A Dire Situation

[Yourmother]

Questions for all you knowledgeable INTPs out there.

Let's say there's a middle aged man walking down the river, and he spots a guy getting dragged down into the rapids, of whom is clearly drowning. When he pulls him out, hes clearly is suffering from a lot of blood loss due to inflicted laceration and slash wounds, along with a lack of breathing due to the water in his lungs.
After CPR is successfully applied and he succeeds in not breaking any of his ribs in the process, how could he successfully save him from hypovolemic shock assuming he has no way of contacting a hospital or any emergency service for at least two or three days (ie. hes in a remote area)?
Let's assume there is a military base nearby with medical supplies, including catheters, bags of normal saline, alcohol wipes, antibiotic substances, and a battery powered infusion pump, but it doesn't have electricity or communication lines.

The guy is clearly suffering from a class 3 hemorrhage case, so yeah, its pretty dire.

 

[TheScornedReflex]

Screw that guy. What's he ever done for you but caused problems? After all that effort he needs more of my time? Not gonna happen.

I'm not a INTP though. I'm a JPEI or whatever they are.

 

[Ex-User (5841)]

If you don't break a rib via CPR you're either not doing it right or are very lucky...

Address lacerations with direct pressure & stopping blood flow via pressure points, elevate legs and arms, apply bandages, and IV him the saline. If this fails and he's important enough to justify you sucking out a pint of your own blood and putting into him in the face of pathogen concerns, go for it.

 

[Yourmother]

Let's say the guy breaks his rib. Is there any way to transport him safely to the site with medical supplies? Is a one-person fireman carry a safe way to send him around without having to worry about a broken rib penetrating his lungs?

And even if the emergency blood transfusion is successful after saline transfusion, how long would the poor guy have to live without hospital access? (If there's no blood poisoning or anything, or if the middle aged guy has the luck to have O- blood.)

P.S: I'm going off on a limb to say that the guy's your brother or something, so that it makes it worth it.

 

[Ex-User (5841)]

The rib isn't really a problem. It'll hurt like hell to move and breathe, but people with *only* broken ribs can still walk around on their own, etc. The rib's likely not going to penetrate anything unless you drop him after CPR (glances at TSR ). The concern is for the apparent hemorrhage, which is not something you want to bust open again. Ideally you don't want to move him at all and wait for someone with training and licensure (and insurance!) to move them.

I mean... after arms and legs are elevated and IV saline has been administered, you should be waiting for a helicopter assuming the military base has been notified that the patient exists and his condition.

The dude may be stone cold dead within 5 minutes if the hemorrhage doesn't initially clot, so I wouldn't worry too much about transfusion success. If it clots and it's successful, then maybe 24 hours with infusion + transfusion. Depends more on the amount of available saline, tbh. Dehydration will nab him in a couple days. (Also, you want the guy to have AB+ blood and you to have O-. O- is the universal donor. Someone who's O- can only receive O-. ....Though that would mean he's definitely not your brother ).

Ultimately...

Spoiler

 

[Yourmother]

Woah, thanks so much for your information. That was incredibly helpful.

 

[The Gopher]

*Now Yourmother goes out to find the guy he saw drowning 3 hours ago*

It's most likely for a story I imagine.

 

[Ex-User (5841)]

*Now Yourmother goes out to find the guy he saw drowning 3 hours ago*

It's most likely for a story I imagine.

Plot twist: the patient survives only to discover 8 years later that the field blood transfusion gave him HIV.

 

[Yourmother]

Oh wait, sorry I have another question.

Should the wounds be washed in mind of hygiene and preventing infection, and is adding antibiotic substances before attempting to seal them up a smart idea or something that can cause unforeseen problems?

Should soap be used or not?

 

[Cognisant]

Let's assume there is a military base nearby with medical supplies, including catheters, bags of normal saline, alcohol wipes, antibiotic substances, and a battery powered infusion pump, but it doesn't have electricity or communication lines.

I have Rh negative "O" blood so anyone can receive mine but I can only receive blood from other Rh negative people, which is only 15% of the world's population, so I could perform a transfusion and the guy would have a relatively high chance of surviving.

Assuming I can stop the hemorrhaging first.

Should the wounds be washed in mind of hygiene and preventing infection, and is adding antibiotic substances before attempting to seal them up a smart idea or something that can cause unforeseen problems?

Generally a good idea, ideally the less you expose a wound to the better however if you have to improvise then first priority is preventing an infection, I would even cut away "dead" flesh that could normally be saved like the tip of a finger that's been partially cut off.

Without antibiotic drugs you should never underestimate an infection.

 

[Yourmother]

Thanks for the info. By the way, I respect how you bared all the ugly feelings on dating or something. I remember reading something about women around a few weeks ago.

 

[Ex-User (5841)]

Oh wait, sorry I have another question.

Should the wounds be washed in mind of hygiene and preventing infection, and is adding antibiotic substances before attempting to seal them up a smart idea or something that can cause unforeseen problems?

Should soap be used or not?

It should be done but it's very low on the priority list compared to everything else this guy has going on.

Antibiotic substances + sterile water > soap to clean wounds. The former kills bacteria, the latter kills everything and provides food for future bacteria in the form of dead cells. Soap's fine on the skin after it's closed though.

Also (for whatever purpose this is for) if we're talking deep lacerations, make sure you leave a drain in the wound, otherwise it'll fill up with pus and become a fun little timebomb of septic (blood) infection which is difficult to treat without powerful antibiotics and often fatal.

 

[Yourmother]

Oh okay. I tried to look up expiry dates for 0.9% normal saline but I heard they never really expire? In essence, what are the best IV fluids that can be stored for a long time without refrigeration?

Also, how do you know when to stop transfusing normal saline before performing a blood transfusion (conversely, when there's not enough blood or too much blood to transfuse)? Would heating up the IV needle to sterilize it be a smart idea?

All of this is for a military project in spec course. You all have been really helpful so far.

 

[Ex-User (5841)]

Oh okay. I tried to look up expiry dates for 0.9% normal saline but I heard they never really expire? In essence, what are the best IV fluids that can be stored for a long time without refrigeration?

Also, how do you know when to stop transfusing normal saline before performing a blood transfusion (conversely, when there's not enough blood or too much blood to transfuse)? Would heating up the IV needle to sterilize it be a smart idea?

All of this is for a military project in spec course. You all have been really helpful so far.

Saline's the only one I know of (everything I've said so far has been what I learned as a boy scout. I'm no doctor ), which doesn't physically expire so long as the seal's intact (though institutional policy usually has them replaced every so often). There's nothing in it to support bacterial growth. Glycerin is used in IV solutions sometimes, but I'm not sure of its function.

The trigger to switch from saline to transfusion should be blood oxygen levels. Saline's good for dehydration and shock, but it doesn't exactly carry oxygen, you know? But I'm really not qualified to answer this far though.

Heating the needle is better than nothing. There might be some risk of the heat harming the plastic components and creating a hole (i.e. no longer sterile) though. Alcohol would be best.

 

[EditorOne]

Nobody mentioned building a fire to keep this guy warm? Nobody mentioned the obvious threat to the rescuer. OK:
Who needs a medical base nearby for this story? Get him out of his wet clothing, build a roaring bonfire, stuff any of about six kinds of moss in the cuts and wrap them with leaves, vines or the inner bark of a variety of trees, elevate his feet 12 inches higher than the rest of him, THEN go see about the medical gear. Someone might notice the fire and investigate. You haven't had to move him, you're bringing the supplies to him. You're on the move and more aware, without trying to move him, of anyone else who might be around. That's good, because "anyone else" could be the psychopath who put him in the river. Now you're protecting yourself while trying to help this guy, who, for all you know, DESERVED to be put in the river.
Just remember to exercise caution returning with the medical stuff just in case the killer investigated the fire and realized his work wasn't done.