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Special effects that can save a life | Peter Weinstock | TEDxNatick

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    What if I told you
    there was a new technology
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    that, when placed in the hands
    of doctors and nurses,
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    improved outcomes for children
    and adults, patients of all ages;
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    reduced pain and suffering,
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    reduced time in the operating rooms,
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    reduced anesthetic times,
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    had the ultimate dose-response curve
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    that the more you did it,
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    the better it benefitted patients?
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    Here's a kicker: it has no side effects,
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    and it's available no matter
    where care is delivered.
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    I can tell you as an ICU doctor
    at Boston Children's Hospital,
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    this would be a game changer for me.
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    And the good news is that I'm here
    to tell you about this technology
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    and that we're finding, as we apply
    this technology in health care,
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    we are having these exact outcomes
    I've just described to you.
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    That technology is lifelike rehearsal.
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    Just in the times that matter most,
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    and in the places that matter most,
    and for the teams that matter most,
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    and ultimately, for the patients
    that matter most.
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    And this technology,
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    this lifelike rehearsal,
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    is being delivered
    through medical simulation.
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    I thought I would start with a case,
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    just to really describe
    the challenge ahead,
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    and why this technology is not just
    going to improve health care
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    but why it's critical to health care.
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    This is a child that's born, young girl.
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    "Day of life zero," we call it,
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    the first day of life,
    just born into the world.
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    And just as she's being born,
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    we notice very quickly
    that she is deteriorating.
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    Her heart rate is going up,
    her blood pressure is going down,
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    she's breathing very, very fast.
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    And the reason for this
    is displayed in this chest X-ray.
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    You can see here,
    it's a quick study in radiology.
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    As you see here, the upper portion
    of this child's --
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    That's called a babygram,
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    a full X-ray of a child's body,
    a little infant's body.
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    As you look on the top side of this,
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    that's where the heart and lungs
    are supposed to be.
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    As you look at the bottom end,
    that's where the abdomen is,
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    and that's where the intestines
    are supposed to be.
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    And you can see how
    there's sort of that translucent area
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    that made its way up into the right side
    of this child's chest.
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    And those are the intestines --
    in the wrong place.
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    As a result, they're pushing on the lungs
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    and making it very difficult
    for this poor baby to breathe.
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    The fix for this problem
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    is to take this child immediately
    to the operating room,
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    bring those intestines
    back into the abdomen,
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    let the lungs expand
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    and allow this child to breathe again.
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    But before she can go
    to the operating room,
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    she must get whisked away
    to the ICU, where I work.
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    I work with surgical teams.
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    We gather around her,
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    and we place this child
    on heart-lung bypass.
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    We put her to sleep,
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    we make a tiny
    little incision in the neck,
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    we place catheters into the major
    vessels of the neck --
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    and I can tell you that these vessels
    are about the size of a pen,
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    the tip of a pen --
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    and then we have blood
    drawn from the body,
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    we bring it through a machine,
    it gets oxygenated,
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    and it goes back into the body.
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    We save her life,
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    and get her safely to the operating room.
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    Here's the problem:
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    these disorders --
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    what is known is congenital
    diaphragmatic hernia --
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    this hole in the diaphragm that has
    allowed these intestines to sneak up --
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    these disorders are rare.
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    Even in the best hands in the world,
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    there is still a challenge
    to get the volume --
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    the natural volume of these patients --
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    in order to get our expertise
    curve at 100 percent.
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    They just don't present that often.
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    So how do you make the rare common?
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    Here's the other problem:
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    in the health care system
    that I trained for over 20 years,
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    what currently exists,
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    the model of training is called
    the apprenticeship model.
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    It's been around for centuries.
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    It's based on this idea that you see
    a surgery maybe once,
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    maybe several times,
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    you then go do that surgery,
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    and then ultimately you teach
    that surgery to the next generation.
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    And implicit in this model --
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    I don't need to tell you this --
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    is that we practice on the very patients
    that we are delivering care to.
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    That's a problem.
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    I think there's a better approach.
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    Medicine may very well be the last
    high-stakes industry
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    that does not practice prior to game time.
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    I want to describe to you a better
    approach through medical simulation.
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    Well, the first thing we did is we went
    to other high-stakes industries
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    that had been using this type
    of methodology for decades.
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    This is nuclear power.
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    Nuclear power runs scenarios
    on a regular basis
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    in order to practice
    what they hope will never occur.
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    And as we're all very familiar,
    the airline industry --
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    we all get on planes now,
    comforted by the idea
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    that pilots and crews have trained
    on simulators much like these,
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    training on scenarios
    that we hope will never occur,
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    but we know if they did,
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    they would be prepared for the worst.
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    In fact, the airline industry has gone
    as far as to create fuselages
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    of simulation environments,
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    because of the importance
    of the team coming together.
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    This is an evacuation drill simulator.
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    So again, if that ever were to happen,
    these rare, rare events,
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    they're ready to act
    on the drop of a dime.
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    I guess the most compelling for me
    in some ways is the sports industry --
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    arguably high stakes.
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    You think about a baseball team:
    baseball players practice.
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    I think it's a beautiful example
    of progressive training.
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    The first thing they do
    is go out to spring training.
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    They go to a spring training camp,
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    perhaps a simulator in baseball.
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    They're not on the real field,
    but they're on a simulated field,
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    and they're playing in the pregame season.
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    Then they make their way to the field
    during the season games,
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    and what's the first thing they do
    before they start the game?
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    They go into the batting cage
    and do batting practice for hours,
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    having different types of pitches
    being thrown at them,
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    hitting ball after ball
    as they limber their muscles,
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    getting ready for the game itself.
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    And here's the most
    phenomenal part of this,
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    and for all of you who watch
    any sport event,
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    you will see this phenomenon happen.
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    The batter gets into the batter's box,
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    the pitcher gets ready to pitch.
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    Right before the pitch is thrown,
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    what does that batter do?
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    The batter steps out of the box
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    and takes a practice swing.
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    He wouldn't do it any other way.
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    I want to talk to you about how
    we're building practice swings like this
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    in medicine.
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    We are building batting cages
    for the patients that we care about
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    at Boston Children's.
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    I want to use this case
    that we recently built.
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    It's the case of a four-year-old
    who had a progressively enlarging head,
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    and as a result,
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    had loss of developmental milestones,
    neurologic milestones,
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    and the reason for this problem is here --
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    it's called hydrocephalus.
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    So, a quick study in neurosurgery.
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    There's the brain,
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    and you can see the cranium
    surrounding the brain.
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    What surrounds the brain,
    between the brain and cranium,
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    is something called
    cerebrospinal fluid or fluid,
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    which acts as a shock absorber.
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    In your heads right now,
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    there is cerebrospinal fluid
    just bathing your brains
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    and making its way around.
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    It's produced in one area
    and flows through,
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    and then is re-exchanged.
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    And this beautiful flow pattern
    occurs for all of us.
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    But unfortunately in some children,
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    there's a blockage of this flow pattern,
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    much like a traffic jam.
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    As a result, the fluid accumulates,
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    and the brain is pushed aside.
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    It has difficulty growing.
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    As a result, the child loses
    neurologic milestones.
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    This is a devastating disease in children.
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    The cure for this is surgery.
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    The traditional surgery is to take
    a bit of the cranium off,
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    a bit of the skull,
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    drain this fluid out,
    stick a drain in place,
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    and then eventually bring
    this drain internal to the body.
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    Big operation.
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    But some great news is that advances
    in neurosurgical care
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    have allowed us to develop
    minimally invasive approaches
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    to this surgery.
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    Through a small pinhole,
    a camera can be inserted,
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    led into the deep brain structure,
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    and cause a little hole in a membrane
    that allows all that fluid to drain,
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    much like it would in a sink.
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    All of a sudden, the brain
    is no longer under pressure,
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    can re-expand
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    and we cure the child
    through a single-hole incision.
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    But here's the problem:
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    hydrocephalus is relatively rare.
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    And there are no good training methods
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    to get really good at getting
    this scope to the right place.
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    But surgeons have been quite creative
    about this, even our own.
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    And they've come up with training models.
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    Here's the current training model.
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    (Laughter)
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    I kid you not.
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    This is a red pepper,
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    not made in Hollywood;
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    it's a real red pepper.
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    And what surgeons do is they stick
    a scope into the pepper,
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    and they do what is called a "seedectomy."
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    (Laughter)
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    They use this scope to remove seeds
    using a little tweezer.
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    And that is a way to get under their belts
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    the rudimentary components
    of doing this surgery.
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    Then they head right into
    the apprenticeship model,
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    seeing many of them
    as they present themselves,
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    then doing it, and then teaching it --
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    waiting for these patients to arrive.
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    We can do a lot better.
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    And I want to take you now into
    what is veritably the Willy Wonka shop
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    at Boston Children's Hospital,
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    where we are manufacturing
    reproductions of children
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    in order for surgeons and surgical
    teams to rehearse
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    in the most relevant possible ways.
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    Let me show you this.
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    Here's my team
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    in what's called the SIM Engineering
    Division of the Simulator Program.
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    This is an amazing team of individuals.
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    They are mechanical engineers;
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    you're seeing here, illustrators.
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    They take primary data
    from CT scans and MRIs,
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    translate it into digital information,
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    animate it,
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    put it together into the components
    of the child itself,
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    surface-scan elements of the child
    that have been casted as needed,
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    depending on the surgery itself,
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    and then take this digital data
    and be able to output it
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    on state-of-the-art,
    three-dimensional printing devices
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    that allow us to print the components
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    exactly to the micron detail of what
    the child's anatomy will look like.
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    You can see here,
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    the skull of this child being printed
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    in the hours before
    we performed this surgery.
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    But we could not do this work
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    without our dear friends on the West Coast
    in Hollywood, California.
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    These are individuals
    that are incredibly talented
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    at being able to recreate reality.
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    It was not a long leap for us.
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    The more we got into this field,
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    the more it became clear to us
    that we are doing cinematography.
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    We're doing filmmaking,
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    it's just that the actors are not actors.
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    They're real doctors and nurses.
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    So these are some photos
    of our dear friends at Fractured FX
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    in Hollywood California,
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    an Emmy-Award-winning
    special effects firm.
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    This is Justin Raleigh and his group --
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    this is not one of our patients --
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    (Laughter)
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    but kind of the exquisite work
    that these individuals do.
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    We have now collaborated
    and fused our experience,
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    bringing their group
    to Boston Children's Hospital,
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    sending our group
    out to Hollywood, California
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    and exchanging around this
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    to be able to develop
    these type of simulators.
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    What I'm about to show you
    is a reproduction of this child.
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    This is not a real child.
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    You'll notice here that every hair
    on the child's head is reproduced.
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    And in fact, this is also
    that reproduced child --
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    and I apologize for any queasy stomachs,
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    but that is a reproduction and simulation
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    of the child they're about to operate on.
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    Here's that membrane we had talked about,
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    the inside of this child's brain.
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    What you're going to be seeing here
    is, on one side, the actual patient,
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    and on the other side, the simulator.
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    As I mentioned, a scope, a little camera,
    needs to make its way down,
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    and you're seeing that here.
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    It needs to make a small hole
    in this membrane
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    and allow this fluid to seep out.
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    I won't do a quiz show to see
    who thinks which side is which,
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    but on the right is the simulator.
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    So surgeons can now produce
    training opportunities,
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    do these surgeries
    as many times as they want,
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    to their heart's content,
    until they feel comfortable.
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    And then, and only then,
    bring the child into the operating room.
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    But we don't stop here.
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    We know that a key step to this
    is not just the skill itself,
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    but combining that skill with a team
    who's going to deliver that care.
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    Now we turn to Formula One.
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    And here is an example
    of a technician putting on a tire
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    and doing that time and time
    again on this car.
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    But that is very quickly
    going to be incorporated
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    within team-training experiences,
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    now as a full team orchestrating
    the exchange of tires
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    and getting this car back on the speedway.
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    We've done that step in health care,
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    so now what you're about to see
    is a simulated operation.
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    We've taken the simulator
    I just described to you,
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    we've brought it into the operating room
    at Boston Children's Hospital,
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    and these individuals --
    these native teams, operative teams --
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    are doing the surgery before the surgery.
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    Operate twice;
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    cut once.
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    Let me show that to you.
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    (Video) Surgical team member 1:
    You want the head down or head up?
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    STM 2: Can you lower it down to 10?
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    STM 3: And then lower
    the whole table down a little bit?
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    STM 4: Table coming down.
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    STM 3: All right, this
    is behaving like a vessel.
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    Could we have the scissors back, please?
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    STM 5: I'm taking my gloves,
    8 to 8 1/2, all right? I'll be right in.
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    STM 6: Great! Thank you.
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    Peter Weinstock: It's really amazing.
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    The second step to this,
    which is critical,
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    is we take these teams out
    immediately and debrief them.
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    We use the same technologies
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    that are used in Lean
    and Six Sigma in the military,
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    and we bring them out
    and talk about what went right,
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    but more importantly,
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    we talk about what didn't go well,
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    and how we're going to fix it.
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    Then we bring them right back in
    and do it again.
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    Deliberative batting practice
    in the moments when it matters most.
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    Let's go back to this case now.
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    Same child,
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    but now let me describe
    how we care for this child
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    at Boston Children's Hospital.
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    This child was born
    at three o'clock in the morning.
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    At two o'clock in the morning,
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    we assembled the team,
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    and took the reproduced anatomy
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    that we would gain
    out of scans and images,
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    and brought that team
    to the virtual bedside,
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    to a simulated bedside --
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    the same team that's going to operate
    on this child in the hours ahead --
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    and we have them do the procedure.
  • 17:00 - 17:01
    Let me show you a moment of this.
  • 17:06 - 17:08
    This is not a real incision.
  • 17:10 - 17:12
    And the baby has not yet been born.
  • 17:13 - 17:15
    Imagine this.
  • 17:21 - 17:25
    So now the conversations
    that I have with families
  • 17:25 - 17:28
    in the intensive care unit
    at Boston Children's Hospital
  • 17:28 - 17:29
    are totally different.
  • 17:30 - 17:32
    Imagine this conversation:
  • 17:33 - 17:38
    "Not only do we take care of this disorder
    frequently in our ICU,
  • 17:38 - 17:40
    and not only have we done surgeries
  • 17:40 - 17:42
    like the surgery we're going
    to do on your child,
  • 17:42 - 17:46
    but we have done your child's surgery.
  • 17:47 - 17:50
    And we did it two hours ago.
  • 17:50 - 17:52
    And we did it 10 times.
  • 17:52 - 17:56
    And now we're prepared to take them
    back to the operating room."
  • 17:58 - 18:00
    So a new technology in health care:
  • 18:01 - 18:04
    lifelike rehearsal.
  • 18:04 - 18:08
    Practicing prior to game time.
  • 18:09 - 18:10
    Thank you.
  • 18:10 - 18:17
    (Applause)
Title:
Special effects that can save a life | Peter Weinstock | TEDxNatick
Description:

Medicine may be the only high stakes industry left that does not routinely practice prior to game time. Critical Care Doctor and Medical Simulation Expert, Peter Weinstock shows how a unique blend of simulation, Hollywood special effects and 3D-printing are used to create amazingly lifelike reproductions of real patients and for the first time give surgical teams the power to "operate twice, but cut once” to improve outcomes for infants and children.

Peter is an Intensive Care Unit physician and Director of the Pediatric Simulator Program at Boston Children’s Hospital/Harvard Medical School. He is committed to improving the surgical outcomes of neonates and children. Peter and his team fuse medicine with state of the art special effects, puppeteering and 3D print technologies to create lifelike simulations of complex surgeries.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

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Video Language:
English
Team:
TED
Project:
TEDxTalks
Duration:
18:26

English subtitles

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