Posted in Psychology & Medicine

Agonal Breathing

When a person is on the verge of death, they may show a very strange pattern of breathing. They will begin gasping for breath, take deep laboured breaths, begin to make strange noises and possibly have some muscle jerks (which may look like a seizure). The breathing makes it look as if the person is taking a deep breath and sighing, while gasping every now and then irregularly. This is called agonal breathing and it is most likely caused by an oxygen-starved brain sending weak signals to try kick up the respiratory drive for more oxygen.

Agonal breathing is not uncommon in cases of cardiac arrest. It is important to note that agonal breathing is not an efficient form of breathing and thus it cannot be said that the victim is “breathing” when this occurs. Because it looks like the patient is taking deep breaths, bystanders may be fooled into thinking that they have been resuscitated and have begun breathing again. But this is not the case and the patient is still clinically dead. Ergo, one should not stop CPR even if the patient begins taking deep breaths and sighs. The presence of agonal breaths usually indicate a better outcome for the patient.

(Link to video examples of what agonal breathing looks like:

Posted in Psychology & Medicine

Sudden Death

Unlike diseases such as tuberculosis or cancer, some disease processes are known to kill a human being within an hour of onset. Other than the obvious causes such as decapitation, massive bleeding or any other trauma-related injuries, these diseases tend to be cardiac or respiratory in origin.

A common example is coronary artery disease, where the blood vessel providing blood to an area of the heart becomes completely blocked by stenosis (narrowing, often by atherosclerosis) or a clot. This results in immediate ischaemia (lack of oxygen) to heart muscles, which causes cell death. This produces scar tissue which disrupts the electrical activity of the heart, which may lead to a condition called ventricular fibrillation where the heart beats in an uncontrolled, erratic manner. When in VF, the heart effectively becomes useless as it cannot coordinate proper pumping function. Blood circulation stops and the patient goes in to multiple organ failure (the brain goes first) within a very short time. Although it can kill within a short time, early identification and treatment may be able to prevent VF from occurring and save the patient’s life. If VF does occur, it is crucial to begin CPR or use a defibrillator if available.

VF can also occur in other situations. For example, there is a genetic condition called long QT syndrome which predisposes the patient to spontaneous arrhythmias (electrical abnormalities in the heart). Even becoming too excited can sometimes set off a VF in some LQTS patients, thus they require an implantable cardioverter-defibrillator (ICD) to shock their heart back in to normal rhythm every time they develop an arrhythmia.

Some other causes of sudden death include: aortic dissection (tearing of the aorta that may cause massive internal bleeding), pulmonary embolism (a clot obstructs blood flow in the lung, stopping circulation), commotio cordis (a blow to the heart at a certain moment in the heart rhythm triggers VF), ruptured brain aneurysm (ballooning of an artery in the brain), anaphylaxis (severe allergic reaction that cuts off airflow to the lungs) and poisoning (various mechanisms, mainly related to disrupting cellular function).

Death can strike swiftly, even from within your body.

Posted in Psychology & Medicine


When people think of the word “flatline”, they immediately visualise a medical crisis where a patient is lying unconscious, with doctors and nurses shouting out medical terminology while administering drugs, all to the suspenseful music and apathetic monotone and single horizontal line on the ECG machine. The doctor then shouts “Clear!” and proceeds to shock the patient with two paddles. This is repeated until some structures appear on the ECG, symbolising that the crisis has been resolved.

Of course this is a scene from a typical medical drama. Television shows, especially medical ones, are notorious for sacrificing medical accuracy for the sake of drama and tension. The “flatline” is the most cliché, repeated mistake made by almost every medical television show ever made.

The proper terminology for a flatline (a colloquial term), is asystole. This means that there is no systole, or contraction of the heart. An ECG (electrocardiogram) measures electrical signals in the heart, and in asystole there is insignificant amounts of electric activity, and the classic QRS complex is not seen. In this state, the heart is not pumping any blood and is electrically silent, meaning that the patient is clinically dead.

When asked how to treat this condition, the majority of people (even medical students) will shout “Shock!” or “Defibrillate!”. Defibrillation is the administering of an electrical shock to try “reboot” the heart, and correct the fibrillation – the chaotic electrical signal interfering with the normal, rhythmic electrical activity. Unfortunately, this is completely wrong yet so often depicted on television and films.
As asystole is a state of no electrical activity, there is no fibrillation to remove, nor is there anything to reset. Defibrillation in this state may even cause harm, causing tissue damage and lowering the chance of survival.

The correct treatment is injecting adrenaline (epinephrine in the U.S.A, atropine may be administered also) and CPR. Unfortunately, asystole is a condition that cannot be reversed, unless the heart somehow restores its own electrical activity. CPR merely keeps the patient’s perfusion going to preserve the organs for a longer time. Ergo, asystole signifies certain death, especially after 5 minutes where the heart will not respond to any drugs or electric shocks. In fact, asystole is one of the conditions required for the certification of a patient’s death.

Another related example of a (potentially fatal) misrepresentation of medicine in the media is the adrenaline injection. As mentioned before, this is the treatment for asystole. However, it is administered intravenously (into a vein) and never directly into the heart as in Pulp Fiction. This is more likely to kill the patient than save them, as the heart muscles could be damaged and delicate coronary arteries may become ruptured.

So why is it that the media continues to depict such blatant errors, that set a “common sense” that affect even medical professionals? This is most likely due to the audience wanting to see a dramatic scene, in a gripping life-or-death situation with drastic, powerful action. For example, the audience would much rather see the use of paddles or a giant needle being stabbed into the patient than seeing continuous CPR with no showy movements.

The next time you watch a medical television show, count how many times the doctors try to defibrillate a flatline.