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History of resus


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History of resus

  1. 1. The History of Resuscitation Joseph Shiber, MD, FACEP, FACP, FCCM UF College of Medicine - Jacksonville
  2. 2. Outline Early conceptions and techniques Airway Breathing Compressions Defibrillation ICU development
  3. 3. “I heard of an Egyptian that had nine hours lien dead, who was by good appliances recover’d” Shakespeare – Pericles Act 3, Scene 2
  4. 4. Historical Perspective O Recognized “almost dead” vs “very dead” O Didn’t understand physiology O Tried to wake up person who looked asleep O Yelling, slapping/beating, water, fumigation O Remnants: Precordial Thump, NH4 Inhalant
  5. 5. Early Resuscitation Techniques O BC Egypt: Inversion for drowning O Barrel rolling and horse trotting into 1800’s
  6. 6. Jiu Jutsu Books 1600’s: Kappo
  7. 7. 1st Organized Effort to Respond to Sudden Death o Amsterdam 1767 Society for the Recovery of Drowned Persons 1. Warming 2. Elevate feet above head 3. Abdominal pressure to clear aspirated water 4. Respirations via bellows 5. Tickling the throat 6. Fumigation with smoke
  8. 8. London 1788
  9. 9. London Royal Humane Society O 1865 recommendations for nearly dead 1. Take to nearest house 2. Dry and warm 3. Clear nose and mouth 4. Rub skin briskly 5. Pass volatile salts under nose 6. Admit no more persons into room than absolutely necessary
  10. 10. Airway O 1540 Vesalius inserted reed into trachea O 1871 Trendelenberg cuffed tracheostomy tube O 1889 Head cuffed endotracheal tube O 1895 Kristen laryngoscope
  11. 11. Breathing o Old Testament references to Mouth-to-Mouth o Hebrew midwives used for centuries o 1500’s Parcellus used bellows in nose/mouth o 1732 Tossach used MTM resuscitate coal miner o Disappeared for 200 yrs: discovery of Oxygen
  12. 12. Silvester Method 1861
  13. 13. Modern Era (?) 1900’s
  14. 14. Elam & Safar: Rescue Breathing O Open airway: chin lift and jaw thrust O Ventilated residents and students under curare O Published JAMA 1958 O Endorsed by Red Cross 1960
  15. 15. Circulation: Compressions O 1628 Harvey finger stimulation dove hearts O 1874 Schiff open “cardiac massage” in dogs O 1878 Boehm external compressions in cats O 1891 Maass 1st successful external compression (not widely appreciated by medical community) O 1901 Igelsand 1st successful open massage O 1904 Crile 1st use of IV saline, Epi, MAST suit
  16. 16. Circulation: Compressions “The surgeon’s left hand was placed firmly across the front of the chest, the fingers resting over the fifth, Sixth, and seventh cartilages on the right side, while the tip of the thumb lay on the second piece of the sternum and the muscular part of the hand on the corresponding cartilages on the left side. The right hand now crossed over the left and forcible pressure made; the hands then being suddenly removed, the chest was allowed to expand by its own elasticity.” John Hill - 1868
  17. 17. Kouwenhoven, Knickerbocker, Jude O Working on external defib but re-discovered external compressions O Didn’t discuss MTM since patients intubated in OR O Published 1960 JAMA
  18. 18. Defibrillation O 1775 Abildgald electricity in birds could stun and then revive but didn’t know heart involved O 1889 Prevost & Batelli shock induce VF in dogs then 2nd “countershock” could reverse it
  19. 19. Defibrillation O 1947 Beck internal defib “hearts too good to die” O 1956 Zoll external defib O Initial units A-C line 110v; transformer boost>500v O 1962 Lown D-C safer & more effective battery to charge capacitor smaller and portable
  20. 20. Putting it together: CPR O 1960 Maryland Medical Society Meeting O “Two techniques complete approach to resuscitation” O 1962 film Pulse of Life: 1st use of ABC teaching O 1963 AHA endorses CPR (as it is now called) O 1966 1st CPR guidelines published
  21. 21. Development of the ICU O 1854 Florence Nightingale 1st “monitoring unit” near RN station for most seriously ill/injured soldiers O 1863 “small room leading to OR where pt remains until recovered from immediate effects of operation” O 1890 Tarnier in Paris: infant incubator & 1st NICU/PICU O 1923 Dandy JHH 1st modern ICU: neurosurgical care
  22. 22. Development of the ICU O 1953 Ibsen Copenhagen 1st ICU for Polio patients PPV by bagging using MS’s instead NPV O 1958 Safar Baltimore 1st ICU w/ 24hr MD coverage O 1960s: ICUs for s/p open-heart patients & s/p MI since needed to be near immobile defibrillator O R Adams Cowley Baltimore Shock-Trauma
  23. 23. Summary O Long history of attempting to reverse sudden death or near death events O Do not think we ever “know how to do it now” O We are getting better by studying resuscitation O It helps to know our past as we move forward
  24. 24. “Believe those who are seeking the truth; doubt those who find it." “Once in a while you will stumble upon the truth but most of us manage to pick ourselves up and hurry along as if nothing had happened.”
  25. 25. Questions & Comments Thank You for Your Attention