Saving a Life

I'm now on the email list for my old friend Dan Mattson, who works in anesthesiology with the military in Iraq. He just sent out the following email, which his brother has already posted:

Yesterday started with a bang. Around 0800 I went to the EMT as a casualty just came through the door. He had a tourniquet on his leg, and was barely conscious, cold, and clearly in shock. Brett had the honors of intubating him, while I put in an arterial pressure line and the ER doc put in a femoral IV. His initial blood pressure was around 45-50 over 20. We got some emergency release blood for him and stabilized his pressure enough to get him up to the OR. The case finally ended around 1530, so it was a long, long case, and very labor intensive. There were 3 of us working on the rescusitation most of the time. This guy got 30 units of red cells, 5 units of whole blood, 16 units of plasma, and as many platelets as we could get our hands on. It is amazing the resources we spend on saving the "enemy" soldier. Yes, he was a bad guy, or what we call an SI (Security Interest). We basically depleted our blood bank for him. If he had come in 5 minutes later, he would have been dead. I think it's a good that we treat everybody, but it could become disturbing if an American GI had shown up soon afterwards and we were left without the resources to save him. His femoral artery was damaged, so the surgeon did a saphenous vein bypass graft. This surgeon is conveniently a vascular surgeon, and will be leaving in a few weeks because he was here with the 31st CSH. Today we brought him back to the OR, and he was incredibly stable. He will probably have a good outcome, and then go to jail.

Stuart Buck