Tuesday, February 26, 2008

Near Death Experiences Support Eternal Families

My younger brother Stephen passed away last Monday of complications of pneumonia. Although unexpected, he had been sick for a long time, so his passing was not a total surprise. I am convinced of life after death and the continuation of family relationships in the next life. Stephen had had a near-death experience in the past while clinging to life on a ventilator. During that experience (typical of many other NDEs), he met and spoke with people on the other side who had died who he knew to be family and friends. Although, not his time then, I am confident that his time to pass into the next life had come at last. Stephen died quietly and painlessly in his sleep yet I believe that our relationship will live on forever.

It is interesting how many NDEs involve already deceased family and friends. It seem this would confirm by direct observation that familial relationships continue into the next life. It is unfortunate that other Christian religions have contrived doctrines contrary to this self-evident truth. Family relationships are a treasure which we can lay up in store where theives cannot break in and steal and where moth and rust cannot corrupt.

The assurance of Eternal Families results in LDS funerals which are different than funerals the world over. LDS funerals are reverent and mournful, but never grief- or despair-filled. There is always a bright spirit of hope, peace, comfort and faith that the deceased who has keep the faith is in a better place awaiting a literal resurrection and our future reunion.

I have since wondered why God wouldn't have just taken Stephen to heaven when he was in the hospital and on the ventillator and in severe septic shock. But then I realized, after a phone converstion with our mother, that had Stephen died in the hospital he would have died a mental patient. That is because he had just gotten out of a mental health hospital for an exacerbation of paranoia. As it worked out, he was able to be nursed back to health, return to college, and play the trumpet in the university marching band, symphonic band, and jazz band. I am not really sure how he would play the trumpet, a wind instrument, during the day and go to bed hooked up to oxygen at night. In any event, he didn't die a mental patient, but he died as a student, a musician, and a faithful disciple of Christ.

Wednesday, February 13, 2008

10 Advancements in Trauma, Tactical, and Battlefield Medicine

I enjoyed an excellent Grand Rounds lecture by Frank K. Butler, Jr., M.D. CAPT MC USN (RET), Medical Consultant for Naval Operational Medicine Institute in Pensacola, FL entitled “Tactical Combat Casualty Care: Update 2008.” Dr. Bulter outlines a number of advancements in trauma care which the military has been implementing and showcased the outstanding survivability data as a direct result of these developments.

There are some injuries for which nothing can be done on the battle field. Soldiers stuck in the head or through the heart cannot be saved. Unfortunately, a great percentage of soldiers die from injuries that could easily be saved with minimal resources and training. But new revolutionary advancements in Trauma and Tactical Medicine during the Afghanistan and Iraq wars have demonstrated significants improvements in survivability on the battle field over the past 50 years.

Mortality of Injured: WW2: 30%, Vietnam: 20%, Iraq 10%.

1. Tourniquets: Used to stop large arterial extremity bleeding as a last resort after direct pressure bandages. New designs can be easily placed with only one hand by the injured person.
2. Clotting Agents: HemCon and Quick Clot can be poured or packed into deep puncture wounds to stop bleeding.
3. Interosseous Access (IO): Using a small drill and cutting catheter, a line can be placed quickly into the sternum or tibia. Fluids, blood, antibiotics, and pain medicine can all be given through the IO line into the bone itself. IO lines have demonstrated very low rate of infection and are much less prone to failing like typical IVs.
4. Permissive Hypotension: In a bleeding patient, blood pressure should only be maintained to the point that consciousness is maintained. Resuscitating a patient to a normal blood pressure will blow newly formed clots off bleeding sites causing more severe bleeding.
5. Intravascular Volume Expanders: Traditional resuscitation fluids like NS and LR stay inside the vasculature for only 45 minutes before leaking out. Products like Hespan pull fluids into the blood vessels and stay in circulation for days. Also, medics aren't weighed down carrying heavy bags of IV fluids. Hespan does not carry oxygen so upcoming artificial blood products which do carry oxygen will be the exciting next development.
6. Oral Antibiotics: Moxifloxicin and other newly formulated antibiotics have 100% bioavailibility when taken orally as compared to IV dosing. An injured patient can easily receive antibiotics by mouth without needing a high maintenance IV. Using these antibiotics, wound infection rates have virtually evaporated to near zero.
7. Fentanyl Suckers: a powerful pain medicine sold under the trade name Actiq can easily and quickly be administered by mouth without using a high maintenance IV and removed if the patient becomes too sedated and experiences respiratory depression.
8. Fresh Frozen Plasma: Studies from Afghanistan and Iraq show that bleeding patients have better survival outcomes when given Fresh Frozen Plasma (FFP) in a 1:1 ratio with Packed Red Blood Cells (PRBCs).
9. Thorocostomy Needles: Gun shot wounds to the lung kill patients because air leaking out of the injured lung fills the chest until the pressure stops the heart from pumping blood. This is called cardiac tamponade resulting from a tension pneumothorax . This is easily prevented by inserting a needle and catheter into the chest wall allowing the trapped chest air to escape. Newer thoracostomy needles are longer and larger to facilitate this procedure on thick chested soldiers.
10. Advanced Airways: Many wounded soldiers who are knocked unconscious die simply because they suffocate on their own tongue. A simple chin lift or head tilt by another soldier is all that is needed many times to save a life until the soldier regains consciousness and can maintain his own airway. However, it can be very inefficient use of resources for a medic to hold open one airway while a handful of other wounded slowly bleed to death around him. So, new devices have been invented, tested, and successfully implemented which can be inserted into the airway and assist in respiration.

Thursday, February 07, 2008

Republicans: Lost Base, Lost Election

Today former governor Mitt Romney suspended his bid to become the Republican nominee for President of the United States. I can't help but feel a deep sense of disappointment. Not just because my guy lost; I feel bad for America. I have been a Romney supporter from the beginning. I feel that Romney represented conservative ideals better than any other candidate and he was the most qualified candidate to lead this country and compete and win in a general election. The Republican primary should have been designed to select the candidate which would have the best chance in a general election against the Democratic candidate. So, what happened? If Romney was the best candidate, how did the election process fail?

Romney started out as a relative unknown to most of the country (except UT, MI, and MA). The primary process did work to allow Romney to organize a well-oiled campaign, raise money, and get his message out. So, by the start of the start of the primary he was a contender.

Being Republican is not the same as being Conservative. The Republican party doesn't care about conservative principles. At the end of the day, they want their guy to win. And in a two-party system, the candidate who can attract the moderates and undecideds has the advantage. In the primaries, a candidate seeks to attract the base of his or her party first. And then in the general election try to appeal to the moderates and undecideds with the help of his enthusiastic base. In this case, the Republican leadership put it's support behind McCain, not because he was conservative, but because he was more liberal or moderate.

Many people in the US do not consider themselves strict Democrats or strict Republicans. These luke-warm individuals call themselves independants or moderates. But even the middle in the US has drifted left over the years. According to several recent polls, most people in the US and in the Republican party do not believe that sex before marriage is wrong. This shift in values is also reflected in other issues such as abortion, gay rights, and welfare. So, the middle has moved left and as a consequence, the "New, Modern Republican Party" has moved left. That's how a pro-choice, Rudy Giuliani, could run as a Republican and how Independent, Joseph Lieberman, is being considered as John McCain's VP. It's not about conservative principles. It's about taking the middle and winning power.

However, the "New Republican Party" made a grave miscalculation. In the past they sought the candidate in the primary that could unify its base. But this time they went with McCain because they are counting on his moderate views to attract more of the middle. That is why leaders of the "New Republican Party" came out with their endorsements for McCain leading into Super Tuesday. They know the conservative base does not like McCain, but they are counting on conservatives voting for him anyways in a general election. However, the Republican Party overlook a very important principle.

In supporting McCain, the Republican party has just alienated its base. Moderates and Independents are luke-warm. Moderates don't make good phone callers or donors. Independents arent the people who put out lawn signs, talk to their friends at work, and put bumper stickers on their car. The luke-warm moderates don't have the passion to drive the campaign. They are the ones who are taken whichever way the wind is blowing. Conservatives may hold their nose and vote McCain, but McCain is not going to stimulate the base to drive a grass roots movement in the general election to win over enough of these luke-warm voters. Voting for McCain because you hate or fear Hillary will not generate the ground swell that love for your candidate would. This is the "New Republican's" mistake. Love wins campaigns, not hate and fear. Consequently, I predict McCain will lose to Clinton or Obama.

The West Virginia primary convention represented everything wrong with Washington and this election. According to West Virginia convention rules, the winner must have a majority of the vote. After the first vote Romney was way ahead of McCain or Huckabee. But he just fell short of the 51% needed. So, before the second vote, McCain's people called Huckabee's and Ron Paul's people and arranged a back-room deal to railroad any momentum an early West Virginia win would give Romney going into Super Tuesday. McCain told Huckabee that hewould tell his and Paul's people to vote for him in exchange for a couple delegates awarded to Paul. When then second vote was tallied, with McCain and Paul's votes to Huckabee, Huckabee was just able to edge Romney by a few points, get the majority, the delegates, and derail any momentum by Romney going forward. This was a deal I would expect to see done on "Survivor" or some other "reality"-TV show and exactly the kind of thing that has corrupted Washington.

In his campaign suspension speech, Mitt Romney made an interesting observation. Even though McCain was well ahead of Romney in the delegate count, he was only slightly ahead in terms of overall votes and states won. This is because a back-room deal had been struck with Rudy Giuliani a year earlier making the big states like California, New York, and Illinois winner-take-all. Coming from a big city, Giuliani thought he had the best chance of attracting the votes from other states with big cities such as California and Illinois. Giuliani was able to convince the Republican Convention to go along because he hoped the winner-take-all situation would result in an early front runner and result in the ability of the party to launch their general election campaign earlier. Giuliani miscalculated or was purposefully mislead by not engaging in the early primary states and the winner-take-all set up served to benefit McCain and TKO Romney.

The Republican Party knew that Huckabee wasn't a viable presidential candidate. Even Huckabee knew he wasn't a viable candidate as he was seen blatantly "kissing up" to McCain during their last 3 or 4 debates. After coming in a distant 3rd in Florida, Huckabee was rightfully criticized for staying in the race. He stayed in the race for one reason and one reason only-- to serve as spoiler. He knew he would fracture the conservative base who were choosing between himself and Romney allowing McCain to just edge Romney in the polls because of the moderate vote. I'm sure someone may have told Huckabee that he may be considered for VP. That will never happen. McCain and the Republican Party would have no respect for the pawn they have used in their political chess game.

Dr. Richard Land, the President of the Southern Baptist Convention, (who has made numerous appearances in the media), appeared tonight "The News Hour with Jim Lehrer" to comment on Mitt Romney's withdrawal. After commenting on numerous political policies, he said he was happy with McCain because he was pro-life and that's what was important to him. I can't say I would be surprised to learn that Huckabee was urged to stay in the race by the Southern Baptist Convention through Super Tuesday to hurt Romney. It is not secret that Evangelical leaders didn't want Romney as the nominee because, according to them, having a Mormon as president would have served to somehow "legitimize" the LDS faith and lead to more LDS conversions (heaven forbid).