Angels of the Battlefield:
From Rome to Napoleon
Later in the newsletter, Steve Schauer talks about trauma in the combat zone. With so much medical care being rendered by medics, we should take some time and look at the history of medics. The history of military medics dates back to ancient civilizations, with the earliest organized medical care emerging in ancient Egypt around 1600 BCE, where the Smith Papyrus documented sophisticated wound treatment and fracture care. The Romans later developed the most advanced early system of military medicine, introducing "immunes" (medical corpsmen) who provided front-line treatment. Their sophisticated system included: organized field sanitation, dedicated military hospitals, a casualty collection system, and an evacuation chain for wounded legionnaires. However, after the fall of Rome, military medical care regressed significantly during the Middle Ages.
The Early Modern Period (1450-1700) saw the rise of barber surgeons in military medicine, with pioneers like Ambrose ParƩ making significant contributions to wound treatment. The 18th century brought crucial advances including the tourniquet and formal wound debridement techniques. These innovations set the stage for the revolutionary changes that would come during the Napoleonic Wars, when military medicine began to take its modern form.
The most significant leap forward came through Dominique Jean Larrey, considered the first modern battlefield surgeon, who revolutionized military medicine during the Napoleonic Wars. His key innovations included: establishing the criteria for "triage," inventing the "ambulance volante" (flying ambulance) for rapid battlefield evacuation, implementing a system of initial care just behind battle lines, organizing dedicated corpsmen and litter-bearers, and creating a network of field hospitals positioned strategically away from the fighting. Despite these advances, military medicine still faced enormous challenges, as demonstrated by Napoleon's 1812 Russian campaign, where disease and poor logistics led to massive casualties among both soldiers and medical personnel.
Welcome to the 88th edition of ResusNation!
Does ROC, Rock?
The debate over using rocuronium vs. succinylcholine is a classic one in resuscitation. There are meta-analyses, opinions, and debates over the use of these drugs. Well, this week Anand Swaminathan (@EMSwami) published a post this week on IG talking about the benefits of using rocuronium for RSI. In fact, he likes ROC so much he was rocking his Rocuronium t-shirt during the reel (you can find this at the link here).Swami raises up some excellent points and makes a compelling argument for the use of rocuronium.
Watch the full video here.
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Trauma Contributions from the Military
In this episode, Dr. Steven Schauer explores how military trauma care innovations are now revolutionizing civilian emergency medicine. Recorded at the ResusX: Golden Hour conference, Dr. Schauer discusses breakthroughs such as the widespread use of tourniquets, the shift to balanced transfusions, and the growing role of ECMO. From combat lessons to civilian hospitals, these advancements are saving lives in both arenas. Tune in to learn how battlefield medicine is pushing the boundaries of trauma care and improving outcomes for all trauma patients.
Check out this video now and watch the entire ResusX: Golden Hour conference for more content from Steven and our other all-star faculty!
How The Heck Does
That Thing Work?
@CritCareReviews did an outstanding review on chest drainage units from a larger article reviewing chest tubes and drainage, which you can review here.
Modern chest drainage units (CDUs) have evolved from simple designs to sophisticated systems aimed at removing pleural fluid/air, preventing reflux, and restoring negative pleural pressure for lung re-expansion. The basic systems include one-way valves (Heimlich valve) or water-seal drainage setups, with three main configurations: single-bottle, two-bottle, and three-bottle systems. In the single-bottle system, a rigid tube connected to the chest tube is immersed in saline, but its effectiveness decreases as fluid accumulates. Two-bottle systems improve upon this by separating fluid collection and water seal functions, while three-bottle systems add capability for suction control.
The application of suction in chest drainage remains controversial. While it can help facilitate lung re-expansion and fluid/air removal, data supporting its benefit in post-surgical cases and pneumothorax are mixed. The amount of suction is typically regulated through water column height in traditional systems, with a 20 cmHā‚‚O water column providing a maximum -20 cmHā‚‚O suction pressure regardless of external vacuum strength. Modern digital drainage systems have now been introduced that can record evacuated air/fluid flows, monitor pleural pressure, and provide graphical data reporting. These smart-systems offer more precise control and monitoring capabilities, though they require electricity and are more expensive than traditional setups. Importantly, immediate suction after chest tube insertion should be avoided due to the risk of re-expansion pulmonary edema, particularly in young patients with complete pneumothorax.
Huge thanks and shout out to @CritCareReviews for highlighting this article.
Watch ResusX:ReUnion on Replay!
Tomorrow, October 8th, we are launching the replay for ResusX:ReUnion. If you weren't there live for ResusX:ReUnion then you missed an amazing experience with 3 days of education and over 50 faculty members. Fortunately for you, we got the whole incredible event captured on video and you can start watching tomorrow.
These videos were recorded in high-definition and have remastered audio. When you register you'll also have access to high-yield summaries that you can download to take with you on the go. You'll also be able to earn CME or CEU credits as you watch.
And because I'm grateful that you are a newsletter subscriber, I'm giving you early-bird access with a coupon to save over 20% off the registration price. Starting tomorrow, use code "SAVE20" at checkout to get your discount. Please note, we only have a limited number of these coupons so don't wait too long to register.
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Recent Articles in Resuscitation & Critical Care
In this episode, Dr. Mike Winters dives into the most recent articles and studies impacting resuscitation and critical care. Recorded at the ResusX: ReUnion conference, Dr. Winters covers essential updates, including innovative sepsis management, the role of beta-lactam infusions, and adjunct therapies for vasopressors. With insights into both the science and practical application of these new findings, this episode is a must-listen for healthcare providers seeking to stay current on advancements in critical care. Tune in to learn about the evidence thatā€™s shaping patient care in the emergency and intensive care settings.
Check out this video now and watch the entire ResusX: ReUnion conference for more content from Mike and our other all-star faculty!
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