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11-27-2016, 06:46 PM #1
Hypothermia for saving gunshot victims
Surgeons at Baltimore Shock Trauma are planning a trial of replacing victims blood with cold salt water while they sew up the holes. The goal is a body temp of 54F. This would apply to people who have lost so much blood that their hearts have stopped. After the injuries are repaired the patient would be transfused with blood and warmed on a heart lung machine. The trial poses ethical problems because the great majority of patients would be black--given the history of using black people in experiments without consent in this country-- and there would be no way to obtain informed consent.
(In November of 1978 I helped care for a 2 year old girl who had drowned, in Michigan. Estimated submersion time 20 minutes. She had no pulse or electrical activity and after an hour of attempted resuscitation she was pronounced dead. The doctor in charge, went to tell the parents, couldn't do it, went back to see the child, who had a pulse. She went home intact 2 weeks later. It could work.)
http://www.newyorker.com/magazine/20...unshot-victims
This could go in the interesting science thread but I couldn't find it.
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11-27-2016, 06:51 PM #2
We probably warm 1-2 drowning victims a year with bypass. Success is variable.
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11-27-2016, 07:14 PM #3Registered User
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I got some MD buddies who revived a guy that had drowned in a ww kayaking incident in very cold water, the victim was under for 7-8 minutes, they got him to shore, 2 mds working to get air into him, called SAR, had him lined out and right into an oxygen tent, the victim was able to return to work 1.5 yrs later
Lee Lau - xxx-er is the laziest Asian canuck I know
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11-27-2016, 07:26 PM #4
Cooling ( besides cold water drowning) has had some remarkable successes. It's in the acls algorithm and also common in neonate w birth insults. Also ECMO for witnessed trauma arrests is commmon.
Given that, I think the ethics are a little more clear. Is it a heroic measure to save a life? Sure. But what is the alternative?I rip the groomed on tele gear
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11-27-2016, 07:40 PM #5
That was a great article. The author does an excellent job highlighting the potential of the treatment while truly explaining the ethical dilemma of providing such expirimental treatment sans consent.
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11-27-2016, 07:53 PM #6
Old goat will appreciate this, the measures taken to save people who have unsurvivable injuries is astounding. Sometimes I wonder what we're doing. The technology now for rapid transfusion allows us to pump blood so fast that we can deplete our resources in the blood bank very quickly. This leaves us vulnerable when we need to get blood products to a patient that has a likelihood of favorable outcomes. Trying to save someone who has 3 or 4 or more separate fatal gunshot wounds is questionably heroic IMO. I would say there are only a handful of trauma surgeons who possess the skill to pull it off. Experiments like this seem to make everyone else of lesser skill want to try and do it too. Our system is really great but at the same time perverse. Sometimes it feels like a vanity project in these situations.
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11-28-2016, 07:42 AM #7
Friend on patrol helped revive a kid that had been in a cold water drowning for about 45 minutes.
Agreed, I sometimes wonder if we have outstripped our common sense sometimes on medical procedures. Yes, you can be saved, but what is the quality of life afterward.
Had a client that they ran 3x his blood volume through him, following a botched radical nephrectomy surgery via the DaVinci machine. 32 units of whole blood, tons of packed platelets, and other fluids. Surgeon apparently whacked a vein that retracted into the lumbar muscles and he couldn't find or stop it. Used over 100 lap-packs in the process. He went into hypovolemic shock which killed his remaining good kidney. Dialysis for 3.5 years, and finally a kidney from his son. Realize they won't consider you as a transplant candidate for several years because he had been a cancer patient.
If a doc asks to do a DaVinci procedure on you, make sure the first question is how many procedures have you done with this machine? This was #2 for this doc.In order to properly convert this thread to a polyasshat thread to more fully enrage the liberal left frequenting here...... (insert latest democratic blunder of your choice).
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