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Trauma Through the Ages

Join us on April 5, 2019, to delve into the epochs of trauma spanning prehistoric times to the present day. Explore advancements in medicine and nursing, from cultures like the Egyptians, Greeks, Romans, and beyond, shedding light on the evolution of healthcare practices.

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Trauma Through the Ages

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  1. Trauma Through the Ages Grant Christey MTS Symposium 5 April 2019

  2. Today • Epochs of Trauma • Ebb and flow of medicine and nursing • The advances • The doldrums • What next

  3. Epochs • Prehistoric • 120,00BC – 3000BC • Early Civilizations • 3000BC -200AD • Egyptians,Greeks, Romans • Dark and Middle ages; Middle East • 200-1500 • Renaissance • 1400- 1600 • Post Renaissance • 1600-1840 • The Wars • 1840-present

  4. Prehistoric (before 3000 BC) • 162 Prehistoric skeletons from California • 10% long bone fractures • 4.4% cranial injuries including missiles • Interpersonal violence was common • Neolithic German farmers (7K BC) • Skull injuries • Spear tips • Fractured tibias • Men and children • Neanderthal vs Paleolithic • (rodeo mystery solved)

  5. Early Civilisations 3000BC-200AD • Egyptians • Greeks • Romans • South America • Eastern Europe

  6. Egyptians • 3000-2000 BC • Bandages, • Beer • Magic • Sharp things • Edwin Smith Papyrus 2500-1700BC • Imhotep and the pyramids • 48 trauma cases • Only one mystical cure • Examination, diagnosis, treatment • Outcome Options: favourable uncertain, no hope

  7. Greeks • Hippocrates 480BC • Applied a systematic approach to medicine • Humoral Imbalance Theory: blood, yellow bile, black bile, phlegm • Theory dominated for almost 1000 years • Hippocratic Oath • Aristotle 384BC • “Man is an animal” so can be dissected • Soul higher than man: • Anatomy flourished • Bridge between anatomy and science • Nurses • Organised nursing in sanitariums • “Therapainis” = maid or servant that provided care

  8. Romans • Celsus 25BC – 50 AD • Used anatomic knowledge • Pioneered open wound care • open fracture management • Galen 165 AD • Physician to Marcus Aurelius • Dissected different animals • Confused everyone • Errors persisted until Vesalius in 1540 • “Said everything that could be said” Caracalla Baths 100AD

  9. Nurses in Ancient Rome • Deaconesses cared for the elderly and needy • Deaconess Order is first organised district nursing service • Roman matrons held in high esteem, founding hospitals and monasteries • In 350AD Fabiola, a roman matron erected a house for the sick and injured; the first public hospital • Christianity fuelled the importance of nursing while inhibiting medicine through the Middle and Dark ages.

  10. Trepanation in South America • 400-200 BC: long term survival 40% • 1000-1400 AD: long term survival 91% • 1400-1500 (Inca period): 80% • (American Civil war: 50%)

  11. Trepanation in Eastern Europe • Neolithics 10k-7kBC developed sharp tools • 3000BC (Copper age in Russia) • Obellion defect into superior sagittal sinus • Not a great strategy for SDH but dura usually intact • 1500: Craniectomy popular for surgeons. No anaesthetic

  12. Dark and Middle Ages • 200-1500 AD • In Europe • Rome fell • Catholic church suppressed science and heresy • Western medicine stalled for 1300 years • In the Middle East • Mixtures of mysticism and innovation • Avicenna (Arab) published “the Canon of Medicine” in 1025 • Bits of Hippocrates, Aristotle and Galen • the go-to text until 1600s • Mutual interactions of body elements • “The temperament of the coldest member by level of moisture is the serious humour”

  13. Renaissance • 1400-1600 • Vesalius was the hero • Understood Greek and Latin • Wrote “De HumaniCorporisFabricus” in 1543 • Utilised dissection as a primary teaching tool (mostly dead criminals)

  14. Rennaisance • Ambroise Pare • War surgeon • Used ligatures when he ran out of hot oil in the Seige of Turin 1537 • Huge reduction in infections and amputations • Successful trauma surgery • Lead bullet extraction tools • Plastic surgical techniques

  15. Post-Rennaisance Acceleration • 1600-1800 • John Hunter 1728 • Scottish surgeon: Pioneered modern surgical techniques based on anatomy • “Don’t think, try the experiment” • Dominique Larrey (Napoleon’s Surgeon) • Flying Ambulance at Waterloo 1797 • CPR was born • Dutch Society for the Recovery of Drowned Persons 1767 • Charles Kite FRS 1788 “An Essay on the Recovery of the Apparently Dead” • Ist successful defibrillation on 3 year old after a 3rd floor fall

  16. Larrey’s Flying Ambulance 1797

  17. The Dawn of Modern Nursing 1850 • Florence Nightingale: the lady of the lamp in the Crimean War 1854 • The symbolic figure of modern nursing: stubborn opinionated • Inspired by hospital visits with her mother to improve care • Established St Thomas nursing school • Sanitary reform • Hunger relief in India • Pioneer in medical infographics • Mystical novelist

  18. American Civil War 1861-1865 • Ist modern war • Docs got 2 years at Med School • Lead bullets than flatten on impact • Little anaesthesia at the beginning (more up north) • Morphine powder into wounds, opium pills or whisky • Then chloroform (35 deaths in 80,000 cases) • 60,000 amputations; anaesthetictime 15 minutes • Letterman’s Ambulance Plan: no-one left on the field at Gettysburg

  19. Nurses in the Civil War • Florence’s influence strong • Transitioned from untrained to trained • Established first permanent nursing corps • Change from welfare organisations to scientific • Greater responsibility and autonomy • George Washington: 1 nurse/10 patients; 1 matron/100 patients

  20. WW1 • 1914-1918 • Major advances in trauma surgery and survival • Antiseptics in surgery • Inhalational anaesthesia • Battel field evacuation • Diagnostic X-Rays • Saline via hypodermic trocar • 1 anaesthetist per patient

  21. WW1 Casualty Clearing Station

  22. WW1 1914-1918 • 1914-1918 • Rapid haemostasis: mortality from 1-8 hours is 10-81% • Started the concept of the “Golden Hour” • Guedel designed his airway and dunked his dog

  23. Between the Wars • IV Anaesthesia • 1934 Johnathon Lundy used thiopentone via a piston syringe • (Similar to those recovered from the Mary Rose sunk in Portsmouth Harbour in 1542) • Penicillin • discovered by Alexander Fleming in 1928 • mass production started in 1942 • Fluid Therapy • Advances driven by new knowledge of physiology

  24. WW2 • 1939-1945 • Antibiotics (thanks Alexander) • Delayed Closure • Sophisticated evacuation • PTSD • Birmingham Accident Hospital is 1st trauma centre • Separate the ill from the injured • Single team from admission to discharge • Care directed by senior surgeon • Rehab is integral to care and starts at admission

  25. After some more wars.... • 1950s: Fluid Therapy • Electrolyte solutions • Balanced fluid administration • 155-1975 Vietnam war • Many advances • Nurses provide complex care; amputations, wounds • 1980s: Monitored Resuscitation • Damage control surgery • Advances in critical care medicine • New medicines • 1990s • Trauma systems are established ”Two County Study” • 2000s • Emergency non-invasive techniques • Rapid imaging • System analytics and improvement

  26. Now and beyond.. • Seamless, high quality care through the whole patient journey • Whole system quality assessment and monitoring • Targeted risk reduction from incidence and treatment • Evidence-based change • Patients first! Assisting trauma patients to the life that is meaningful for them

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