The time now is one in the morning. An unconscious man has been discovered lying on the road. Upon inspection, mechanism of injury determined to be hit-and-run accident. Victim has multiple wounds on his head, and suffers from massive bleeding. He is immediately transported to the nearest hospital, and blood transfusion is given. However, even though his treatment was not delayed by a long time, he still eventually dies due to a lack of oxygen to his brain. His parents and friends have good reasons to grief for his demise: Not only have they lost a good son, a good friend, but also they grieved over the fact that his death could have been prevented.
This is where the use of nitric oxide steps in. One particular function of nitric oxide is that it dilates the artery. As a result, it increases blood flow. Thus, it could be of a source of significant aid in A&E departments. When patients come in with massive hemorrhages, we all know that they need blood immediately. But why is this so? This is because blood transports oxygen to the whole body, and hence the faster, the greater the amount of blood pumped into the body, the more the oxygen is delivered to the victim, especially to the brain. Blood banks do exist, but as stated in a recent article from The Economist “Blood Simple”, the level of nitric oxide stored in blood bags already decreases by 70% in the first day, leading to an great fall in the efficiency of stored blood. Thus, more blood does not mean the chances of survival are higher. The quality of the blood matters too.
Hence, paramedics should consider the storing of nitric oxide in ambulances and A&E departments. In the future, when such patients come, old blood could be combined with nitric oxide to further boost its efficiency in relaxing blood vessels. In turn, more oxygen is pumped, and thus chances of brain damage are minimized.
There are also certain points that have to be carefully reviewed before implementing this change. Considering that storing nitric oxide in a portable fashion could be difficult; its low melting and boiling point makes it difficult to be transported. Hence this would be one primary concern for paramedics. Nitric oxide can also combine with the ozone in the air to form nitrogen dioxide, which is a major air pollutant. Hence, any possible leak of nitric oxide from the cylinders would not only damage the environment, but also adversely affect the health of paramedics and healthcare workers using it in the long run.
Nevertheless, I think more studies can be carried out to determine the feasibility of this area. As a trained Level 1 paramedic myself, I know that we as paramedics can only do so much with our existing drugs. If this idea can really save unnecessary grief and lives in the future, then it is an idea worth considering.
Article by Yeo Teck Wei, who is a freelance writer based in Singapore. Alll articles are usually written for the complete novice. For any comments or ideas, please email me @ yeoteckwei@yahoo.co.uk, and I’ll write it out.
