A wide intravenous catheter used to get the RBCs into his system by quick, massive transfusion.

"... and a needle aspirator in him stat!"

The needle aspirator being a large syringe used to drain the air out of the pneumothorax, inflate the lungs, and restore normal breathing; stat, medical jargon for I need it done five seconds ago, a word derived and abbreviated from the original Latin statim, meaning immediately.

While the image of medical professionals working in conditions of ordered, clockwork sterility is a common one, nothing will dispel it faster than a glimpse inside a trauma room, where the battle to save lives is a close, tense, chaotic, messy, sweaty affair. Jabbing a 14-gauge big-bore needle into the chest of a powerfully built two-hundred-pound man, clenching the attached syringe in your fist and unsuccessfully attempting to insert it between hard slabs of pectoral muscle once, twice, and again before finally making a clean entry, then drawing out the plunger and getting a rush of warm, moist air in your face as the pocket that had formed around the lungs decompressed, was nobody's idea of a picnic--as the young doctor who had been hastily summoned on duty tonight, and who was now toiling away over Rollie Thibodeau here in the ISS facility's critical-care unit, trying to prevent him from dying before he made it onto an operating table, would have attested if he'd had the time. But he was too busy following the instructions called out by the chief physician, himself standing over the patient, working to get the big line and saline IVs connected to him in a hurry.

With the syringe in place and the air suctioned from the pneumothorax, it was essential to prevent its recurrence and keep the patient breathing. This meant going ahead with a full closed-tube thorascostomy.

The first step was to create an airtight seal around the tube. Barely registering the frantic activity around him, the young doctor lifted a scalpel from an instrument tray and sliced into the flesh between the ribs, making a horizontal incision. Then he took a Kelly clamp off the tray and pushed it into the incision, holding it by the shaft, expanding it to spread the soft tissue and create a tunnel for his finger. Blood splashed up around the clamp as he removed it from the opening and pressed his gloved finger between the lips of the cut, going in as deep as his knuckle, carefully feeling for the lung and diaphragm. After assuring himself that he had penetrated through to the intrapleural area--the space between the lungs and ribs where the air pocket had formed--he asked a scrub nurse for the chest tube and carefully guided it into the opening.