Frozen. Yeah, they 0:09:51.920 --> 0:09:54.360 were clinically dead. Yeah, and then they would he would 0:09:54.400 --> 0:09:56.960 put a little uh, a little hot teaspoon against their 0:09:57.000 --> 0:09:59.719 belly and warm them back up, and he found that 0:09:59.760 --> 0:10:02.120 they were actually okay, and he was able to revive 0:10:02.200 --> 0:10:04.760 them some of them. Well yeah, I'm sure there were 0:10:04.800 --> 0:10:07.600 losses along them, but I mean even one coming back 0:10:07.640 --> 0:10:12.640 to life and seeming normal again is pretty significant. It's 0:10:12.640 --> 0:10:16.800 a significant finding, Yeah, because basically the idea was planted 0:10:16.880 --> 0:10:20.520 all of a sudden that hypothermia can kill you or 0:10:20.559 --> 0:10:24.000 it can preserve you and keep you from dying in 0:10:24.080 --> 0:10:27.320 an extreme situation, right, which is kind of counterintuitive, Like 0:10:27.360 --> 0:10:32.360 you think of people who undergo hypothermia or you know, 0:10:32.440 --> 0:10:35.480 being exposed to extremely cold temperatures, they're dead. I mean, 0:10:35.880 --> 0:10:38.439 we've all seen the shining, we know the end. Yeah, 0:10:38.880 --> 0:10:41.160 But apparently there's a rule of thumb among e er 0:10:41.760 --> 0:10:46.040 physicians and staff that there's no such thing as a 0:10:46.080 --> 0:10:49.480 cold dead body. I thought it was measured twice cut once. 0:10:49.800 --> 0:10:54.560 It's a little different. That's for the surgeons. Um, No, 0:10:55.160 --> 0:10:58.000 there's no such thing as a as a cold dead body. 0:10:58.080 --> 0:11:02.160 You're only dead when you're warm and dead, right, Because well, 0:11:02.200 --> 0:11:04.600 there's been some some cases throughout the years, the one, 0:11:04.640 --> 0:11:08.520 that spectacular one. Yeah, this lady um was she with 0:11:08.600 --> 0:11:12.439 Norwegian on a boggenhorn. Um, I don't even know what 0:11:12.480 --> 0:11:14.360 that is. It's not an oom out, it's a single 0:11:14.440 --> 0:11:19.760 circle above that a. It's very Norwegian. Yeah, um death 0:11:19.760 --> 0:11:24.720 metal band name totally. Uh So she was skiing and um, 0:11:24.840 --> 0:11:27.280 actually I think she was Swedish, but she was on 0:11:27.360 --> 0:11:31.240 holiday skiing in Norway. Um fell headfirst into a frozen 0:11:31.280 --> 0:11:35.640 stream and was trapped under ice, submerged for eighty minutes, 0:11:36.240 --> 0:11:40.360 stopped breathing, hearts stopped. H Yeah, I mean she was 0:11:40.400 --> 0:11:43.680 well known. She didn't drown. They thought she drowned until 0:11:43.880 --> 0:11:49.480 they reheated her. Ten days they reheated her and she 0:11:49.600 --> 0:11:52.800 was fine. Like weeks and months later she fully recovered. 0:11:53.520 --> 0:11:57.400 And basically, if you're underwater warm water, you have a 0:11:57.440 --> 0:12:00.400 few minutes at most. But what they discovered it was 0:12:00.440 --> 0:12:05.400 if you actually go into hypothermia, it can preserve your body. Um, 0:12:05.440 --> 0:12:09.400 which was amazing and a big breakthrough into like, hey, 0:12:09.440 --> 0:12:12.080 maybe we can use this right. Yeah, she was one 0:12:12.120 --> 0:12:14.559 of a few a handful of people, and we'll talk 0:12:14.559 --> 0:12:19.760 about some others too, But um, that what researchers into 0:12:19.840 --> 0:12:22.800 hypothermia I've learned and why they figured out that they're 0:12:22.880 --> 0:12:25.120 you're not cold and dead, you're just warm and dead, 0:12:25.880 --> 0:12:30.920 is that it's not the the the addition of cold 0:12:31.559 --> 0:12:35.080 for the exposure to cold that kills you. It's warming 0:12:35.120 --> 0:12:38.760 back up in the wrong way too rapidly under the 0:12:38.800 --> 0:12:43.400 wrong circumstances, stances that that's what can kill you. Yeah, 0:12:43.440 --> 0:12:47.079 it seems like it's a very fine line between well, 0:12:47.080 --> 0:12:49.080 we'll talk about the process, but you have to do 0:12:49.120 --> 0:12:52.200 it just right on the cooling side and the warming 0:12:52.240 --> 0:12:55.400 side if you want to be successful right exactly. You know, 0:12:55.440 --> 0:12:57.880 it's uh, they haven't quite figured it all out yet. 0:12:57.880 --> 0:13:00.640 This is in the very uh nascent stages. It is 0:13:00.800 --> 0:13:04.480 ridiculously primitive and and to the point where it's kind 0:13:04.480 --> 0:13:06.840 of like, if you're a doctor experimenting with this, you 0:13:07.160 --> 0:13:11.320 you would be like, there's a hud chance that your 0:13:11.520 --> 0:13:16.360 dad is going to die under normal circumstances. We have 0:13:16.440 --> 0:13:19.600 this one radical technique we can try that might help. 0:13:20.200 --> 0:13:23.959 Can we try this? And that that that whether the 0:13:24.120 --> 0:13:28.520 dad lives or dies after being given medical hypothermia, he's 0:13:28.520 --> 0:13:30.960 still going to end up as like the subject of 0:13:31.000 --> 0:13:34.320 a major paper that would be written, because that's where 0:13:34.320 --> 0:13:36.559 it's at right now. Yeah, And I read one doctor 0:13:36.640 --> 0:13:39.560 said that they they think they pretty much know it's 0:13:39.800 --> 0:13:42.760 super possible and will work, he said, but it's the 0:13:42.920 --> 0:13:45.840 doing of it that's just really really hard exactly. Yeah, 0:13:45.920 --> 0:13:49.160 I mean, like it makes a complete sense intuitively, we 0:13:49.280 --> 0:13:52.959 understand like what it's doing. It's just yeah, the fine tuning, 0:13:53.000 --> 0:13:56.040 the nuance behind it that is still kind of a mysterious. 0:13:56.320 --> 0:13:59.640 The most brilliant doctors say, this's just really hard. He said, 0:13:59.640 --> 0:14:02.000 it's really dog gone hard to do. It kind of 0:14:02.040 --> 0:14:06.800 makes you go, you know that he know. His quote was, 0:14:06.840 --> 0:14:09.080 it's really dog gone hard. And then my quote was, 0:14:11.520 --> 0:14:15.760 so we'll talk about medical hypothermia and what it is specifically, 0:14:16.400 --> 0:14:38.720 uh in just a minute, all right, So therapeutic hypothermia. 0:14:39.040 --> 0:14:44.400 Hypothermia is basically when you lower the body temperature for 0:14:44.880 --> 0:14:49.080 various reasons to keep it alive. And right now, what 0:14:49.200 --> 0:14:53.720 they're mainly doing now, this isn't the second wave which 0:14:53.760 --> 0:14:57.080 is freezing somebody. This is just cooling a body before 0:14:57.280 --> 0:15:02.080 and after surgery to help them increase their chances of survival. 0:15:02.080 --> 0:15:07.400 Basically your your body. Um, they're doing that now on 0:15:07.440 --> 0:15:10.120 this side. They're just not doing the other quite yet. 0:15:10.120 --> 0:15:15.200 On humans. Um, So, under normal circumstances, your body maintains 0:15:15.240 --> 0:15:19.360 a normal core body temperature. Normative temperature I think is 0:15:19.400 --> 0:15:23.120 what it's called, right and um, that's somewhere between like 0:15:23.280 --> 0:15:26.640 nineties six and ninety eight point six degrees is a 0:15:26.680 --> 0:15:30.480 normal human core body temperature. And all of this is 0:15:30.600 --> 0:15:32.920 And dude, do you remember and like when I went 0:15:32.960 --> 0:15:36.200 on that crazy weird metaphysical tangent and does the body 0:15:36.240 --> 0:15:41.320 replace itself? Somebody wrote in and said, check this article out, 0:15:41.360 --> 0:15:45.640 like here's a really great explanation of why things live, 0:15:45.920 --> 0:15:49.080 where life comes from. And it was this, Um, this idea, 0:15:49.120 --> 0:15:53.480 it's a physics based idea of life and evolution. And 0:15:53.520 --> 0:15:57.280 it says that because of entropy, because of one of 0:15:57.280 --> 0:16:00.640 the laws of thermodynamics, that atoms will arringe inge themselves 0:16:00.640 --> 0:16:03.520 in a way that they can take in energy and 0:16:03.880 --> 0:16:07.520 dissipate heat in a really efficient manner, and so of 0:16:07.560 --> 0:16:10.920 course they're gonna atoms are eventually going to arrange themselves 0:16:10.920 --> 0:16:14.600 into life. It just makes total sense, right. So, being 0:16:14.680 --> 0:16:18.320 living things like we are, we take in energy and 0:16:18.400 --> 0:16:22.080 we dissipate heat, and that's what forms our core body temperature. 0:16:22.720 --> 0:16:28.920 With therapeutic hypothermia, what you're doing is lowering the metabolic 0:16:29.040 --> 0:16:33.000 rate through the addition of cold, and so we put 0:16:33.000 --> 0:16:37.400 out less heat. And by doing that, we're also lowering 0:16:37.400 --> 0:16:41.760 our energy demand, so that that that little engine that's 0:16:41.800 --> 0:16:44.480 going all the time and ourselves and our body in 0:16:44.520 --> 0:16:48.320 general gets slowed down. And it's not altered in any 0:16:48.320 --> 0:16:51.720 way except for the speed and the energy consumption. It's 0:16:51.800 --> 0:16:55.360 just slowed down. It's doing everything slower. And you can 0:16:55.400 --> 0:17:00.480 do that simply by lowering the temperature of the person. Yeah, 0:17:00.520 --> 0:17:05.199 and it's it's not just lower it's um it doesn't 0:17:05.240 --> 0:17:07.600 need to be faster. Does that make sense, Like the 0:17:07.600 --> 0:17:10.200 heart beat slower because it doesn't need to beat any faster. 0:17:10.680 --> 0:17:12.639 It's not like your body is struggling. Your body is 0:17:12.640 --> 0:17:16.159 still doing fine. It's just reducing the demand for stuff 0:17:16.160 --> 0:17:20.159 like blood flow and neurotransmitter action and stuff like that exactly. 0:17:20.320 --> 0:17:22.879 And ultimately, what your heart does is pumps blood, and 0:17:22.920 --> 0:17:26.159 what your blood has is, among other things, oxygen, and 0:17:26.240 --> 0:17:29.639 your cells need oxygen to carry out these metabolic processes 0:17:29.680 --> 0:17:34.040 to burn energy, right, So if they need less, then 0:17:34.200 --> 0:17:35.960 your heart doesn't have to beat as much. It's like 0:17:36.000 --> 0:17:39.119 you said, it's just the normal processes, but on a 0:17:39.240 --> 0:17:43.960 much slower scale. Pretty awesome stuff it is. And it's 0:17:44.080 --> 0:17:46.800 just through the application of colder temperatures. Oh yeah, and 0:17:46.880 --> 0:17:49.119 in this case, um, and we'll get to how to 0:17:49.200 --> 0:17:51.120 do it, But in this case you're not I mean 0:17:51.160 --> 0:17:53.760 you're literally cooling the body with like ice packs and 0:17:54.680 --> 0:17:58.000 cold blankets and stuff like that pre surgery and post surgery. 0:17:58.600 --> 0:18:00.800 It's not the suspended anime some one that we'll get 0:18:00.840 --> 0:18:04.760 to when they're actually like pumping frozen saline through your pains. No, 0:18:04.920 --> 0:18:08.919 there are, but there are some UM techniques for uh 0:18:09.840 --> 0:18:14.600 medically induced hypothermia that do put in like chilled saline 0:18:14.960 --> 0:18:17.920 really to chill your body down very quickly. But it's 0:18:17.920 --> 0:18:20.600 not like replacing your blood. Yeah yeah, yeah, I hear you. 0:18:21.040 --> 0:18:24.160 So there's a couple of applications at this point and 0:18:24.720 --> 0:18:29.040 the cases are either involved intervention or prevention. An intervention 0:18:29.240 --> 0:18:33.160 is when they're trying to prevent further damage from an 0:18:33.160 --> 0:18:36.760 incident like a stroke or cardiac arrest or sort of 0:18:36.800 --> 0:18:41.280 the two main ones. UM and then preventative wise, it's 0:18:41.320 --> 0:18:44.679 to extend operating time because back in the day you 0:18:44.720 --> 0:18:48.360 could not operate on UM. Well, back in the day, 0:18:48.359 --> 0:18:51.240 you couldn't stop the heart to operate on it. No, 0:18:51.440 --> 0:18:53.800 which is I do you remember we did like this 0:18:53.880 --> 0:18:56.119 day in history about the first guy to ever do 0:18:56.160 --> 0:19:00.320 open heart centuries of black surgeon in Chicago the early 0:19:00.359 --> 0:19:03.720 twentieth century, I think, and he did an emergency open 0:19:03.760 --> 0:19:11.280 heart surgery with a beating heart. That guy was totally awesome. UM. 0:19:11.320 --> 0:19:13.840 This was the case for a very long time, and 0:19:14.000 --> 0:19:16.840 you couldn't stop the heart. And they finally invented a 0:19:16.880 --> 0:19:21.359 machine UM that basically does the work of the heart 0:19:21.560 --> 0:19:26.520 and the lungs called the exactly where you're transferring blood 0:19:26.520 --> 0:19:30.280 through this machine and UM, it's removing c O two, 0:19:30.320 --> 0:19:33.240 it's adding oxygen, and it's pumping it back into the 0:19:33.280 --> 0:19:37.600 body while the heart and lungs are stopped. Revolutionized open 0:19:37.680 --> 0:19:41.120 heart surgery. There's problems with it. One of the problems 0:19:41.200 --> 0:19:44.120 is um when the blood comes back in the body, 0:19:44.240 --> 0:19:47.080 since it's been through this machine, it may have picked 0:19:47.160 --> 0:19:51.760 up some sort of foreign in bacteria, and the immune 0:19:51.760 --> 0:19:55.080 system sometimes mounts an attack on the blood. So this, 0:19:55.080 --> 0:19:59.439 this machine poses its own problems. And alternatively, an alternative 0:19:59.480 --> 0:20:02.240 method for or stopping the heart, of slowing the heart 0:20:02.720 --> 0:20:07.639 is to use medically induced hypothermia. So that's an intervention, no, 0:20:07.800 --> 0:20:13.040 a prevention, preventative use of medically induced hypothermia. But intervention 0:20:13.160 --> 0:20:14.960 is another way, like you said, and it can have 0:20:15.040 --> 0:20:19.479 to do a stroke or heart attacks or cardiac arrests. Right, 0:20:19.600 --> 0:20:22.879 aren't those two different things? I think so, yeah, technically, 0:20:23.400 --> 0:20:26.200 but it's some sort of cessation of the heart pumping blood. 0:20:26.560 --> 0:20:29.040 And the big problem with that it doesn't really matter 0:20:29.119 --> 0:20:31.840 whether your hand is getting blood for a while. The 0:20:31.960 --> 0:20:34.760 big problem that comes from a heart attack is your 0:20:34.760 --> 0:20:39.439 brain not getting blood for a while. So here's what 0:20:39.520 --> 0:20:43.240 happens when blood stops slowing into your brain. Right, And 0:20:43.280 --> 0:20:47.879 we we covered this somehow in the How Dying Works episode. Yeah, 0:20:48.000 --> 0:20:51.479 the dying process. Okay, because it's not a it's not 0:20:51.520 --> 0:20:54.080 a black and white thing. Uh, you're not alive and 0:20:54.119 --> 0:20:57.280 then you're dead. It comes in many, many stages, and 0:20:57.320 --> 0:21:00.639 we talked about the stages of death. Yeah, so there's 0:21:01.040 --> 0:21:04.040 when what they've discovered is that yeah, you're not like 0:21:04.280 --> 0:21:06.920 I'm alive and now I'm dead. Is what we covered 0:21:06.960 --> 0:21:09.000 in the How Dying Works episode, Right, like dying in 0:21:09.000 --> 0:21:12.280 your sleep? I mentioned that how like nobody dies in 0:21:12.320 --> 0:21:15.040 their sleep. That's just a nice thing. That's a nice 0:21:15.040 --> 0:21:21.600 way to say they died in their bed overnight. Overnight, Yeah, exactly. Um, so, yeah, 0:21:21.680 --> 0:21:25.240 there's with medically induced hypothermia, they've been able to extend 0:21:25.359 --> 0:21:28.680 that that time between when you appear to be dead 0:21:28.720 --> 0:21:31.920 and when you're actually dead, and by extending that time, 0:21:31.960 --> 0:21:37.520 they can intervene um better. And yeah, even a little 0:21:37.520 --> 0:21:39.800 bit of time can go a long way. So one 0:21:39.840 --> 0:21:43.159 of the one of the things that medically induced hypothermia 0:21:43.200 --> 0:21:45.919 has been shown to really help is what's called return 0:21:46.000 --> 0:21:50.919 of spontaneous circulation. After uh, you have a heart attack. 0:21:51.320 --> 0:21:53.920 The problem is is your heart and lungs can your 0:21:53.960 --> 0:21:57.600 cardiopulmonary system can start working again, but you might not 0:21:57.680 --> 0:22:01.800 regain consciousness. And in that case, that's a sign that 0:22:01.920 --> 0:22:05.000 your brain may be in trouble, your cognitive function, you 0:22:05.080 --> 0:22:07.680 may be suffering brain damage at that moment. Yeah, And 0:22:07.800 --> 0:22:11.040 isn't the stat one and ten cardiac arrests outside of 0:22:11.080 --> 0:22:14.360 a hospital, has it like goes on to live like 0:22:14.400 --> 0:22:18.760 a without brain damage. Yeah, because you have a very 0:22:18.800 --> 0:22:21.639 small window, and that window is usually longer than it 0:22:21.640 --> 0:22:23.680 takes to get to the hospital. Right. So if they 0:22:23.680 --> 0:22:26.960 bring you in and you are showing signs of UM 0:22:27.119 --> 0:22:31.040 r OSC without return to consciousness too, um, they may 0:22:31.080 --> 0:22:34.600 induce medical medical hypothermia. And the reason why is the 0:22:35.040 --> 0:22:40.040 heart pumps blood, and blood contains things including oxygen, right um. 0:22:40.680 --> 0:22:44.280 And one of the organs that uses probably the most 0:22:44.320 --> 0:22:47.720 oxygen of all is the brain, and the brain uses 0:22:47.760 --> 0:22:51.320 its oxygen to um burn energy. Basically, it uses it 0:22:51.359 --> 0:22:55.200 to oxidized glucose. And when it does that, the reason 0:22:55.240 --> 0:22:58.680 it does is because you're neurons, your little neural cells 0:22:58.760 --> 0:23:01.960 that fire the way they fires because their chemical battery, 0:23:02.400 --> 0:23:05.880 their chemical battery with the stored potential charge, and they 0:23:05.880 --> 0:23:10.040 do that by keeping a lower concentration of electrolytes inside 0:23:10.040 --> 0:23:14.119 the cell than outside. So this difference creates the electrical 0:23:14.200 --> 0:23:18.320 charge that your neurons used to fire. Right on normal circumstances, 0:23:18.359 --> 0:23:21.600 that's all well and good, but when they stop. When 0:23:21.640 --> 0:23:25.480 they stop getting oxygen, they can switch to anaerobic mode 0:23:25.480 --> 0:23:27.679 for a little while, so they're still burning energy, but 0:23:27.720 --> 0:23:30.000 they're like, you need to start breathing again because this 0:23:30.080 --> 0:23:32.919 is not very efficient. It's like the like when the 0:23:32.920 --> 0:23:37.439 emergency lights go on exactly exactly. So UM as a 0:23:37.480 --> 0:23:42.000 byproduct of anaerobic um respiration, you get the stuff called 0:23:42.080 --> 0:23:45.560 lactic acid. Lactic acid in and of itself isn't bad, 0:23:45.680 --> 0:23:47.960 but it can build up. One of the other things 0:23:47.960 --> 0:23:51.200 that happens to when these um when this UH, when 0:23:51.200 --> 0:23:55.520 that runs out, is the difference between electrolytes inside. Now 0:23:55.600 --> 0:23:59.760 inside the cell stops like it evens out, and now 0:23:59.760 --> 0:24:02.360 all of a sudden you have things like calcium, potassium, 0:24:02.400 --> 0:24:04.600 sodium coming in and out of the cell as much 0:24:04.640 --> 0:24:06.960 as they please, and the cell is like, what is 0:24:07.000 --> 0:24:10.280 going on? This isn't good and releases its store of glutamate. 0:24:10.880 --> 0:24:16.760 And glutamate is a neurotransmitter that excites neurons, and again 0:24:16.760 --> 0:24:19.920