New Medical Device: X-STAT

As a medical nerd, I’m always a little fascinated by new medical devices and what they can do. I was alerted to this device by Mike H. via Facebook (Thanks, Mike!) and found it worthy to post upon to keep all your medical treatment scenes in those novels up to date.

The Blaze

It is true that not all bleeding can be controlled by direct pressure. It is also true that bleeding is the leading cause of death when it comes to bullet wounds (unless you have suffered a direct hit to either your heart, brain, and/or spinal cord which is likely the end of your life here on earth.) Uncontrolled bleeding from limbs is one thing that harkened back the use of the tourniquet. First by the military and now by civilian EMS agencies. They found the concern over tissue damage didn’t pan out in the research.

For those other folks who get shot in the chest and/or abdomen, it’s always a race to the hospital where definitive control of bleeding can happen– which usually necessitates a trip to the OR– which takes time. You may have heard the term “Golden Hour” which is generally the preferred window to get the patient to definitive treatment before they die.

Rapid control of bleeding could actually extend this hour in my opinion.

Enter the X-STAT.  For lack of a better term, the X-STAT is a tampon shaped (sorry, guys) device that is filled with dime-sized medical grade sponges that are coated with a hemostatic (stops bleeding) agent. It is inserted into the wound and the plunger places these sponges deep into the wound where they expand (like the firework snakes) and stem bleeding without direct pressure. The expansion of the sponges prevents them from being forced out of the wound.


Thus far it seems to be listed as an investigational device and its use is limited but if it does what it says it does I think this could mean a big difference for trauma patients.

You can read more about the X-STAT here

What do you think of the X-STAT? Would you use it in a novel? You can bet I’ll find a way to.

Medical Critique: CBS Drama Hostages 1/2

As you know, I’m critically watching some of the new Fall TV shows for medical accuracy. I’ve already posted about the CBS drama Hostages. You can find that here.

This week, I’m going to knock it down but then offer it a helping hand back up. Episode 5 is going to be the brief knock down.

If you haven’t watched all the episodes you have been thusly warned that there will be spoilers in this post.

If you’re not familiar with the show, the President needs an operation and his surgeon, played by Toni Collette, and her family have been taken hostage to force her hand to assassinate him or her family will be killed.

In episode five, the family plots to escape. They end up getting split up. The husband at home. The children on a bus to Canada and Ellen (Toni’s character) almost getting on the bus until she sees video of her husband being shot in the gut.

And, of course, even though he’s a cheating slime ball she goes home to save his life.

Issue One: One of the ways a person who has been shot and is bleeding dies is of exsanguination– meaning all their blood leaks out. The reason significant blood loss kills you is that your body is no longer delivering oxygen and you go into shock/circulatory collapse. What you really need is BLOOD to save your life. Without it– nothing the medical team can do will pull you out from the drain you’re swiftly traveling down. When our trusty surgeon arrives home she finds her husband unconscious and not breathing . . . no pulse.

She starts CPR– yea!! Then asks Mr. Hostage taker to get her medical bag from which she happens to have a hospital grade defebrillator.

Issue Two: There are only a few shockable rhythms. I’ve blogged about the use of electricity here. A likely rhythm for the patient to be in strictly from blood loss is what we call PEA or pulseless electrical activity. There is actually two parts of good heart activity. The electrical component and mechanical component. You need both working appropriately to propel your blood forward and keep you alive. You can actually have normal electrical activity and yet the heart is not mechanically beating– thus the term pulseless electrical activity.

In the case of this character’s husband– his heart likely has normal electrical activity but since he’s lost so much blood– it doesn’t have blood filling the chambers and so doesn’t have anything to pump out. Hence the lack of a pulse.

I’m guessing this husband’s injuries would lead to this set-up. Normal electrical activity with no pulse. So he doesn’t need electricity. He needs BLOOD.

Issue Three: I don’t know any physician anywhere that has a hospital grade defibrillator for their private use. Or would know how to work it . . . quickly. Now, this isn’t a backhanded slap to my physician co-workers. They know how to do their job very well. This just isn’t necessarily in their skill set. Nurses usually set-up the defribillator. The physician orders the desired amount of electricity.

I’ve taught advanced resusitation courses for two decades and I can tell you, across the board, every type of physician struggles to get it programmed. These classes are not a requirement for EVERY physician to take either.

So– wrong treatment with too much ease of use.

What would have been more believable would have been for her to have an AED (automatic external defibrillator) in the home. These are designed for lay people to use and some people do actually have them for home use. They basically diagnose the shockable rhythms and provide electricity if indicated. It’s what many first responders are carrying to even high school settings. They are very user friendly.

Check out my post on Thursday where I’ll continue my discussion of this particular episode.

Author Question: Gunshot Wounds

I’m happy to have award-winning author Jocelyn Green return to Redwood’s with a couple of questions about gunshot wounds.
Welcome back, Jocelyn!
Jocelyn asks:
I decided not to do a gunshot to my character’s shoulder because of all the bones and major things it could have hit. Too complicated for my story. Instead, I am writing that she was shot through her bicep, missing the bone, though. A year later, she raises a gun for the first time since her injury, to do target practice.
Is it possible that due to nerve injury, her aim is off, or she can’t raise the gun properly? It would be great if something doesn’t look right to her “instructor.” So, can we limit her range of motion or something, due to her injury? The year is 1863, by the way, and according to my medical textbooks from that time, the treatment of a gunshot wound was to clear out the debris and just put water dressings over it.
Jordyn says
Yes, this is possible. A gunshot wound through the bicep could injure the musculocutaneous nerve that is responsible for part of the upper arm like the flexor muscles. Flexor muscles decrease angles at joints like the elbow. So, if her arm would need to be slightly bent to shoot the weapon, she would be unable to do that. That being said—if it were needed that the opposite be true (for instance her arm would need to be straight to shoot the weapon) you could injure a nerve that supplies the extensor muscle—which decreases the angle at joints like the elbow. You can view the two links below for detailed information about flexor and extensor muscles. 
Remember, though, she would exhibit these deficiencies all the time—not just when she’s learning to shoot the weapon with her instructor so that would need to be written into the story as well.
Jocelyn asks:
I also have another character who broke his arms and legs in an accident on a ship under construction. How long would he be in slings for his arms and casts for his legs? How long would he use a wheelchair or cane?
Jordyn says:
Wow! You are really torturing your poor characters in this novel! Those are very significant injuries. Bones can take anywhere from four weeks (on the short end) to eight weeks (on the long end) to heal. In the time era your novel is set in—I’m doubtful they would have done plating, screws, etc for stabilizing fractures but likely did externally set them. 
I think he’s going to be wheelchair bound for a long time. A person quickly loses muscle mass and strength in a few short weeks of being immobile so even when he’s out of his casts (in say six to eight weeks) he would not be able to tolerate a lot of physical activity for likely several months.

These days a person who suffered these injuries might be in a rehab center for several weeks building their strength and mobility back up.  

 A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.