I'd like to again qualify my status as a non-expert with regards to the surgical aspects of trauma treatment and biochemistry. I have seen similar articles about the foam, and I must admit I am similarly skeptical. The ‘Golden Hour’ is one of those concepts in medicine that everyone praises (it originated @ Marylan’s Shock Trauma center if I recall), but it actually does not have an evidentiary basis.
There are 3 categories of trauma patient, people who will die no matter what you do (hole in the aorta), people who will live no matter what you do (fractured extremities), and people where the outcome may be influenced by treatment in the field. My non-evidence based opinion is that the people in this 3rd population who have the types of injuries that would benefit from this foam will be rather limited. The aorta, inferior vena cava, kidneys and parts of the duodenum, pancreas and rectum are all retroperitoneal. Thus, filling the peritoneal cavity with foam could put pressure on bleeding structures located in the retroperitoneal space, but I would be skeptical. So this foam is for people who have don’t have large hemorrhage of anything in retroperitoneal space and don’t have a fatal mesenteric, liver, or spleen injury, but do have an injury to one of these structures that is sufficiently bad to warrant the foam. The risk of exposing patients with liver and spleen lacerations that could have been managed non-operatively (again, not a surgeon by any stretch but I believe this is a growing trend) to an unnecessary laparotomy isn’t mentioned.
The target audience for this item is going to be armed forces medics with (in my opinion) highly variable clinical skills. Expecting these medics to accurately diagnosis these injuries under heavy stress and not sacrifice time that should be spent on proven therapies like blood administration, tourniquet placement, warm blankets, etc. seems unwise to me.
Thanks so much for responding. My worry when reading articles like these is that I know I don't have the background to evaluate the technology, but I don't often know where to go to find people who do.
There are 3 categories of trauma patient, people who will die no matter what you do (hole in the aorta), people who will live no matter what you do (fractured extremities), and people where the outcome may be influenced by treatment in the field. My non-evidence based opinion is that the people in this 3rd population who have the types of injuries that would benefit from this foam will be rather limited. The aorta, inferior vena cava, kidneys and parts of the duodenum, pancreas and rectum are all retroperitoneal. Thus, filling the peritoneal cavity with foam could put pressure on bleeding structures located in the retroperitoneal space, but I would be skeptical. So this foam is for people who have don’t have large hemorrhage of anything in retroperitoneal space and don’t have a fatal mesenteric, liver, or spleen injury, but do have an injury to one of these structures that is sufficiently bad to warrant the foam. The risk of exposing patients with liver and spleen lacerations that could have been managed non-operatively (again, not a surgeon by any stretch but I believe this is a growing trend) to an unnecessary laparotomy isn’t mentioned.
The target audience for this item is going to be armed forces medics with (in my opinion) highly variable clinical skills. Expecting these medics to accurately diagnosis these injuries under heavy stress and not sacrifice time that should be spent on proven therapies like blood administration, tourniquet placement, warm blankets, etc. seems unwise to me.