When life doesn’t imitate sport

Monday, April 13, 2009

Sport allows us to celebrate a win while still lamenting a loss. There is a zero sum gain. For every collapse like Kenny Perry at the Masters or Miami University at the NCAA Frozen Four finals, there is an Angel Cabrera or Boston University. The real world fails to mimic life on the playing field. Too often, death is the victor and there is no true winner at celebrate.

Often, emergency workers celebrate a save when they resuscitate a patient whose heart has stopped or when they extricate a victim from being trapped at an accident site. Depending upon the situation, defeat may be pulled from the jaws of victory by physiology and the inability of the body to cope with the injury.

When people die from heart attack, it is usually because of a heart rhythm abnormality. The electrical rhythm, like ventricular fibrillation, does not translate into a mechanical heart beat. The most effective treatment is an electrical shock to defibrillate the heart back to a functioning rhythm. CPR is done to buy time to get a defibrillator to the patient. Once a paramedic gets on scene, medications can also be used to stabilize the heart. The win is to get a heart beating with enough force to restore circulation and blood pressure. Unfortunately, the story doesn’t end here. With no oxygen, the cells in the body switch from aerobic metabolism using oxygen to anaerobic metabolism where the byproduct is lactic acid. The longer the delay in getting the heart started, the more lactic acid is produced in the cells. Once circulation restarts, the lactic acid can overwhelm the body and cause it to fail.

Trauma and crush injuries can cause similar problems. A person who is trapped for a prolonged time with no circulation getting to part of the body, may have sudden death occur when they are extricated because so much lactic acid is set free. Hours of work by a rescue crew can be lost because the acid-base balance of the body is relatively fragile.

Victims of hypothermia and cold exposure have a related problem. The body shunts blood away from the skin surface and tries to protect the vital organs, the heart, lung, kidneys and brain. Once warming restarts, there is a risk that all the cold blood and lactic acid that has pooled in the arms and legs will then be circulated and afterdrop occurs. The core temperature of the body drops and body parts start to fail.

In sports, poor execution by one person allows another competitor to seize the advantage and win… net sum zero. In medicine, with the ability to theoretically predict that bad things will happen during and after resuscitation or extrication, care may not be able to fend off physiology. The patient dies, even when member of the medical team is at peak performance. Life isn’t sport.

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