the 100% directionless thread

DragonClaw said:
Hmm okay. I anticipate this to be field ready sometime during my career and I'll tell everyone I had this idea once.


Why does it kill them though. Why is pasta water and sugar water evil.
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All they due is increase the intravascular volume. The downsides to that is the more fluids you add the more diluted the patients clotting factors become. So now you have a bleeding patient who is not able to clot off the bleed. Also one of the main purposes of blood is to transport oxygen. LR/NS does not have the ability to transport oxygen.
 
DesertMedic66 said:
All they due is increase the intravascular volume. The downsides to that is the more fluids you add the more diluted the patients clotting factors become. So now you have a bleeding patient who is not able to clot off the bleed. Also one of the main purposes of blood is to transport oxygen. LR/NS does not have the ability to transport oxygen.
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So it can keep turgor and BP but at such a price. And there's no artifical clotting factors or way to add something that's oxegenated.... that I know of.

Geez.
 
DragonClaw said:
Hmm okay. I anticipate this to be field ready sometime during my career and I'll tell everyone I had this idea once.
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Not going to happen. You have one hour to remove it or you loose end organ function, if you place the REBOA balloon too high you kill the kidneys. You are better off just giving them replacement product as they hemorrhage as you get in the OR. Plus a cross clamp is placed by a surgeon or by (a very few very brave) emergency physicians, it isn't anywhere close to something EMS will ever do.

REBOA may hold some benefit for providers who get to practice and have a somewhat extended transport time to a trauma surgeon (1-6 hours), but that is going to be very rare outside of the military.

DragonClaw said:
Why does it kill them though. Why is pasta water and sugar water evil.
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No only are you making cool aid, you are also making them cold and acidotic. Trauma triad of death.
 
DragonClaw said:
So it can keep turgor and BP but at such a price. And there's no artifical clotting factors or way to add something that's oxegenated.... that I know of.

Geez.
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For short periods of time you need much less blood pressure than you would think. Most young healthy people (the vast majority of the victims of trauma) are just fine with an SBP of 70-80 for short periods of time. This is permissive hypotension.

Artificial clotting factors do exist, they are so expensive that EMS doesn't carry them. EMS can mimic them to a degree with TXA and calcium.

There were studies on artifical hemoglobin infusions, too much risk with too little benefit.
 
Peak said:
Not going to happen. You have one hour to remove it or you loose end organ function, if you place the REBOA balloon too high you kill the kidneys. You are better off just giving them replacement product as they hemorrhage as you get in the OR. Plus a cross clamp is placed by a surgeon or by (a very few very brave) emergency physicians, it isn't anywhere close to something EMS will ever do.

REBOA may hold some benefit for providers who get to practice and have a somewhat extended transport time to a trauma surgeon (1-6 hours), but that is going to be very rare outside of the military.



No only are you making cool aid, you are also making them cold and acidotic. Trauma triad of death.
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I meant the idea. We have confirmed the possibly of this and explore the efficacy of certain techniques.

Such as taking pig valves, pancreas and blood until other replacement are more suitable. We don't need pig pancreas anymore but we now have more accessible insulin.

Pizza hut smart cars have a pizza warmer but the 400K ambulance can't have a 1-5 bag of fluid warmer? On my clinicals, narcs were kept in a tiny fridge built into the unit.

Acidotic. Okay well maybe a cocktail to balance things out. I know it's easy to say "Well why don't you just..."

Ugh I need to go get a doctorate.

Peak said:
For short periods of time you need much less blood pressure than you would think. Most young healthy people (the vast majority of the victims of trauma) are just fine with an SBP of 70-80 for short periods of time. This is permissive hypotension.

Artificial clotting factors do exist, they are so expensive that EMS doesn't carry them. EMS can mimic them to a degree with TXA and calcium.

There were studies on artifical hemoglobin infusions, too much risk with too little benefit.
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Again, these things are in their infancy. Maybe we find the next step in its evolution before the best version of these are completed. But I'm sure there's a way to stop a lot of these untoward effects
 
VentMonkey said:
Blah. Polytrauma is currently the bane of my existence. I’m happy to push it off on the trainee when they start. I’m over the paperwork. I’m just saying.
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Honestly, GSW's are some of my simpler legitimately sick/injured reports. Even the bad ones. Arrests are where I really get bogged down. 8 defibrillations on top of everything else is a busy call sheet. Well....short of those balloon pump, 83 medications, tubes from every orifice patients you fancy folks run. Those must be a hell of a report.

I get it though. Id' definitely rather be the one driving those kinda calls where the report is not mine to write. I'm happy to not touch the tablet all day when I get so lucky.
 
DragonClaw said:
Wait. Why can't you just reroute the blood to skip over the injured vessels, like run some lines. Bypass affected tissue
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They can for some things, but this guy was not a viable candidate. His damage appeared to be in the area of the aortic arch and it's branches. Some damage just can't be circumvented while repairs are made.
 
StCEMT said:
They can for some things, but this guy was not a viable candidate. His damage appeared to be in the area of the aortic arch and it's branches. Some damage just can't be circumvented while repairs are made.
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I know it's not a catchall. Just a thought if a concept that is done a bit differently
 
This is getting painfully close to having a topic.
 
DragonClaw said:
Hmm okay. I anticipate this to be field ready sometime during my career and I'll tell everyone I had this idea once.


Why does it kill them though. Why is pasta water and sugar water evil.
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I hate to be the bearer of bad news but someone had the idea and put it in practice prehospitally long before you came to EMS.
 
Anesthesia records are gibberish. Triangles, dots, circles, arrows. All I know is that the line of triangles on the 30 line makes for a long flight
 
DragonClaw said:
WAIT WAIT .

WHY DO WE DO CPR IF WE CAN JUST PACE THEM?

There's probably a really good answer. But. Yeah..
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Chest compressions mechanically squeezes the heart whether there is an electricity problem or not. Pacing only works if the electrical heart rate is slow and still has an associated mechnical squeeze. If the heart rate is normal or fast or there is no associated mechnical squeeze, then pacing won't work.
 
I met a cattail outside a SNF. I named it Tony.
Aprz said:
Chest compressions mechanically squeezes the heart whether there is an electricity problem or not. Pacing only works if the electrical heart rate is slow and still has an associated mechnical squeeze. If the heart rate is normal or fast or there is no associated mechnical squeeze, then pacing won't work.
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You can't force a contraction assuming the pathways are good?
 
DragonClaw said:
Right, so if the pts natural pacemaker is not working, asystole, why can't we just pace that?
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Usually when a prehospital patient is in asystole, it's because they've been dead awhile, and their heart won't produce any electrical activity. It's like pacing a rock. Even in my area where we practice medicine like it is 1890, we work these patients for 20 minutes and determine death on scene. We transport everything else and their moms too.
 
Doing whole 30 again... Day two and I already hate my life.
 
Finally got a night warm enough to watch an outdoor movie. Oldest is loving it, youngest was being a jerkface so she went to bed. Watching the Greatest Showman. Tomorrow is the last of my 6 days off. Then i work 7 shifts every other.
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