On 17 September 2015 at 17:42, Rob O'Connor <xxxxxx@ozemail.com.au> wrote:

Using ECMO (extra-corporeal membrane oxygenation, a heart-lung machine for the non-medics) as an example precursor technology to cold sleep, you put people on the pump prior to cooling them down.

It doesn't matter if they have an arrhythmia because you're supporting the circulation.
It doesn't matter if their lungs don't work - you're oxygenating the blood.
It doesn't matter if there's a hole in the circulation - you keep filling them in the imaging department/operating theatre/emergency department until the leak is demonstrated and controlled or you run out of blood products and IV fluids.

Is the situation salvageable with local resources?
Salvage, decide whether to come off the pump, or cool and transfer.

Not salvageable with local resources?
Decide whether to "Freeze 'em and ship 'em out" or palliate.

<snip>
 
Unless fast drug is a omnicidal antibiotic, your immune system is slowed by 'x' times and the bacteria eat you anyway.

There's no reason fast drug should slow all your commensals, or infection causing micro-organisms. Otherwise you could use it as a universal antibiotic - slow down the germs but leave the immune system at normal tempo!

Well, the descriptions of Fast and Slow drugs as written _are_ kind of magical.  Fast slows metabolism and perception (so presumably mental processes too) by a factor of 60.  Now of course, I can't see any way that it is pharmacologically realistic to slow all metabolism by an identical factor.  And if all physiological processes are not being slowed by a similar factor, then we will start getting some nasty breakdowns of physiological homoeostasis.  

Nodding my head to Clarke's 3rd Law, and assuming that Fast works as written (no matter how improbable that may be), I had always conceived it as being (functionally) a temporal distortion MacGuffin: the patient (and all their microbiological cargo) are moving at 1/60th the pace of the rest of the universe.  Similarly, Cold Sleep is (functionally) a stasis chamber ... or a temporal distortion MacGuffin with a factor of less than 1/10,000.  

Now if such "Magic Tech" as described in the LBBs _was_ available, I can see the use of Fast being an almost obligatory component of any time-critical medical intervention, and an adjunct to ECMO etc.

However, if we are talking about more realistic prognostications about SF health care and medicine, then I would direct all list members to the fabulous GURPS 4thEd Bio-Tech.  (Gee, it almost looks as though a doctor had input into the Medical Technology chapter of that book!)  And if we are talking realism, then LBB-style Fast and Slow disappear, and the approaches you describe in the first two paragraphs above are the likely way medical tech will go.
 
> I often have to manage patients in "slow stream rehab" for a few
> weeks before they are up to entering more intensive rehab.
> Still, even then the "slow stream rehab" process is not necessarily
> a passive process.

I'm trying to get them from the "not fit for a haircut" stage to where we can think about rehab.
I can see a real role for something like slow drug there.

Medical Slow turns 1 day real time into 30 days of healing.  Downside is unconsciousness (presumably to prevent min-max combat situations).  That has me wondering how the body gets through 30 days of intake of O2, H2O, nutrients etc (and output of metabolic waste products) in 24 hours.  Assuming the "Magic-Tech" takes care of all of that, we still have to deal with the downsides of the effect 30 (subjective) days of unconsciousness and loss of active mobility.  I am sure that, working in ICU, you would be more familiar than me of the absolute disaster that that usually is.  Even 7 subjective-days would have significant harms associated with it.
 
Sorry. Professional cynicism skewing my views again.

Yeah.  I have immense respect for the intellectual firepower required to be a good intensivist - the only specialty I am routinely in awe of - but the thing I found toughest to deal with as an ICU reg was the amount of resources being spent on patients with only a small chance of returning to a reasonable quality of life.

Peace,
KB.