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Turner MD, Shah MH. Dominique-Jean Larrey (1766-1842): The Founder of the Modern Triage System. Cureus 2024; 16:e62375. [PMID: 39006619 PMCID: PMC11246613 DOI: 10.7759/cureus.62375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/16/2024] Open
Abstract
Dominique-Jean Larrey was a prominent French surgeon who rose to fame during the age of the Napoleonic Wars. During his service in the French military, he developed dozens of medical innovations. Most important of all were his improvements to the evacuation of the wounded from the battlefield, triage of the wounded, and rapid surgical intervention. His innovations revolutionized military medicine and are still the basis for modern practice today.
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Affiliation(s)
- Matthew D Turner
- Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Muhammad Hamza Shah
- Deanery of Biomedical Sciences, The University of Edinburgh, Edinburgh, GBR
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
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Niesvizky-Kogan I, Bass M, Goldenholz SR, Goldenholz DM. Focal Cooling for Drug-Resistant Epilepsy: A Review. JAMA Neurol 2022; 79:937-944. [PMID: 35877102 PMCID: PMC10101767 DOI: 10.1001/jamaneurol.2022.1936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Epilepsy affects at least 1.2% of the population, with one-third of cases considered to be drug-resistant epilepsy (DRE). For these cases, focal cooling therapy may be a potential avenue for treatment, offering hope to people with DRE for freedom from seizure. The therapy leverages neuroscience and engineering principles to deliver a reversible treatment unhindered by pharmacology. Observations Analogous to (but safer than) the use of global cooling in postcardiac arrest and neonatal ischemic injury, extensive research supports the premise that focal cooling as a long-term treatment for epilepsy could be effective. The potential advantages of focal cooling are trifold: stopping epileptiform discharges, seizures, and status epilepticus safely across species (including humans). Conclusions and Relevance This Review presents the most current evidence supporting focal cooling in epilepsy. Cooling has been demonstrated as a potentially safe and effective treatment modality for DRE, although it is not yet ready for use in humans outside of randomized clinical trials. The Review will also offer a brief overview of the technical challenges related to focal cooling in humans, including the optimal device design and cooling parameters.
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Affiliation(s)
- Itamar Niesvizky-Kogan
- Harvard Medical School, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | - Daniel M Goldenholz
- Harvard Medical School, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Koehler U, Conradt R. [The Inventor of the "Triage": Dominique-Jean Larrey (1766-1842), Napoleon's Chief Military Doctor]. Pneumologie 2022; 76:365-369. [PMID: 35213925 DOI: 10.1055/a-1756-3879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
During the reign of Emperor Napoleon I, Dominique-Jean Larrey (1766-1842) was chief surgeon in the French army. He has become known as the father of modern military surgery and for the development of the "triage system". Larrey was an outstanding and dedicated physician who provided medical care not only to his own troops but also to those of the enemy. Without reliable analgesia and anaesthesia, speed and skill were the most salient characteristics of a surgeon at that time. Against the opposition of the administration, Larrey is credited with the introduction of first-aid on the battlefield as well as a quick rescue of the wounded with the help of the so-called "flying ambulances". He was considered the soldiers' greatest friend.
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Lantry JH, Mason P, Logsdon MG, Bunch CM, Peck EE, Moore EE, Moore HB, Neal MD, Thomas SG, Khan RZ, Gillespie L, Florance C, Korzan J, Preuss FR, Mason D, Saleh T, Marsee MK, Vande Lune S, Ayoub Q, Fries D, Walsh MM. Hemorrhagic Resuscitation Guided by Viscoelastography in Far-Forward Combat and Austere Civilian Environments: Goal-Directed Whole-Blood and Blood-Component Therapy Far from the Trauma Center. J Clin Med 2022; 11:356. [PMID: 35054050 PMCID: PMC8778082 DOI: 10.3390/jcm11020356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 12/31/2021] [Accepted: 01/10/2022] [Indexed: 12/18/2022] Open
Abstract
Modern approaches to resuscitation seek to bring patient interventions as close as possible to the initial trauma. In recent decades, fresh or cold-stored whole blood has gained widespread support in multiple settings as the best first agent in resuscitation after massive blood loss. However, whole blood is not a panacea, and while current guidelines promote continued resuscitation with fixed ratios of blood products, the debate about the optimal resuscitation strategy-especially in austere or challenging environments-is by no means settled. In this narrative review, we give a brief history of military resuscitation and how whole blood became the mainstay of initial resuscitation. We then outline the principles of viscoelastic hemostatic assays as well as their adoption for providing goal-directed blood-component therapy in trauma centers. After summarizing the nascent research on the strengths and limitations of viscoelastic platforms in challenging environmental conditions, we conclude with our vision of how these platforms can be deployed in far-forward combat and austere civilian environments to maximize survival.
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Affiliation(s)
- James H. Lantry
- Department of Medicine Critical Care Services, Inova Fairfax Medical Campus, Falls Church, VA 22042, USA;
| | - Phillip Mason
- Department of Critical Care Medicine, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX 78234, USA;
| | - Matthew G. Logsdon
- Department of Emergency Medicine, Indiana University School of Medicine—South Bend, Notre Dame, IN 46617, USA; (M.G.L.); (C.M.B.)
- Department of Emergency Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA; (E.E.P.); (C.F.); (J.K.)
| | - Connor M. Bunch
- Department of Emergency Medicine, Indiana University School of Medicine—South Bend, Notre Dame, IN 46617, USA; (M.G.L.); (C.M.B.)
- Department of Emergency Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA; (E.E.P.); (C.F.); (J.K.)
| | - Ethan E. Peck
- Department of Emergency Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA; (E.E.P.); (C.F.); (J.K.)
| | - Ernest E. Moore
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health and University of Colorado Health Sciences Center, Denver, CO 80204, USA; (E.E.M.); (H.B.M.)
| | - Hunter B. Moore
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health and University of Colorado Health Sciences Center, Denver, CO 80204, USA; (E.E.M.); (H.B.M.)
| | - Matthew D. Neal
- Pittsburgh Trauma Research Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA;
| | - Scott G. Thomas
- Department of Trauma Surgery, Memorial Leighton Trauma Center, Beacon Health System, South Bend, IN 46601, USA;
| | - Rashid Z. Khan
- Department of Hematology, Michiana Hematology Oncology, Mishawaka, IN 46545, USA;
| | - Laura Gillespie
- Department of Quality Assurance and Performance Improvement, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA;
| | - Charles Florance
- Department of Emergency Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA; (E.E.P.); (C.F.); (J.K.)
| | - Josh Korzan
- Department of Emergency Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA; (E.E.P.); (C.F.); (J.K.)
| | - Fletcher R. Preuss
- Department of Orthopaedic Surgery, UCLA Santa Monica Medical Center and Orthopaedic Institute, Santa Monica, CA 90404, USA;
| | - Dan Mason
- Department of Medical Science and Devices, Haemonetics Corporation, Braintree, MA 02184, USA;
| | - Tarek Saleh
- Department of Critical Care Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA;
| | - Mathew K. Marsee
- Department of Graduate Medical Education, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA;
| | - Stefani Vande Lune
- Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA;
| | | | - Dietmar Fries
- Department of Surgical and General Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Mark M. Walsh
- Department of Emergency Medicine, Indiana University School of Medicine—South Bend, Notre Dame, IN 46617, USA; (M.G.L.); (C.M.B.)
- Department of Emergency Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USA; (E.E.P.); (C.F.); (J.K.)
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Presciutti A, Perman SM. The evolution of hypothermia for neuroprotection after cardiac arrest: a history in the making. Ann N Y Acad Sci 2021; 1507:60-69. [PMID: 34554586 DOI: 10.1111/nyas.14676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/09/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022]
Abstract
While much has been observed regarding hypothermia by way of environmental exposure, it is modern day medicine that deployed hypothermia as a therapeutic. From the early 1930s, when Temple Fay deployed "refrigeration" to treat pain, to the work of Wilfred Bigelow and Charles Drew, who utilized hypothermia in open heart surgery-the opportunities seemed endless. However, questions arose surrounding appropriate temperatures to achieve best outcomes and how to minimize adverse events, such as coagulopathy and infection. In the 1980s, hypothermia underwent a resurgence through Peter Safar's critical studies in large animals, which quickly translated into feasibility studies and the landmark trials of 2002 that paved the way for postcardiac arrest care as we currently know it. Through clinical and observational trials, modern-day targeted temperature management continues to adapt, striving to improve patient outcomes. While hypothermia has come a long way from the writings of Hippocrates, the ideal therapy has not yet been defined, and more work is needed. While the history is long, there is more to be written and advances to be achieved as we optimize the neuroprotective effects of hypothermia for comatose survivors of cardiac arrest.
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Affiliation(s)
| | - Sarah M Perman
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
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Flécher E, Leguerrier A, Nesseler N. An odyssey of suturing cardiac wounds: Lessons from the past. J Card Surg 2020; 35:1597-1599. [PMID: 32485004 DOI: 10.1111/jocs.14675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Cardiac wounds have been described for centuries and still remain to be fatal. For a long period of time, the suturing of a myocardial laceration was thought to be absolutely impossible if not sacrilege. METHODS It is only at the end of the 19th century that pioneers decided to defy such a dogma in desperate cases. RESULTS Nowadays, it seems obvious that a cardiac stab wound requires emergent surgery whenever possible. CONCLUSIONS The story of cardiac wounds highlights nicely the change of mind that is required to accept progress and new procedures in medicine.
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Affiliation(s)
- Erwan Flécher
- Department of Cardiothoracic and Vascular Surgery, University Rennes Hospital, INSERM, LTSI-UMR 1099, Rennes, France
| | - Alain Leguerrier
- Department of Cardiothoracic and Vascular Surgery, University Rennes Hospital, INSERM, LTSI-UMR 1099, Rennes, France
| | - Nicolas Nesseler
- Department of Anesthesia, University Rennes Hospital, Rennes, France
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Ramdhan RC, Rai R, Brooks KN, Iwanaga J, Loukas M, Tubbs RS. Dominique Jean Larrey (1766-1842) and His Contributions to Military Medicine and Early Neurosurgery. World Neurosurg 2018; 120:96-99. [PMID: 30172978 DOI: 10.1016/j.wneu.2018.08.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 11/25/2022]
Abstract
Dr. Dominique Jean Larrey was a pioneer in the field of military surgery. His creative innovation and drive to improve the quality of medical services available to those injured during war guided his achievements in medicine. Dr. Larrey has often been referred to as "the father of emergency medical services" and "the father of modern military medicine." His contributions to medicine continue to live on in common procedures and healthcare systems today, such as aspiration of pericardial effusion and drainage of hemothorax and empyema. Based on his own writings, he treated multiple cases of intracranial injury, making him an early, but often forgotten, pioneer of neurosurgery.
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Affiliation(s)
- Rebecca C Ramdhan
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | - Rabjot Rai
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | | | - Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington, USA.
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies; Seattle Science Foundation, Seattle, Washington, USA
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Abstract
Therapeutic hypothermia is a relatively new protocol that can improve patients' chances of favorable neurologic outcomes after cardiac arrest. However, implementation rates remain low nationwide. This article describes recommendations for and benefits of therapeutic hypothermia in postresuscitation care.
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Nakao H, Ukai I, Kotani J. A review of the history of the origin of triage from a disaster medicine perspective. Acute Med Surg 2017; 4:379-384. [PMID: 29123897 PMCID: PMC5649292 DOI: 10.1002/ams2.293] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/30/2017] [Indexed: 12/12/2022] Open
Abstract
We usually associate triage with the Simple Triage and Rapid Treatment method, but much of its origin is still unknown. Therefore, French studies and the origin of triage shown in domestic and foreign published works have been investigated and its significance reaffirmed. The etymology of the word “triage” means “to break into three pieces.” It was suggested by a literature review that the rise of Napoleon led to military tactical changes, and that the prototype of triage arose from the experience gained in the difficult campaign in Egypt and Syria. Subsequently, triage was refined by Napoleon's military surgeon, D. J. Larrey, who created the ambulance transport system. Although there is a clash between the ruthless and philanthropic aspects of triage, triage is in accordance with the primary purpose of evacuation or treatment. We should choose the triage method that is consistent with the purpose of each disaster situation.
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Affiliation(s)
- Hiroyuki Nakao
- Department of Emergency Disaster and Critical Care Medicine Hyogo Medical College of Medicine Nishinomiya Hyogo Japan
| | - Isao Ukai
- Trauma and Resuscitation Center Hyogo Prefectural Nishinomia Hospital Nishinomiya Hyogo Japan
| | - Joji Kotani
- Department of Emergency Disaster and Critical Care Medicine Hyogo Medical College of Medicine Nishinomiya Hyogo Japan
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Lampe JW, Bratinov G, Weiland TR, Illindala U, Berg RA, Becker LB. Volume infusion cooling increases end-tidal carbon dioxide and results in faster and deeper cooling during intra-cardiopulmonary resuscitation hypothermia induction. Intensive Care Med Exp 2015; 3:37. [PMID: 26715581 PMCID: PMC4695470 DOI: 10.1186/s40635-015-0073-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/20/2015] [Indexed: 11/22/2022] Open
Abstract
Background Intra-arrest hypothermia induction may provide more benefit than inducing hypothermia after return of spontaneous circulation. However, little is understood about the interaction between patient physiology and hypothermia induction technology choice during ongoing chest compressions. Methods After 10 min of untreated ventricular fibrillation, mechanical chest compressions were provided for 60 min (100 CPM, 1.25" deep) in 26 domestic swine (30.5 ± 1.7 kg) with concurrent hypothermia induction using one of eight cooling methods. Four cooling methods included volume infusion with cold saline or an ice particulate slurry through the femoral vein or carotid artery (volume infusion cooling group, VC); three included cooling via an intra-vascular heat exchange catheter, nasal cooling, or surface ice bags (no volume cooling group, NVC); and the other was a control group with no cooling (no cooling group, NC). Physiological monitoring included end-tidal carbon dioxide, aortic pressure, right atrial pressure, brain temperature, esophageal temperature, and rectal temperature. Results During cardiopulmonary resuscitation (CPR), the volume infusion cooling group cooled faster and to lower temperatures than the other groups (VC vs. NVC or NC; ∆T = −5.6 vs. −2.1 °C or −0.6 °C; p < 0.01). The aortic pressure and right atrial pressure were higher in the volume cooling group than the other groups (VC vs. NVC or NC; AOP = 23.6 vs. 16.7 mmHg or 14.7 mmHg; p < 0.02). End-tidal carbon dioxide measurements during CPR were also higher in the volume cooling group (VC vs. NVC; EtCO2 = 23.4 vs. 13.1 mmHg; p < 0.05). Intra-corporeal temperature gradients larger than 3 °C were created by volume cooling during ongoing chest compressions. Conclusions Volume infusion cooling significantly altered physiology relative to other cooling methods during ongoing chest compressions. Volume cooling led to faster cooling rates, lower temperatures, higher end-tidal carbon dioxide levels, and higher central vascular pressures. IACUC protocol numbers: UPenn (803178), CHOP (997)
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Affiliation(s)
- Joshua W Lampe
- The Feinstein Institute for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA.
| | - George Bratinov
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Theodore R Weiland
- Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | | | - Robert A Berg
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Lance B Becker
- The Feinstein Institute for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA.
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Wang HS, Han JS. Research progress on combat trauma treatment in cold regions. Mil Med Res 2014; 1:8. [PMID: 25722866 PMCID: PMC4340833 DOI: 10.1186/2054-9369-1-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 04/17/2014] [Indexed: 12/29/2022] Open
Abstract
Cold regions are a special combat environment in which low temperatures have a great impact on human metabolism and other vital functions, including the nervous, motion, cardiovascular, circulatory, respiratory, and urinary systems; consequently, low temperatures often aggravate existing trauma, leading to high mortality rates if rapid and appropriate treatment is not provided. Hypothermia is an independent risk factor of fatality following combat trauma; therefore, proactive preventative measures are needed to reduce the rate of mortality. After summarizing the basic research on battlefield environments and progress in the prevention and treatment of trauma, this article concludes that current treatment and prevention measures for combat trauma in cold regions are inadequate. Future molecular biology studies are needed to elucidate the mechanisms and relevant cell factors underlying bodily injury caused by cold environment, a research goal will also allow further exploration of corresponding treatments.
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Affiliation(s)
- Hui-Shan Wang
- Department of Cardiovascular Surgery, General Hospital of Shenyang Military Command, Shenyang, 110016 China
| | - Jin-Song Han
- Department of Cardiovascular Surgery, General Hospital of Shenyang Military Command, Shenyang, 110016 China
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Roux FE, Reddy M. Neurosurgical work during the Napoleonic wars: Baron Larrey's experience. Clin Neurol Neurosurg 2013; 115:2438-44. [PMID: 24120506 DOI: 10.1016/j.clineuro.2013.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 09/05/2013] [Accepted: 09/08/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Considered as the most famous French military surgeon, Dominique-Jean Larrey (1766-1842), who joined all the campaigns of Napoleon, wrote his memoirs and several medical articles. This paper discusses how in the Napoleonic times, Larrey dealt with neurosurgical diseases or injuries. PATIENTS AND METHODS We reviewed four main publications of Larrey published between 1812 and 1838 and analyzed the type of neurosurgical cases presented and their treatment. RESULTS These works include his practice of what we call now "neurosurgery" since most injuries described concern the skull or spine. He seemed to treat patients with humanity, integrity and perseverance. Larrey dealt with many aspects of neurosurgery, such as cranial or spinal trauma surgery, and also infectious diseases. He saw many head injuries inflicted not only by muskets or artillery, but also with spears and sabers. Unlike some others, Larrey advocated the use of trepanation in many situations as practiced, for instance, in the treatment of depressed fractures or in presence of subdural collections. On the other hand, this surgeon who saw thousands of amputees during his career did not mention the phantom limb phenomenon in his memoirs. Similarly, the issue of cerebral localizations is only mentioned in his last work, published in 1838. CONCLUSIONS In his work, Larrey (and all his contemporaries) dealt essentially with "cranial" surgery, as in skull fractures where the brain could potentially have been injured by bone fragments. The time for brain surgery had not come yet.
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Affiliation(s)
- Franck-Emmanuel Roux
- UMR Unité 825, Université Paul Sabatier, IFR 96 and Pôle Neurosciences, Centres Hospitalo-Universitaires, F-31059 Toulouse, France.
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Goniewicz M. Effect of military conflicts on the formation of emergency medical services systems worldwide. Acad Emerg Med 2013; 20:507-13. [PMID: 23672366 DOI: 10.1111/acem.12129] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 08/20/2012] [Accepted: 12/02/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This article briefly reviews the evolution of medical support during wars and conflicts from ancient to modern times and discusses the effect warfare has had on the development of civilian health care and emergency medical services (EMS). Medical breakthroughs and discoveries made of necessity during military conflicts have developed into new paradigms of medical care, including novel programs of triage and health assessment, emergency battlefield treatment and stabilization, anesthesia, and other surgical and emergency procedures. The critical role of organizations that provide proper emergency care to help the sick and injured both on the battlefield and in the civilian world is also highlighted.
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Affiliation(s)
- Mariusz Goniewicz
- Faculty of Health Sciences; School of Economics and Law; Kielce; Poland
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Therapeutic hypothermia: a state-of-the-art emergency medicine perspective. Am J Emerg Med 2012; 30:800-10. [DOI: 10.1016/j.ajem.2011.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Revised: 03/13/2011] [Accepted: 03/15/2011] [Indexed: 01/06/2023] Open
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Sahota P, Savitz SI. Investigational therapies for ischemic stroke: neuroprotection and neurorecovery. Neurotherapeutics 2011; 8:434-51. [PMID: 21604061 PMCID: PMC3250280 DOI: 10.1007/s13311-011-0040-6] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Stroke is one of the leading causes of death and disability worldwide. Current treatment strategies for ischemic stroke primarily focus on reducing the size of ischemic damage and rescuing dying cells early after occurrence. To date, intravenous recombinant tissue plasminogen activator is the only United States Food and Drug Administration approved therapy for acute ischemic stroke, but its use is limited by a narrow therapeutic window. The pathophysiology of stroke is complex and it involves excitotoxicity mechanisms, inflammatory pathways, oxidative damage, ionic imbalances, apoptosis, angiogenesis, neuroprotection, and neurorestoration. Regeneration of the brain after damage is still active days and even weeks after a stroke occurs, which might provide a second window for treatment. A huge number of neuroprotective agents have been designed to interrupt the ischemic cascade, but therapeutic trials of these agents have yet to show consistent benefit, despite successful preceding animal studies. Several agents of great promise are currently in the middle to late stages of the clinical trial setting and may emerge in routine practice in the near future. In this review, we highlight select pharmacologic and cell-based therapies that are currently in the clinical trial stage for stroke.
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Affiliation(s)
- Preeti Sahota
- Department of Neurology, University of Texas Medical School at Houston, Houston, TX 77030 USA
| | - Sean I. Savitz
- Department of Neurology, University of Texas Medical School at Houston, Houston, TX 77030 USA
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Improving prehospital trauma management for skiers and snowboarders - need for on-slope triage? J Trauma Manag Outcomes 2011; 5:5. [PMID: 21521524 PMCID: PMC3098779 DOI: 10.1186/1752-2897-5-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Accepted: 04/26/2011] [Indexed: 11/27/2022]
Abstract
Background Injuries from skiing and snowboarding became a major challenge for emergency care providers in Switzerland. In the alpine setting, early assessment of injury and health status is essential for the initiation of adequate means of care and transport. Nevertheless, validated standardized protocols for on-slope triage are missing. This article can assist in understanding the characteristics of injured winter sportsmen and exigencies for future on-slope triage protocols. Methods Six-year review of trauma cases in a tertiary trauma centre. Consecutive inclusion of all injured skiers and snowboarders aged >15 (total sample) years with predefined, severe injury to the head, spine, chest, pelvis or abdomen (study sample) presenting at or being transferred to the study hospital. Descriptive analysis of age, gender and injury pattern. Results Amongst 729 subjects (total sample) injured from skiing or snowboarding, 401 (55%, 54% of skiers and 58% of snowboarders) suffered from isolated limb injury. Amongst the remaining 328 subjects (study sample), the majority (78%) presented with monotrauma. In the study sample, injury to the head (52%) and spine (43%) was more frequent than injury to the chest (21%), pelvis (8%), and abdomen (5%). The three most frequent injury combinations were head/spine (10% of study sample), head/thorax (9%), and spine/thorax (6%). Fisher's exact test demonstrated an association for injury combinations of head/thorax (p < 0.001), head/abdomen (p = 0.019), and thorax/abdomen (p < 0.001). Conclusion The data presented and the findings from previous investigations indicate the need for development of dedicated on-slope triage protocols. Future research must address the validity and practicality of diagnostic on-slope tests for rapid decision making by both professional and lay first responders. Thus, large-scale and detailed injury surveillance is the future research priority.
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Abstract
Historically, hypothermia was induced prior to surgery to enable procedures with prolonged ischemia, such as open heart surgery and organ transplant. Within the past decade, the efficacy of hypothermia to treat emergency cases of ongoing ischemia such as stroke, myocardial infarction, and cardiac arrest has been studied. Although the exact role of ischemia/reperfusion is unclear clinically, hypothermia holds significant promise for improving outcomes for patients suffering from reperfusion after ischemia. Research has elucidated two distinct windows of opportunity for clinical use of hypothermia. In the early intra-ischemia window, hypothermia modulates abnormal cellular free radical production, poor calcium management, and poor pH management. In the more delayed post-reperfusion window, hypothermia modulates the downstream necrotic, apoptotic, and inflammatory pathways that cause delayed cell death. Improved cooling and monitoring technologies are required to realize the full potential of this therapy. Herein we discuss the current state of clinical practice, clinical trials, recommendations for cooling, and ongoing research on therapeutic hypothermia.
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Affiliation(s)
- Joshua W. Lampe
- The Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104
| | - Lance B. Becker
- The Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104
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