The way a major trauma patient acts in the hours after a trauma does not make sense until you look back in time…

Bob the caveman was hunting with his mate Dave and a few others from the Stone Mason’s club when they were attacked by a local saber toothed tiger called L.Triad who fancied the same woolly mammoth as they did. His mates managed to get away but the tiger bit Bob in the leg really badly. Fortunately he managed to crawl away into a nearby cave while the tiger ate the mammoth. His mates came back but, as they did not have iPhones, they never found him.

Bob sat in his cave, he had lost a lot of blood but he was still alive. His capillaries became leaky and he autotransfused from his interstitial space so that he could perfuse what he needed to survive. His body kept his Blood pressure low to prevent further bleeding and he entered a protective low flow state. Fortunately he became coagulopathic as sitting in the cave not moving for 4 days in a low flow state meant he was extremely high risk for a Pulmonary Embolus, Deep Vein Thrombosis or even arterial thrombosis. It was good thing no one gave him an anti fibrinolytic. Luckily his inflammatory cascade meant that he could get his white cells to area of injury to get rid of dead tissue, repair damaged tissue and fend off infection, this was also helped by his pyrexia which denatured some bacterial enzymes.

Bob tried to call for the PHEMs team (prehistoric emergency medical team) but no one would be available for a few thousand years as they could not offload in A and E. However he was pretty lucky he did not call because in his cave no one strapped him to an uncomfortable hard board, put plastic round his throat and took him out into a cold room and stabbed him multiple times. He was also not asked to give a medical history to an upside down man while he could only look at the ceiling. He also luckily missed out on 2 litres of cold acid to dilute his circulation and a finger up where the sun does not shine, but he would have taken the pain relief!

After 4 days he crawled out of the cave and back to Mrs Bob. Unfortunately he had been too long and Mrs Bob had moved out into his mate Dave’s cave.

Steve Young
@steveyoungmedic