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Sat, 16 Mar 2002 09:37:26 +1030

Thankyou for the articles. I will go looking. Once again, there seems to be
nothing HUGELY definitive forthcoming on how i should manage the
exansguinating patient in my care.

Okay, let's take a different tac on this.... What is the most likely result
if i either don't infuse iv fluid in to this patient or i go real low
volume? Arrest? What next? cerebral anoxia and a cascade of deleterious
chemical reactions begin (continue) to occur that make irretrievable brain
insult the most likely outcome. What about cooling? We know that it
institutes cerebral protection to some extent and slows down these cascades.
The current problem i see is logistics. Removing 4 degrees of heat from the
body within 15 minutes (this is what we think needs to be reached if this is
going to have any chance of working) is difficult to say the least. Try
doing this in the back of an ambulance or in a CCS near a battlefield and
the challenge mounts further.

And then what? Is it realistic yet to "stop/slow the clock" as Safar puts
it, and then transport to a surgeon who can go in and find the bleeder and
fix, reconnect and rewarm? Is this still a technology for Star Treks era, or
is this closer to becoming a viable option? If not, are the lessons from
hypothermia teaching us about other strategies to achieve the same results?
Just looking at different ways to skin the cat!

Chris Cotton,
IC Paramedic
South Australia.

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