The astronaut suffered a deep vein thrombosis, and the rocket delivered medicine across 400 kilometers, a space rescue worth 350 million

Clinically, if a patient with suspected deep vein thrombosis comes to the emergency department, even a doctor with rich clinical experience may feel like a big enemy, and quickly explain to the patient and family members the various accidents and hidden behind this seemingly stable Risks, and then seize all the time to perfect various checks and start anticoagulation treatment as soon as possible.

Imagine if this emergency appears in the vast universe, faced with a crumbling blood clot that may fall off at any time, what should the astronauts and doctors on the ground do?

In January of this year, NEJM posted a case report, detailing this emergency in space.

Old movie with the same name. Source: YouTube

"Houston, we have a problem. (Houston, we have a problem.)"

Accident in the vast universe

The endless darkness.

In the sky 400 kilometers above the ground, a behemoth flies overhead from time to time at a speed of more than 28,000 kilometers per hour. This is the International Space Station. Here, astronauts are intensively conducting various space experiments.

Astronaut George (pseudonym), who has just arrived at the International Space Station for 2 months, is video-connected with a doctor to conduct a 6-month experiment: This is a blood flow experiment. George learned before flying to space After using ultrasound equipment, he performed ultrasound examinations on blood vessels throughout his body under the guidance of a doctor, collecting images and sending data back to the earth.

Source: YouTube

Suddenly, the doctor accidentally discovered in real-time ultrasound images transmitted from space back to the earth: How did the blood flow of the internal jugular vein on George's left suddenly stop?

The doctor immediately called for other experts to observe the ultrasound images, and finally confirmed that there was a subacute internal jugular vein thrombosis in George, but fortunately, the doctor did not find any other thrombus in his body.

Internal jugular vein thrombosis is more rare than other deep vein thrombosis. Patients who get thrombosis at this site often have the Virchow triad: vascular intimal damage, abnormal blood flow, and hypercoagulable blood. The doctors looked over and over again from George's medical report before going to heaven and found that he did not have these problems.

On the earth, internal jugular vein thrombosis is already an extremely difficult disease, 10.3% of patients will be complicated by pulmonary embolism, and the mortality rate is as high as 44%.

In space, this unstable internal jugular vein thrombosis becomes more dangerous and uncontrollable. Doctors don’t know how it will develop in a microgravity environment: in addition to falling downwards, it will cause pulmonary embolism. Emboli may also progress to the direction of the head and form cerebral venous thrombosis. These are all complications that can be directly fatal.

The medical team on the ground was terrified, not only because it was a medical emergency, but also because it was the first time that human beings actually needed doctor intervention in space.

Even if there is a perfect plan, I am afraid I have to lament: the plan can never keep up with the changes.

Unlike the battered experts on the ground, George in space appeared to be at ease, perfectly interpreting "the stars in the sky laugh at the people on the ground." Generally speaking, a thrombosis in the internal jugular vein will cause headaches, dizziness, flushing face and other symptoms, but George does not have these changes at all.

Now there are several questions before the doctor:

1. Since George has no high risk factors for thrombosis, how did this thrombosis come from? Is it an accident caused by the special environment of space?

Second, George has no symptoms, is this still necessary for treatment? If he is to be treated, is he to be sent back to Earth immediately?

Dilemma: Returning or delivering medicine?

The doctors first reached an agreement on the first question: They were thousands of miles away without knowing how the blood clot formed. But no matter whether the thrombus was formed accidentally in space, they should treat George, otherwise it might kill him at any time.

The doctors of the Aerospace Center carefully considered the feasibility of returning to Earth, and concluded that this is probably more dangerous than embarking on a dark beach.

After the returning cabin enters the atmosphere, it will fall rapidly under the action of gravity. For a relatively unstable thrombus in the subacute stage, the impact generated by the fall is enough to make the thrombus fall off. On the contrary, it may lose the wife and lose the soldiers. It not only paid a lot of money to get George back, but also gave nothing to the original. Symptoms of George's fatal blow.

Since he can't come back and the doctor wants to give treatment, there is only one question left: how to treat it?

There are many medical kits on the International Space Station. George and other astronauts happened to find 20 vials of enoxaparin, an anticoagulant that can be used directly, from these kits. This is really great news!

So the doctor immediately asked George to inject enoxaparin. Looking at the watch, it was less than 24 hours before the blood clot was found.

The doctor first talked with the personnel of NASA. Since George has no symptoms, and this may be an accident or even an oolong caused by the space environment, they all hope that George can stay on the International Space Station until the end of the mission and come back. As a result, a new problem emerged: George currently only has 20 injections of enoxaparin, which can only last for 40 days, which is not enough.

NASA slapped his forehead and decided to be a takeaway boy delivering medicine: Let's send a rocket again and send him the medicine!

Loading medicine into the cabin. Source: YouTube

With NASA acting as the takeaway brother, the doctors are faced with a new problem: if they continue to prescribe Enoxaparin to George, they will need to attach many disposable injection equipment and disinfectants, which may greatly squeeze the rocket. Not much space. Therefore, they plan to replace enoxaparin with an oral anticoagulant that is easier to load.

Finally, on the 43rd day when George found the blood clot, the rocket carrying the drug slowly lifted off.

Source: YouTube

"Destined for the International Space Station. (Destination: International Space Station.)"

Return to earth

Before the drug was sent to space, George relied on the enoxaparin that was originally on the space station to make the embolus smaller and smaller.

After the rocket arrived, George began to take oral anticoagulants. Four days later, although the ultrasound showed that the thrombus was still there, there was finally an image of the blood flow in the internal jugular vein, but this only appeared when George did the Muller test.

The Muller test is the opposite of the Valsalva test. The person doing this test closes his mouth and nose after doing his best to exhale, so that the pressure in the thoracic cavity will become much lower than the atmospheric pressure, and the amount of blood returning to the right heart will increase. From above, the blood flow in the internal jugular vein will also increase, which also explains well why blood flow occurs in the blocked internal jugular vein when George does this action.

George followed the doctor's advice and kept taking anticoagulant drugs. He never showed any symptoms caused by blood clots, and his daily work was not affected at all.

In actual clinical practice, treatment of patients with deep vein thrombosis for the first time requires continuous use of anticoagulants for 90 days.

Ninety days soon arrived, and the doctor asked George to do another ultrasound for himself, but to the doctor's surprise, the blood flow in the internal jugular vein could still only be restored through the Muller test. In other cases, George's blood vessels were like a dry river, without any vitality. The doctor had to let George continue to take the anticoagulant.

At this time, NASA informed the team of doctors that George's mission was about to end and he was ready to return to Earth.

George will be impacted when he returns from space to land, possibly suffering unknown damage. Under the action of anticoagulants, these small injuries may cause severe bleeding. Therefore, the doctor decided to stop the medication 4 days before his return.

One day before returning home, George performed the last ultrasound in space. Not surprisingly, the image is not much different from the previous one.

The team of doctors sharpened their knives and guns at the landing site to welcome this particular patient.

George boarded the returning cabin. The cabin left the International Space Station's orbit around the earth and slowly turned to this blue planet to accept the bear hug from the gravity of the earth.

Source: YouTube

Challenge from the sea of ​​stars

George went home.

At the landing site, the first to rush to George was the team of doctors with an ultrasound equipment. Apart from the impact of landing, George had no other discomforts. So the doctor immediately performed an ultrasound. To the surprise of all doctors, although a residual thrombus could be found in the internal jugular vein on George's left, the blood flow in the internal jugular vein had been completely restored.

This means that George does not need to take anticoagulant drugs.

In the follow-up 10 days later, George's internal jugular vein was like nothing happened. The doctor could not find the blood clot under ultrasound.

The latest article by the NASA team of doctors analyzed 11 astronauts who flew to space recently and found that in addition to George, one astronaut also had a blood clot. However, whether these thrombi are caused by some factors of the two astronauts or caused by the microgravity environment of space remains to be discussed.

As human beings continue to explore in space, the impact of microgravity on the human body will gradually become clear and vivid. Perhaps since the first time human beings rushed out of the earth and flew into space, these changes brought to astronauts due to environmental changes have already occurred, but until now, with the continuous advancement of technology and the occurrence of some accidental accidents, doctors And the space crew have become more aware of the truth.

These new knowledge and old knowledge are the treasures of mankind's future exploration of space.

As early as 50 years ago, when mankind first entered the universe, astronauts had the "custom" of carrying a medicine box into space. However, as to what medicine should be contained in this small medicine box, there has been no final conclusion. With time after space flight, wave after wave of medical and aerospace knowledge updating, the contents of this medicine box have gradually improved.

In the future, humans will return to the Heavenly Palace and go to Mars, which will be a longer journey than the International Space Station. With the adventures of the astronauts, the medical team is always behind the warriors and will not leave.