A long, long time ago, in a galaxy not so far away….no, wait. That is not quite right.
So, TINS©, TIWFDASL©, with my partner Doug, and we caught a run for a stabbing. This was a bit out of the ordinary, inasmuch as the preferred mode of interpersonal interaction (based exclusively upon my skewed sample of EMS patients in Da City) was labeled as “a GSW”, or less cryptically, “a shooting”.
In any event, we arrived to find a gentleman who was talking, kinda sweaty, but able to tell us the chain of events that led to our meeting, along with niceties such as his allergies, medications, and previous medical history. Oh, yes: with a solitary stab wound in his chest, just left of center, and around 4-6 cm removed from his sternal margin. (Yep, that means just what you suspect that it means).
We packed him up, after Doug, thinking ahead, had laid out the MAST trousers on the cot.
So, back in the mists of time, shortly after the demise of the horse drawn ambulance (I kid! I kid!), there was this tool, based upon the fighter pilot’s “G Suit”, called the Medical Ant Shock Trousers, or MAST Trousers (Yep, that does, indeed, stand for “Medical Anti Shock Trousers Trousers”. Go figure.) The principle was thought to be that, when you inflated bladders in the legs, and overlying the lower abdomen, you would increase venous resistance, and thereby minimize the amount of blood remaining in the lower extremities, and thereby increase venous blood return to the heart. Since that would increase pre load, and preload is one component of cardiac output, the thinking was that, if we could increase preload, we could increase cardiac output, and that would increase blood pressure. Generally, within certain limits, increased blood pressure in a trauma/shocky patient is held to be A Good Thing.
We were coding merrily along to TTBTCIDC (For those of you keeping score at home, that would be “The Third Best Trauma Center In Da City”). Mr Stabee and I were having a lovely conversation, after a fashion, until he got really quiet. Concerned, I checked his pulse and breathing, finding a considerably weaker, and faster, pulse than previously, along with diminished rate of respirations.
I hollered to Doug that our new friend was circling the drain, and both more alacrity on his part, as well as a heads up to the receiving facility might be really appreciated.
I wrapped him (the patient, not Doug) up in the MAST trousers, and inflated the bladders. Now, we had a protocol of inflating the bladders to pressure “X”, re- assessing the patient, and then either holding there, or adding more pressure. In the spirit of Spinal Tap’s Derek Smalls, I bypassed the intermediate steps, and inflated the bladders, metaphorically, to 11.
To my surprise, out stabbee awakened, and began to converse, asking “What happened?”I obtained a new set of vitals, and wrote them down, as we stopped at TTBTCIDC.
We trotted our friend to the trauma room, and, as I wheeled the cot out of the room, I heard the physician order, “Take those things off of him, now!”
I started to offer our valves and suchlike, in order to wean the pressure off of the bladders, rather than precipitously deflating them, but the sound of ripping velcro was my reply.
Shortly afterward, the code was called, and everybody who had not crowded into the room, now entered.
Before we were done cleaning up the truck and restocking our medic bag, the code had been called. Unsuccessfully.