“God willing, we will prevail, in peace and freedom from fear, and in true health, through the essence of our natural fluids.”
—General Buck Turgidson in
It’s an amazing process, isn’t it? You can take something as simple, pure and beautiful as water, mix and pollute it with all kinds of unnatural byproducts approved by the Food, Drug and McDonald’s Administration, and drink it; then, within minutes of indigestion, your body will convert and store that same fluid within its own tissue-tank containment centers until time dictates those now-expired fluids be returned to the outside world.
But it doesn’t end there. Oh, no. For it is written that fluids lost must be replaced in equal amounts. The fluid cycle must therefore begin again. Round and round the fluids go … in and out … over and over again, ceaseless in their sequence. The “circle of fluids” is predictable and essentially redundant—much like these last few sentences.
When you really think about our jobs as EMS providers, for all intents and purposes, it comes down to us keeping the circle of fluids (70% of our body weight) intact for our patients. As we all know, human homeostasis can be made fallible, either through genetic design or environmental influences, causing patients to leak too much fluid or not enough.
From the moment your mother’s amniotic sac began to leak, you also started leaking. As a baby you leaked all the time—mainly because you didn’t know any better. When you get way older, you may know better, but it’s just that you can’t do any better.
Some anatomical places are programmed to leak on a regular basis. These are obvious even to the layman, such as our eyes (tears), nose (filtering, humidifying and flicking), mouth (salivating), ears (waxed-bug entrapment), skin (temperature regulation), hair (oil lubrication), lungs (CO2 dumping), mammary glands (infant sustenance), bladder (eewwww), colon (double eewwww) and reproductive organs (not going there).
For the EMS provider, outward signs of leakage can often tell us how well the patient is perfusing internally. Olfactorily, they tell us if the patient has ever heard of the words “soap” or “shampoo.”
Certain fluids we ingest (such as coffee) can stimulate your bladder to leak immediately, assuming you’re driving your car while stuck in traffic. Alcohol is absorbed by your body fluids quickly, but then your body wants to eliminate it expeditiously—sometimes violently the very same way it came in.
It’s a poison after all, and, yahoo for us as we get to bear witness to all its leakage glory. Organophosphate poisoning is the king, however, insofar as a leaking sludge festival gone wild.
Regardless of the fluids you ingest, they aren’t really inside the body until they’re absorbed in the bloodstream. Depending on how well your fluids are flowing, liquid is constantly moving from the intravascular (inside the blood vessel) to the extravascular (outside the blood vessel) spaces and from the intracellular (inside the cell) to the extracellular (outside the cell) spaces. Hormones, electrolytes, waste, nutrients, O2, CO2, platelets, and red and white blood cells are all swimming along, swapping survival stuff back and forth, spreading rumors, getting lucky … blah blah blah. The important thing to remember is that the heart and blood vessels can’t do their job without their natural fluids.
In a nutshell, our job requires us to suction leakage; compress, restrict and plug leaks; clean leakage; collect and measure leakage; document leakage; aspirate, vent and lance encapsulated leakage; free normally flowing pathways blocked with leakage; chemically balance and maneuver leakage; substitute lost leakage; and even encourage leakage.
To give you an example, I had a diabetic (didn’t leak enough insulin), and he was found diaphoretic (leaked too much dermal fluid). He had a history of congestive heart failure and was on Lasix (needed more urine leakage to prevent third-space leakage in his lungs and extremities). He took potassium supplements (to make up for the leakage of potassium secondary to the leakage from the Lasix). He was involved in a single-car traffic accident with fluid coming out his ears (cerebrospinal leakage). He had a pnuemothorax (leakage of air into his plural space), and I therefore vented his chest (creating a new leak so the trapped leakage of air could leak outside). He had minor arm bruising (capillary leaks), and I was able to establish an IV (reverse pressurized infused leakage). The patient admitted to drinking ETOH (IQ leakage). I, in turn, leaked this information to the police officer on scene causing the patient to leak further distally.
Until next time, plug ’em and lug ’em lest they leak. JEMS
This article originally appeared in September 2010 JEMS as “People Leak: And we fix it.”