[goodells]

I'd offer some pushback, from someone with hands-on experience. I'm a paramedic and work alongside other medics, nurses, and physicians who have seen a wave of change in evidence-based medicine over just the course of a few decades. Not everything is flashy and glamorous like a brain-computer interface. No press release that makes it to the top of HN is going to talk about the choice of isotonic crystalloids or sedation agents on intracranial pressure, but we're making great strides, even if by definition "marginal" ones.

Modern resuscitation is like nothing I have ever seen before. Over the past 100 years, we have gained an almost complete understanding of cardiac electrophysiology, acid-base balance, hematology. In the worst-case scenario that you get hit by a car in a major US city, you will likely have TXA forced into your bloodstream through an intravenous catheter within 13 minutes to counteract the body's incorrect hyperfibrinolytic reaction. Your heart rhythm will be constantly analyzed and treated according to ACLS which has essentially been studied and modified to death by the AHA in a gradient descent pattern - we're stuck in a local minimum where the antidysrhythmic of choice alternates between amiodarone and lidocaine. When you arrive at the hospital, a FAST ultrasound scan will be performed where the culmination of materials science and informatics comes together to quickly identify blood in the retroperitoneal space without incurring the logistics of getting a trauma patient into a CT scanner. All this while a neurologist checks 12 of your cranial nerves and someone checks the tone of your rectal sphincter - because evidence shows us this is an important sign. In the case that you have an intracranial bleed, you'll be followed with MRI (which I'm convinced is the closest we've gotten to Star Trek scanner technology) to identify the penumbra of a stroke based on the deoxygenation of hemoglobin. We can now scan a variety of elements with magnetic resonance spectroscopy besides just precessing hydrogen atoms, which is helpful in identifying neoplastic lesions without the daunting task of a brain biopsy.

Not everything is gloom-and-doom at the financing of some big company.

[wnolens]

Interesting to see a paramedic on HN. I thought we were all desk jockeys here :) Thanks for your service to others.

[manholio]

That contains so much jargon that it has to be 100% legit. The rectal sphincter tone though.

[goodells]

I can try to break it down for an uninitiated audience.

"isotonic crystalloids" - Solutions such as normal saline used to restore volume proportionally to the bloodstream and intracellular spaces (as opposed to hypotonic or hypertonic, isotonic solutions just match the normal blood's osmolality)

"sedation agents" - The patient is out, you keep 'em out, ideally without tanking their blood pressure. Different than paralysis.

"electrophysiology" - Electrical conduction through the heart.

"acid-base balance" - Various chemical processes and enzymes in the body only work well within a certain pH range, and long-term, only a narrow pH range is compatible with life.

"hematology" - Blood and its components, including the cascade of enzymes and clotting factors involved in coagulation.

"TXA" - Tranexamic acid - An anti-anti-clotting agent, which stops the body from breaking down blood clots. In the context of trauma, it allows your body to form the needed clots to avoid imminent exsanguination.

"ACLS" - Advanced Cardiac Life Support - The AHA algorithm for identifying and treating life-threatening heart rhythms that most paramedics, RTs, nurses, etc. and above are trained on. In practice, this means that an unresponsive patient or code situation can be run to a certain standard with the staff who are immediately summoned in any clinical area of any hospital within about 30 seconds.

"antidysrhythmic" - In the ACLS algorithms, it's a drug (usually a potassium channel blocker or sodium channel blocker or both) that acts on the cardiac action potential to do something that tends to make lethal dysrhythmias stop and return to a normal sinus rhythm. How exactly, you'd need to ask a cardiologist or specialized pharmacist.

"FAST [ultrasound] scan" - Focused assessment with sonography for trauma - it's just an ultrasound of the flank area to detect blood around the kidneys ("retroperitoneal space") which has a high mortality rate and usually requires emergency surgery.

"cranial nerves" - Your brain can communicate with the rest of your body either through your spinal cord, or through the cranial nerves which are direct interfaces for things like smell, sight, tongue movement, etc. Checking these is an important part of determining of a brain injury or spinal cord injury is present.

"rectal sphincter tone" - If it's present, then it's unlikely that spinal cord injury above a certain level has occurred.

"intracranial bleed" - It's bleeding, in your brain.

"magnetic resonance spectroscopy" - The original MRI technique was based on spinning all the hydrogen atoms in your body such that they aligned head to toe, then detecting electromagnetic induction in a coil as they were jarred back and forth at a megahertz frequency. Nowadays, we can do this with other atoms like phosphorus in the same way.

"precessing" - The pattern of relaxation of an atom similar to a spinning top where it goes from the aforementioned align orientation (forced by a strong magnet to align head to toe), and gradually relaxes to its random orientation while spinning at the Larmor frequency (megahertz frequency of the corresponding type of atom).

"penumbra" - The border between healthy living brain tissue and dead brain tissue at the outside territory of a brain injury post-stroke.

"neoplastic" - Uncontrolled cell growth, similar to cancer except not all neoplasms are cancer, some are benign tumors which will never be able to metastasize/spread to other parts of the body.

[sizzle]

So helpful, thanks for the layman translation!

[sizzle]

Wow sure you don’t want to be a doctor? You sound super adept in speaking medicine