Medical question from pilot episode : LUSENET : ER Discussions : One Thread

In the pilot episode after Carol overdoses Mark and Morganstern are talking about her condition. In layman's terms what is he saying? I cant't find anything that ever explained her condition in layman's terms. What I can gather is that when Morganstern is stating "If she's decerebrating is any of this worth doing at all" I take that to mean she is losing brain function and her bodily functions are closing down. Is that right? ALso is has been stated that it would have been a miracle in real life for Carol to have come back from the OD - is this why? If there any people in the medical field that could explain this in layman's term I'd appreciate it. Thanks!

-- Kathy (, February 28, 2001


Kathy, I can't answer this question directly but in case you didn't know, the character of Carol was supposed to die in the pilot. Julianna got a call a while later asking her to come back, saying that Carol would survive. There's probably more on this in other threads but I thought I'd mention it here.

-- Diana (, February 28, 2001.

Carol's prognosis in the Pilot is so dismal because of two things mentioned: her serum barbiturate level and her positive Babinski reflex. In the first case, a "serum barb" is part of a tox screening that measures the amount of barbiturates (a potent class of central nervous system depressants/sedatives) in the patient's bloodstream. Depending on the specific drug she took, the serum concentration of barbiturate needed for a fatal dose can range from anywhere between 30 and 80 mcg/mL; Carol's was 45 mcg/mL, which should have been more than enough to kill her.

Second, the positive Babinski. Barbiturates work by inhibiting activity in the nervous system; consequently the CNS slows down, which makes barbiturates a very handy class of drugs for controlling seizures and sedating hyperactive patients. Overdose, however, causes a "shutdown" situation in the CNS, leading to coma, respiratory arrest, and death as the brainstem (the segment of the CNS that controls autonomic functions such as respiration and heartbeat) shuts down. One test used in neurology to see how badly the CNS is damaged is the Babinski reflex; stroking an object (the end of a reflex hammer, a blade, your finger, whatever) along the outside sole of the foot should cause the foot to flex inward (plantar flexion); this is a negative Babinski, and suggests intact motor function. In a positive Babinski, the toes, most notably the big toe, dorsiflex (splay outward); this is a sign of severe motor deficit, and is usually (though not always) associated with diffuse cerebral damage.

This last point also refers to Morganstern's comment. Decerebration, or the loss of cerebral functions, is the complete shutdown of the cerebrum, that portion of the brain that controls all higher functions - senses, thinking, memory, etc. If the cerebellum and hindbrain (or brainstem) are intact, the patient will retain autonomic function and remain in a coma; if these structures are damaged as well, there will be no respiration or heartbeat save for that artificially maintained by a ventilator and/or pacer, and the patient is said to be brain-dead.

Given her barb level and lack of CNS response, Carol should have died. A few patients have been known to survive high doses of barbiturates - the chances of this happening, however, do fall into miracle territory.

Hope this helps!

-- Lindsay E. Murphy (, April 25, 2001.

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