I was covering for the medicine service at the Ann Arbor VA Hospital 1 weekend. I had been there only a few weeks, and the FBI was swarming the building seemingly in the aftermath of a serial killer who had been injecting patients with pavulon. Conditions had quietened, and the Federal agents were gone, and so we thought was the serial killer. An unusual feature of the VA Hospital was weekend coverage for the entire hospital was the responsibility of a single intern and medical student. Now it was my turn. Saturday morning and afternoon were quiet, and I was hoping for a silent night. Unfortunately, att 10:00 p.m. the alarm sounded and the student and I were summoned emergently to a patient’s room, where we found him on the floor vomiting huge quantities of bright red blood. This was in the days of no fiber optic GI scopes, but that would not have mattered anyway. The patient had obviously ruptured either esophageal varices or broken loose an arterial stomach or duodenal ulcer bleed on a massive scale. I managed to get an IV in his arm but before we could even transport him to the MICU or start IV fluids he had a total collapse and cardiac standstill. The student looked at me and said, ” Aren’t we going to pump him?” by which he meant start cardiopulmonary resuscitation and chest compressions. I looked at the scene and replied'” Pump what? It’s all on the floor!” There was nothing we could do.
Blood circulation is normally a closed system, but in the case above, that system was open. When examined closely, our circulatory system is predicated on exact fluid hemodynamics. The components include the physical properties of blood, the diameters and flexibility of blood vessels and the heart wall, cardiac valves, pressure waves and fluid linear flow/ turbulence, and the stroke volume of the heart. Not to mention that all of this is irrelevant if we do not have functioning lungs, kidneys, bone marrow and other anatomic systems. Problems that can arise with our circulatory system medically are numerous and include formation of blood clots, vessel tears, atherosclerosis with vessel narrowing, loss of elasticity, rapidity of heart rate, and malfunction of heart valves just to name some. We have been created with precise physiologic and anatomic parameters to ensure a steady supply of oxygenation and nutrients to distant tissues while removing waste products. The degree of perfection in the system is truly awe inspiring.
to be continued