A man, played video games non-stop for 73 hours.
This is how his organs shut down.
DC is a 25 year old man,
presenting to the emergency room, dead on arrival.
Paramedics were desperately performing chest compressions to try
and push blood back into his brain.
To try and push blood into his organs.
To try to keep him alive.
But it seemed like their attempts, were all in vain.
DC was a college graduate, but he never wanted to go to school.
DC 是个大学毕业生 但他无心从学
He worked a minimum wage job, but he was recently fired.
He wanted to be an internet video game streamer, but no one was watching.
And he lived at home with his mom where she still cooked for him,
but she kicked him out when he was no longer going out to look for a new job.
Depressed and lost, DC binged on video games
at the local internet cafe for days at a time.
Sometimes he’d sleep at the computer,
and wake up to play some more.
He gave up personal hygiene.
He gave up friendships.
His life was games.
He was obsessed, and he just couldn’t stop playing.
One weekend, DC played for 73 hours, nonstop.
Glued to his seat, he barely ate any food.
He hardly drank any water. He didn’t even get up to use the bathroom,
having already released a few times in-between,
and finally couldn’t hold it in anymore.
He got up for the first time in days
as he stood up from his chair. He suddenly felt lightheaded.
He blacked out. And then instantly collapsed.
At the front desk of the internet cafe,
the owner was oblivious to the fact that someone had fainted on his property.
30 minutes pass and DC was found on the floor,
unconscious and struggling to breathe.
911 is called.
In the ambulance, DC suddenly flatlines.
His heart stops beating and he stops breathing.
Paramedics desperately begin CPR
as he’s brought to the emergency room where we are
now. Doctors continue chest compressions.
Ultrasound immediately reveals that the right side of his heart is swollen.
It’s larger than the left ventricle, which is the part of the heart that’s responsible
for pumping blood to the entire body.
The left ventricle has more muscle
so it’s largest part of the heart in every normal functioning human.
But DC can’t function normally now.
His heart is twisted.
This immediately tells the medical team
that he’s suffering from Acute Massive Pulmonary Embolism.
Embolus from Ancient Greek meaning a wedge,
or in this case referring to a blood clot.
Pulmonary meaning Lung.
And Massive referring not to size
of the actual clot but to the SUDDEN hemodynamic collapse that it caused in DC.
A blood clot wedged into the lungs causing his heart to disfigure.
Causing his heart to stop beating because it is disfigured.
Causing his organs to shut down because they’re no longer receiving oxygen due to the fact
his heart has stopped beating.
Acute meaning that he didn’t have any underlying medical issues leading to this problem, except
for sitting at a computer playing video games nonstop for 73 hours.
Doing anything nonstop for 70 hours is dangerous,
but sitting down nonstop for 70 hours is deadly,
because of venous stasis.
This is a time when a lack of movement of the legs causes blood to pool.
The blood pressure in the body’s veins is already low because there isn’t anything
directly pumping it back to the heart.
Venous blood oozes its way back.
Without moving the legs for 70 hours and given
that sitting down compresses the veins, a
compartment of the body where blood flow is already slower than normal, then this pooling
of blood causes some of it to clump together
into a clot, called a deep vein thrombosis,
which is what happened to DC as he sat there,
for days, but there’s more.
As the clot formed,
it stayed in his legs for as long as he was sitting down.
He got up, it broke off,
it went directly into the right side of his heart like how blood normally does,
but then lodged itself directly into the pulmonary artery where the
right side of the heart connects to the lungs.
This back up of blood into the right ventricle, caused it to stretch.
To distend. To disfigure.
But this is only the beginning of the dysfunction.
The right ventricle of the heart typically has a thinner wall than the left.
It has a lower volume to surface area ratio.
This makes sense because blood from here goes directly to the lungs.
You don’t need high pressure going to the lungs when they are right there.
But when the right ventricle swells due to flow backing up,
wall stress increases.
It pushes against the interventricular septum,
causing it to bow out into the left ventricle.
This increased pressure and volume in the right displaces the left,
reducing cardiac output.
In DC’s case
of hemodynamic collapse secondary to massive pulmonary embolism, an occlusion
into the pulmonary artery meant a filling defect
on the left as blood can not be pumped out to the rest of the body.
There is no longer an adequate oxygen supply
in his body as his organs all start to die.
His heart, while still trying to beat, can no longer function.
It arrests, as he comes into the emergency room, without a pulse.
But it wasn’t like this when they found him.
Paramedics tell the medical team that DC was found gasping for air.
That he did have a heartbeat when they found him,
but it was fast, from his body detecting hypoxemia,
a low oxygen presence in blood.
His blood pressure was low from the then hemodynamic compromise.
And that it was on the way to the emergency room
that his heart suddenly stopped beating.
That all of this happened just minutes ago,
meaning that it might not yet be too late.
There might still be a chance to bring DC back to life.
Is there a way, we can somehow remove the clot from DC’s lungs?
But it has to be done, immediately.
Surgery and cutting him open to pull it out,
isn’t an option because it would take too long.
Guiding a catheter through his veins to direct medicine that can dissolve the clot directly,
is also not an option because of time.
The quickest solution, is to infuse that medicine directly into his entire body.
This systemic fibrinolytic therapy, is his last hope.
On the emergency room bed,
DC is immediately infused with a large bolus dose of lytic as
chest compressions are continued.
Additional lytic was set for infusion over time
as this aggressive dosing means the medical team will continue CPR
until he either comes back to life,
or it is absolutely certain that DC is lost.
As the chest compressions are desperately applied, minutes pass.
A detectable heart beat is found
and this return of spontaneous circulation is a good sign.
DC is not lost.
But several hours pass, and he doesn’t regain consciousness.
Admission into the intensive care unit finds that he is missing cognitive factors.
Shining a light into his eyes,
a normal functioning human will exhibit a pupillary reflex, where
the pupils will constrict in reaction to the increased presence of light.
Absence of this indicates brain damage, and in DC, it’s absent.
In a normal functioning human, motor response to pain is natural reflex.
Absence of this reflex indicates brain damage, and in DC, it’s absent.
As the days go by,
DC’s mother arrives to the hospital to see her son.
She tries to speak to him but no response.
He may not have listened to her in life,
but the only thing she would like to see now is
a response, an indication, something,
from her son that tells her he can hear her, but
nothing is returned.
The several minutes where DC’s body
was not receiving oxygen because of a clot blocking the point where his heart and lungs connected,
caused this permanent anoxic ischemic damage.
Most people can easily pick out that
healthy individuals can’t stay up and play games
for 3 days straight, without sleep, without going to the bathroom.
Most people can’t stay up 3 days straight for anything.
That to be able to play that much means that that person, has a problem.
Internet gaming disorder has been described
as a condition for needing further research for several years now.
Back in 2013,
The Diagnostic and Statistical Manual of Mental Disorders, revision 5
put that description on paper.
And in 2018, the World Health Organization placed gaming disorder
as a diagnosable condition in the 11th revision
of the International Classification of Diseases.
DC is at one extreme end of the spectrum of what can be described as internet gaming disorder.
The actual people who will have this are a small subset
of the population, because, most people won’t have this level of obsessive behavior. Context here matters, make no mistake.
People who only hear headlines may be underinformed as to what internet gaming disorder really is.
What behavior those words are describing. It’s probably not describing a kid
who wants to play games with his friends after school,
who day dreams about the game during class,
but is a functional person who is OK if they don’t play games for a few days.
Who can comply with their responsibilities.
It also probably doesn’t describe a 25 year old who plays 20 hours total on the weekend,
but can still show up to work during the week,
hold a relationship and family obligations without problem.
Internet gaming disorder doesn’t describe these people. But,
if someone lets their kids or pets starve to death
because they were too focused on playing a game,
then something might be wrong.
If someone continues to obsessively play
after getting forcibly kicked out their parents ’ house,
plays for several days at a time nonstop,
not getting up, not eating, not using the bathroom, and not sleeping,
从不起身 吃饭 上厕所 睡觉
well then something could be wrong.
Even worse if blood pools in the legs
while that person is playing,
forming a deep vein thrombosis,
that became a massive pulmonary embolism, with end organ malperfusion and
hemodynamic collapse resulting in residual organ dysfunction and hypoxic brain damage.
Something that results in tangible, detrimental and life-threatening consequences due to one’s
lack of self control over playing video games,
IS a problem,
and it’s a good thing that it’s been classified as such.
For DC, limited neurocognitive function was recovered
as he suffered from rounds of pneumonia
and sepsis during his stay in the intensive care unit.
Diminished urine output and elevated transaminase levels
indicated kidney and liver damage.
The loss of pupillary reflex and
absent extensor motor response days after admission were 100
percent specific factors to indicate poor outcome following anoxic injury, secondary
to massive pulmonary embolism.
extensive neuronal damage was found in the parieto-occipital-temporal cortex of his brain.
Cerebellar injury was observed along with losses at the thalamic nuclei.
Little could be done by the time he was found unresponsive at the internet cafe as too much
time had passed in a setting where minutes and seconds matter.
The only hope was to salvage whatever the medical team could,
once DC fell into cardiac arrest.
For gamers today,
be sure to keep yourself hydrated
and don’t sit for more than an hour at a time.
Get up, walk around even if just for a couple of minutes.
And most importantly, be kind to yourself.
Internet gaming is actually stressful, even if it’s fun.
Thank you so much for watching.
Take care of yourself.
A man, played video games non-stop for 73 hours.