FranzJoseph Wise, Aged Ars Veteran
11m
1,581
DavidEmami said:
Hope the everything turns out well for the crew member. It does make me wonder, though -- how would they deal with something life threatening? And have any medical procedures been done in space before? Did some searching and the closest I can find is a post-splashdown injury on Apollo 12 that the crew treated before egress, but that wasn't in free-fall. In particular, I assume the medical concept of the "golden hour" has to be abandoned.
First, obviously IANAD, so take it with a big grain of salt.
"Golden hour" is usually talked in the context of massive traumatic injuries and/or massive haemorrhaging. Even there it's a bit controversial, as it might be more useful only in the context of triage of massively multiple casualties with limited medevac resources down here.
IOTW, if any massive traumatic injury happens on the ISS (say a micrometeorite going through an astronaut or a pressurised cylinder failure resulting in an open fracture and haemorrhaging), the casualty is likely to be fucked anyway.
For things that develop over a longer time (appendicitis ‑‑> septicaemia), the astronauts are hopefully so well monitored that it would be caught early on.
You can find a full equipment list in the CHeCS onboard here (PDF, 2011 link). https://ntrs.nasa.gov/api/citations/20110022379/downloads/20110022379.pdf
Includes BP/ECG, AED, basic dental & surgery stuff (nothing quite major, scalpel and forceps etc), detox kit, airways kit, ambu bag and low‑flow mask and endotracheal oxygen supply, IV with pump and IV solutions, chest drain valve for pneumothorax, dressings, sutures and splints. Plus medicines, obviously.
Not really sure what the survival rate of somebody with a tension pneumothorax would be, even if quickly drained with the drain valve and intubated. I presume NASA has some procedures for getting an intubated or IV'd astronaut back home, even if it might mean not wearing their suit?
What's the max acceleration experienced during re‑entry and chute deployment? Not Soyuz, hopefully something gentler like CrewDragon (I assume Soyuz's retrorockets are less gentle here)?
henryhbk Ars Tribunus Militum
12y
1,891
Subscriptor++
FranzJoseph said:
First, obviously IANAD, so take it with a big grain of salt.
"Golden hour" is usually talked in the context of massive traumatic injuries and/or massive haemorrhaging. Even there it's a bit controversial, as it might be more useful only in the context of triage of massively multiple casualties with limited medevac resources down here.
IOTW, if any massive traumatic injury happens on the ISS (say a micrometeorite going through an astronaut or a pressurised cylinder failure resulting in an open fracture and haemorrhaging), the casualty is likely to be fucked anyway.
For things that develop over a longer time (appendicitis ‑‑> septicaemia), the astronauts are hopefully so well monitored that it would be caught early on.
You can find a full equipment list in the CHeCS onboard here (PDF, 2011 link).
Includes BP/ECG, AED, basic dental & surgery stuff (nothing quite major, scalpel and forceps etc), detox kit, airways kit, ambu bag and low‑flow mask and endotracheal oxygen supply, IV with pump and IV solutions, chest drain valve for pneumothorax, dressings, sutures and splints. Plus medicines, obviously.
Not really sure what the survival rate of somebody with a tension pneumothorax would be, even if quickly drained with the drain valve and intubated. I presume NASA has some procedures for getting an intubated or IV'd astronaut back home, even if it might mean not wearing their suit?
What's the max acceleration experienced during re‑entry and chute deployment? Not Soyuz, hopefully something gentler like CrewDragon (I assume Soyuz's retrorockets are less gentle here)?
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IAAD, most of the survivable emergencies require only a critical but generally simple procedure to buy time. Often I am faced with surgical emergencies in the hospital overnight, and while on paper we have at least one trauma and one cardiac OR on hot standby, it's not like surgeons are standing there in stasis waiting to operate, and often will be several hours until they can formally operate on someone (or we need some test to complete). So for instance for the appendicitis above we use broad spectrum IV antibiotics, then figure it out later, Broken bones easy - splint and transport, pneumothorax (particularly tension) you can do a needle decompression (all it takes is a 20ga IV catheter and a stopcock) and again you've bought plenty of time for surgeons to get ready to do a definitive thoracostomy (chest) tube, most bleeding can be stopped with pressure.
Things where this isn't true would be a stroke or intracranial bleeding. Not 100% sure if the aircraft carriers that picked up Apollo astronauts even have the ability to treat that onboard. depending where the bleed is. If it is an epidural (in the skull, outside the brain but hydraulically crushing the brain) then the answer is simply we drill a hole and relieve the pressure (trepanning) and then some actual neurosurgeon can fix the issue, and when I was the intern, that's who did the burr hole, a 4 minute procedure that bought you hours to the OR. But if the bleed is deeper (such as a sub-arachnoid bleed or interparenchymal bleed) well not much you are doing outside an interventional neuroradiology suite, and those patients often have a poor prognosis on land. Not sure if they screen for berry aneurysms in the astronaut core with a head angiogram? Penetrating trauma management is battlefield medic level care to buy time to get to surgery, and a lot can be done to stall exsanguination within reason without much clinical skill or equipment. There are military medic deployed pro-coagulants that can be put into a wound to form instant clot, and of course the tried and true tampon in the hole. In a penetrating wound something like a tampon works by absorbing blood and expanding to put pressure on the bleeding vessels, which works surprisingly well in the absence of definitive medical care.
As for g-forces anyone who has ridden in an ambulance on our pothole strewn streets in the northeast knows you subject you patient to a surprising number of shock loads, but I worry more about needing to put a critically ill patient into a chair for the descent when bleeding has stopped while lying prone or on their back. Does crew dragon have a stretcher capability?
