Nurse! Fetch the Nikethamide and the Lobeline!

I’ve just had a most enjoyable day wasting a lot of time while watching some pretty amazing videos on youtube.  I’m a big fan of medical history, particularly the history of resuscitation and intensive care.  The Wellcome trust from UK have a cornucopia of videos available and in addition to being a fascinating look at our past, some of them are just downright hilarious.

My favourite thus far is “Respiratory and Cardiac Arrest” from 1945.  It’s aimed at junior doctors delivering general anaesthesia. Some interesting techniques include;

– Mouth to mouth in theatre

–  If trismus is present, wait until the the patient is just about dead, then force a Guedel airway in and start ventilating.

– Internal massage (from the upper abdomen) and intracardiac adrenaline routinely

And of course there are some brilliant quotes, Like;

“If an endotracheal tube is immediately available, intubate the trachea.  But don’t waste time looking for one.”

– (After ROSC) “Accompany the patient back to the ward yourself, with supplemental oxygen if it’s practicable.”

There were a couple of drugs mentioned that I hadn’t heard of:

– Nikethamide: Respiratory stimulant

– Lobeline: Sympathomimetic (increased dopamine release, decreased reuptake of dopamine and serotonin

We really have come a long way in a short time.

Among the other videos that I’ve stumbled upon there is one of what looks like one of my all time favourite moments in medical history – the MacIntosh/Pask Mae-West lifejacket tests.

To cut a long story short, during the war (I know we shouldn’t mention it), lots of airmen were dying after bailing out of their aircraft because once inflated, their life jackets would float them face down.  So the RAF turned to 2 men who, like Sir Kieth Park and Alan Turing, were great unsung (and unheard of) heroes of WWII: Grp Cpt Sir Robert MacIntosh (of Timaru, no less) and Wng Cdr Edgar Pask.  Two anaesthetists from Oxford with an interest in aviation, and war-winning.  MacIntosh of course, was the first professor of anaesthesia in the UK and is immortalized in the name of the most popular laryngoscope blade, which he developed.

MacIntosh and Pask rose the task of lifejacket development the only way that made sense – by anaesthetising Pask and throwing him in the pool while different designs were tested until one was found the would allow him to float face up.  This excellent article from the Royal Army Medical Corps Journal sums it all up nicel, as does Maltby’s excellent little book “Notable Names in Anaesthesia.” Pask got a PhD for this, which he famously joked that he was asleep for most of.  It’s unassuming, humble characters like this that make medicine such a great profession, not the Dr. Oz’s and the like of today.  I hope I can be a little like MacItosh or Pask one day.  However I don’t like the idea of being dunked in the pool while anaesthetised.  It would probably be better than HUET though….

Trauma Resuscitation in the ’80s!

Here’s a nostalgia evoking clip showing the old resus room in Auckland Public (now Auckland City) Hospital (hands up who remembers them!)  Note the absence of gloves, the presence of MAST trousers and the extremely liberal use of various fluids.  A highlight must the the RN opening a bag of blood with her teeth.  Note also the very young Stephen Streat (Now A/Prof in the Auckland Dept. of Critical Care Medicine) and Ian Civil (recent past President of the Royal Australasian College of Surgeons). Fabulous.  I think it’s great looking at the way things were, it helps us to better understand where we are now and where we are going.