DARPA Trying to render us obsolete

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DocVapor

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I wonder how many taxpayer dollars are going to be wasted over how many years trying to find this unicorn drug.

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Third world and battlefield medicine secret: ketamine.

Came here to say this. The perfect drug already exists. Hemodynamically stable agent that causes relatively minimal respiratory depression, can be used for pain or a general anesthetic depending on dose, and doesn’t require an IV for administration in extreme circumstances. Bonus, they’re also treating the depression/anxiety/PTSD that this injury, and whatever lead to it, will no doubt cause them.

Is the head of DARPA cousins with the CEO of Eli-Lilly or something?
 
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Third world and battlefield medicine secret: ketamine.

Two thoughts -

1) In Afghanistan & Iraq we had US and coalition units running around with different meds for use in the field.

Some with morphine autoinjectors, typically 10 mg IM, administered by a medic.

Some with fentanyl lollipops, usually taped to the casualty's hand and self administered. If they got "too much" then the natural flopping/straightening of the arm would pull it out of the casualty's mouth.

And some with ketamine, administered by a medic, either IV or IM.

By far, when it came to receiving these patients in the trauma bays, we preferred receiving the patients who got ketamine, vs the ones who came in with too much or too little opioid.



2) I'm so angry and sick of these ****ing ******ed cowboys (mostly ER clowns) sitting around dreaming their adrenalin and caffeine fueled fantasies about point-of-injury battlefield medicine. I want to kick them in the gonads so hard they taste it for the next month, and to end their genetic lines so whatever's wrong with them can't pollute future generations.

“On the battlefield, the troops have access to pain medication, but unfortunately, there is currently no safe option for general anaesthesia or sedation that would enable life-saving interventions at the point of injury.”

I really have no idea what actual "life-saving interventions" they think are going to happen at the point of injury, and who's going to perform these interventions.

The 3 main causes of preventable battlefield deaths are extremely well understood: extremity hemorrhage, airway obstruction, tension pneumo. These are all well within the capabilities of enlisted medics. If you want to expand on these with more skilled care for more complicated problems, you need to put doctors at the point of injury. For all sorts of practical reasons (relatively few number of doctors available, risk of losing doctors, the logistic footprint to bring the tools doctors need to actually do more than a 19-year-old medic) it's the height of idiocy

What the actual **** do they think the use of this magical DARPAsthetic thing is going to be, without a surgeon to do the damage control surgery?


One of the more recent fantasies these inbred delusional boneheads have been fixating on is REBOAs placed by non-physicians in the field. I've ranted about this before in the milmed forum, but to sum up, I think of all the times I've seen vascular and cardiac surgeons struggle to get femoral access in patients under ideal circumstances, in a well lit OR, with skilled assistant hands, extra supplies, patient on a table at an ergonomic height, ultrasound ....

And those bozos actually thought (think?) that a non-physician in the field is somehow going to
a) get a wire into a vessel in a profoundly hypovolemic patient with clamped down arteries
b) without causing additional bleeding trauma to the femoral vessels
c) while kneeling on the ground
d) with suboptimal lighting
e) and no skilled help
f) using insufficient, incomplete, or otherwise non-optimal supplies
g) THEN get a balloon up into the aorta into proper position and inflate it

Today, right now, listed under "future considerations" the JTS guideline say:

"Training non-physician caregivers to place REBOAs in the prehospital settings is being investigated."

Idiots. It makes me unreasonably angry.


At least part of DARPA's purpose is to study odd, longshot, sometimes weird future ideas. I can respect pure research done even if there are unrealistic goals, and I am certainly interested to see if any new drugs with new mechanisms and new risk profiles ever emerge. That would be cool. Especially if they come up with a better-and-safer-than-ketamine pain reliever to give to casualties prior or during transport to a medical facility. But even if they're wildly successful - there's no place for a general anesthetic on the battlefield, because there's no place for battlefield surgery in the first place.
 
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Investigating feasibility of battlefield mitraclip for traumatic mitral regurgitation from
blast injury
 
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Two thoughts -

1) In Afghanistan & Iraq we had US and coalition units running around with different meds for use in the field.

Some with morphine autoinjectors, typically 10 mg IM, administered by a medic.

Some with fentanyl lollipops, usually taped to the casualty's hand and self administered. If they got "too much" then the natural flopping/straightening of the arm would pull it out of the casualty's mouth.

And some with ketamine, administered by a medic, either IV or IM.

By far, when it came to receiving these patients in the trauma bays, we preferred receiving the patients who got ketamine, vs the ones who came in with too much or too little opioid.



2) I'm so angry and sick of these ****ing ******ed cowboys (mostly ER clowns) sitting around dreaming their adrenalin and caffeine fueled fantasies about point-of-injury battlefield medicine. I want to kick them in the gonads so hard they taste it for the next month, and to end their genetic lines so whatever's wrong with them can't pollute future generations.



I really have no idea what actual "life-saving interventions" they think are going to happen at the point of injury, and who's going to perform these interventions.

The 3 main causes of preventable battlefield deaths are extremely well understood: extremity hemorrhage, airway obstruction, tension pneumo. These are all well within the capabilities of enlisted medics. If you want to expand on these with more skilled care for more complicated problems, you need to put doctors at the point of injury. For all sorts of practical reasons (relatively few number of doctors available, risk of losing doctors, the logistic footprint to bring the tools doctors need to actually do more than a 19-year-old medic) it's the height of idiocy

What the actual **** do they think the use of this magical DARPAsthetic thing is going to be, without a surgeon to do the damage control surgery?


One of the more recent fantasies these inbred delusional boneheads have been fixating on is REBOAs placed by non-physicians in the field. I've ranted about this before in the milmed forum, but to sum up, I think of all the times I've seen vascular and cardiac surgeons struggle to get femoral access in patients under ideal circumstances, in a well lit OR, with skilled assistant hands, extra supplies, patient on a table at an ergonomic height, ultrasound ....

And those bozos actually thought (think?) that a non-physician in the field is somehow going to
a) get a wire into a vessel in a profoundly hypovolemic patient with clamped down arteries
b) without causing additional bleeding trauma to the femoral vessels
c) while kneeling on the ground
d) with suboptimal lighting
e) and no skilled help
f) using insufficient, incomplete, or otherwise non-optimal supplies
g) THEN get a balloon up into the aorta into proper position and inflate it

Today, right now, listed under "future considerations" the JTS guideline say:

"Training non-physician caregivers to place REBOAs in the prehospital settings is being investigated."

Idiots. It makes me unreasonably angry.


At least part of DARPA's purpose is to study odd, longshot, sometimes weird future ideas. I can respect pure research done even if there are unrealistic goals, and I am certainly interested to see if any new drugs with new mechanisms and new risk profiles ever emerge. That would be cool. Especially if they come up with a better-and-safer-than-ketamine pain reliever to give to casualties prior or during transport to a medical facility. But even if they're wildly successful - there's no place for a general anesthetic on the battlefield, because there's no place for battlefield surgery in the first place.
i mean if you work in healthcare you should be used to idiots..
 
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That perfect drug already exists. Maybe this is what they are working on - in the human form.. now with these cyclodextrins (sugammadex) being all the rage and stuff.

Alfaxalone
 
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I wonder how many taxpayer dollars are going to be wasted over how many years trying to find this unicorn drug.

This reads like a fifth grade group project. Where can I find the accompanying PowerPoint with comic sans font and animated gifs?
 
Their program explanation is indeed idiotic sounding. They (like much of the public) think there’s a magic anesthesia drug to give while ignoring the entire death spiral stuff occurring during trauma.

Ketamine is the magic drug already but it won’t help them magically accomplish trauma resuscitation and critical care management for their mystery in field battlefield intervention.

Any legitimate awake field intervention (chest tube, line placement, tourniquet placement) can be done with no anesthesia or local anyway.
 
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Two takeaways i got from the DARPA posting:

1. Anesthesiologists are too valuable for the battlefield. Surgeons arent.

2. They really said anesthesia hasnt changed since the Civil War. Who did they talk to that's doing MAC cases with a stick to bite on and a bottle of whiskey?
 
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Two takeaways i got from the DARPA posting:

2. They really said anesthesia hasnt changed since the Civil War. Who did they talk to that's doing MAC cases with a stick to bite on and a bottle of whiskey?
Well, neither has surgery. They still dig out bullets and amputate limbs with saws and scalpels.
 
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That perfect drug already exists. Maybe this is what they are working on - in the human form.. now with these cyclodextrins (sugammadex) being all the rage and stuff.

Alfaxalone
This drug def needs more study. I remember there was a post on it a couple years back....don't remember what ever came of it
 
This drug def needs more study. I remember there was a post on it a couple years back....don't remember what ever came of it

I was waiting for someone to mention this drug. Some big research name came to our university and gave a history of its drug development and pitfalls. Apparently, the British armed forces took a strong liking to it but stopped its use abruptly due to anaphylaxic reactions if I can correctly recall.
 
I was waiting for someone to mention this drug. Some big research name came to our university and gave a history of its drug development and pitfalls. Apparently, the British armed forces took a strong liking to it but stopped its use abruptly due to anaphylaxic reactions if I can correctly recall.
I think the human formulation that's being tested uses a different solvent or carrier than the veterinary stuff, specifically to address the anaphylaxis problem.

Wikipedia says
Currently, a human form of alfaxalone is in development under the name "Phaxan": alfaxalone will be dissolved in 7-sulfo-butyl-ether-β-cyclodextrin, which, unlike the cyclodextrin used in Alfaxan, is not toxic to people.
and I believe everything I read on Wikipedia.
 
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