Just saw the new Mission Impossible and there's some improvised medicine I'd be excited to hear your take on
Hi!
There's like... a lot to talk about in this movie. So instead of just talking about Benji's pneumothorax, I'm gonna go through as much of it as I can.
First, a shoutout to the injury Paris sustained in the previous movie- the fact that she actually has a realistic scar from the type of surgery they would have had to do for the stabbing injury.
The type of surgery is called a laparotomy. The reason it is done is because you can't just stitch up an abdominal wound and call it a day- there is damage to the intestines and potentially other organs in there from the stabbing, and you have to go in and repair all the damage. If you don't, the person can die of an infection from all the poop that leaks out of the intestine.
The next thing to talk about is the scuba diving situation. Here I feel we were promised a lot of problems Ethan would have to deal with, and then those problems were handled mostly off screen or just not dealt with at all. I would have liked to see some of the HPNS or decompression sickness, personally.
Scuba is a set of equipment that allows a person to breathe underwater. It usually consists of a set of tanks of compressed air, a regulator, and a buoyancy control device- a vest that can fill with air and help control where the person floats in the water.
Diving in relatively shallow water (up to about 60 feet) is a common recreational activity and is relatively safe as long as a person is appropriately trained, sticks to the rules, and dives with a buddy.
Going deeper requires additional training and sometimes different equipment. The deeper a person goes, the more complications they face and the more danger they are in, especially if diving in confined spaces, like Ethan does in the movie.
Some of the different equipment involves a different mix of gases in the tanks. For shallow water dives, regular air is fine. Regular air is about 78% nitrogen and 21% oxygen, with a few other gases making up that last 1%. As people go deeper, two problems occur with this mix of gases.
One is that nitrogen dissolves in body tissues under pressure, and as a person makes their way to the surface, that dissolved nitrogen expands into bubbles that cause severe pain and other problems. This is called decompression sickness, or "the bends". The way to prevent the bends is to ascend slowly, making multiple stops where you wait for the nitrogen to leave the tissues at different depths. Ethan couldn't do that (at significant depth you breathe a lot more air, which meant that the air he went down with wouldn't last long enough to allow him to do his decompression stops... conveniently).
The other problem is something called nitrogen narcosis. Nitrogen narcosis is a situation where high levels of nitrogen get in the brain at depth, causing confusion and euphoria (this is not the same as the HPNS discussed in the movie, we'll talk about that in a bit).
A way to prevent both of these problems is to replace the nitrogen with another gas. The main gases used for this are hydrogen and helium. Since hydrogen is not an "inert gas" as referenced in the movie, helium is really the only choice for that "classified" mixture.
Helium still dissolves in tissues, but it dissipates more quickly as the person ascends, meaning decompression stops can be fewer and quicker. Helium also doesn't cause narcosis at depth, making it safer for Ethan.
Another thing that points to helium is the High Pressure Neurological Syndrome (HPNS). HPNS only happens when breathing helium at depths below 500ft (which is like, serious depth for even commercial/technical diving). As far as I remember from the movie, we don't really know how deep Ethan has to go, but we can probably guess its greater than 500ft.
Now, I'm sure there are dive tables/calculators for helium/oxygen mixtures at that depth (commercial and technical divers do go this deep), but I was not able to find ones I could understand. FYI, the deepest regular recreational nitrogen/oxygen tables go is about 140ft, allowing only a bottom time (which is actually the total time under the water) of 8 minutes without decompression stops.
Again, I really wish we had gotten to see more than Ethan in the fetal position under the water for a few seconds and a not-sex-scene in the decompression chamber. Really feel like I would have enjoyed some HPNS symptoms or some actual symptoms of the bends once he was on the ice.
Anyway. Now onto Benji. Towards the end of the movie, Benji gets shot in the abdomen and then later inexplicably gets a pneumothorax. I say inexplicably because for a pneumothorax to happen something has to happen to a lung- you need either a hole in the chest (open pneumothorax/sucking chest wound) or a hole in the lung without a hole in the chest (tension pneumothorax).
Benji had neither- the entrance wound looked like it was in the lower left quadrant of his abdomen. After thinking about it, the only way he could have gotten a pneumothorax is that the bullet bounced around inside him a little and went up through his diaphragm, puncturing a lung and then stopping without creating an exit wound.
So for the purposes of this post, let's assume that's what happened.
So the bullet goes into his lung, and the lung starts leaking air into the chest cavity. Every time Benji takes a breath, more air gets into the chest cavity, which puts pressure on the rest of the lung, causing it to collapse. This can get bad enough that the amount of air trapped outside the lung in the chest cavity can actually start putting pressure on the heart and other lung, which can be even more life threatening.
The treatment is essentially to give the air trapped in the chest cavity a way to get out. Now, this might seem as simple as what they did in the movie- putting a tube in the chest and allowing the air to escape.
The problem with this is that air can go both ways through this tube. Because of the way air gets into the lungs (diaphragm moves down, increases space in the chest cavity, which then causes the lungs to expand to fill that space), air actually "prefers" to come into the chest cavity through the tube to the space outside the lungs because it is a path of least resistance. This makes things worse.
Here is a post about "chest darts" which is a procedure by which a large bore IV catheter is placed in the chest (about where they put the pen cover in the movie). This usually either has a one-way valve on it or the finger of a glove on it, acting as a one-way valve.
So that's basically it, hope it gave you some interesting things to think about!
