Dring Blood, Cure Seizures?
In ancient Rome, the spectacle of gladiatorial combat extended beyond mere entertainment to the realm of medicine, where the blood and organs of fallen warriors served as macabre remedies. Roman physicians, lacking scientific understanding of epilepsy, earnestly prescribed the warm blood from a gladiator's slit throat as a powerful elixir for those suffering from seizures. Even the renowned scholar Pliny the Elder documented this practice, noting how epileptics consumed gladiators' blood "as though it were the draught of life."
The harvesting of these gruesome "medicines" created disturbing scenes at the arena, where spectators would sometimes rush forward to collect pieces of liver from fallen gladiators still lying in the dust. These bizarre treatments weren't random but followed a certain logic in Roman thinking – gladiators represented peak physical specimens whose strength and vitality might transfer to the afflicted through consumption. The belief that these powerful warriors "died healthily" made their bodily fluids and organs particularly valuable in the eyes of ancient Roman medicine practitioners.
Welcome to the 106th edition of ResusNation!
The Respiratory Therapy
That Many Doctors Overlook
I've been advocating for high flow nasal cannula in patients with respiratory distress for years, and now we have compelling evidence to back it up. A recent meta-analysis examining over 2,000 patients demonstrated that high flow significantly reduces the need for mechanical ventilation compared to traditional oxygen therapy. The numbers speak for themselves—patients on high flow were 15% less likely to require intubation, preventing 44 intubations for every 1,000 patients treated.
While we didn't see a clear mortality benefit in this analysis, the safety profile is excellent. As clinicians, we know that avoiding mechanical ventilation whenever possible is a win for our patients, reducing complications and hospital stays. This heated and humidified oxygen delivery system provides an important tool in our arsenal for managing acute respiratory failure, potentially changing our standard approach to these challenging cases. Have you incorporated high flow nasal cannula into your practice yet?
Watch the full video here and leave a comment.
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Watch 75 of Our Best Resus Videos!
Have you managed a crash airway, had to resuscitate with refractroy ventricular tachaycardia, or lead your team during a resuscitation? If you answered yes, then ask yourself, "are you treating your patients with the most cutting-edge and evidence based medicine?" Today you can sign up for ResusX:Select Volume 1,2, and 3. In all, you will get lifetime access to 75 of our very best resuscitation videos so you can take your skills to the next level!
Each of these videos is hand picked by our editorial team because they demonstrate mastery in resuscitation. Each of these videos is engaging, entertaining, and jam packed with information. At the completion of the program, you will be able to claim 12.0 AMA PRA Category 1 Credits or CEU contact hours.
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Is Saline Increasing Mortality in Sepsis Patients?
For decades, emergency physicians and intensivists have reached for normal saline (0.9% sodium chloride) as the default fluid for resuscitating patients with sepsis-induced hypotension. However, a compelling secondary analysis of the CLOVERS trial published in Critical Care Medicine challenges this practice. Researchers found that patients receiving lactated Ringer's solution for their initial 1-3L fluid resuscitation had significantly lower 90-day mortality (12.2% vs 15.9%) compared to those receiving normal saline. This represents a 29% relative reduction in the risk of death and aligns with recent Surviving Sepsis Campaign guidelines that have begun to favor balanced crystalloids.
The study examined over 1,300 patients with sepsis-induced hypotension across 60 U.S. medical centers. Beyond improved survival, patients receiving lactated Ringer's solution spent more days outside the hospital within the first 28 days (gaining an additional 1.6 hospital-free days on average). While the exact mechanism isn't fully established, patients receiving normal saline developed higher chloride levels and lower bicarbonate levels, suggesting that hyperchloremic metabolic acidosis may play a role in worse outcomes. This evidence supports a simple but potentially life-saving change in practice: reaching for lactated Ringer's solution instead of normal saline when septic patients need fluid resuscitation.
Here's my Takeaways:
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Initial resuscitation with lactated Ringer's reduced mortality by nearly 30% compared to normal saline (adjusted hazard ratio 0.71; 95% CI, 0.51-0.99)
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Emergency departments and ICUs should prioritize lactated Ringer's solution over normal saline for initial sepsis resuscitation
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Adult patients with sepsis-induced hypotension requiring 1-3L of initial fluid resuscitatio
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As a secondary analysis, findings require confirmation in a prospective trial specifically designed to compare these fluids
Want to learn more? Read the full study "Lactated Ringer’s or Normal Saline for Initial Fluid Resuscitation in Sepsis-Induced Hypotension" by Crit Care Med. 2025
Save the Date: ResusX25
Mark your calendars! We're thrilled to announce that ResusX 2025, the premier resuscitation conference of the year, is returning for its seventh spectacular year. Join us September 29 - October 1, 2025, as we take over Philadelphia's iconic Punchline Comedy Club for our most ambitious event yet.
The overwhelming interest we've received through emails and messages has shown just how exited the ResusNation is for this announcement. We're pulling out all the stops to bring you an unforgettable experience featuring the leading voices in resuscitation medicine - live and in person. Don't miss your chance to be part of this landmark event in the City of Brotherly Love. Stay tuned for more details about our world-class speakers, innovative sessions, and more.
We're finalizing an action-packed schedule, including specialized post-conference workshops. Full CME and CEU details will be available on our website shortly.
Given the intimate venue and unprecedented interest in ResusX 2025, we anticipate tickets will sell out rapidly. As a valued newsletter subscriber, we want to ensure you have priority access to registration. So here's how to secure your spot:
If you're committed to attending ResusX 2025, simply complete our priority access form below. You'll receive immediate notification when ticket sales open, giving you first opportunity to register. Based on the overwhelming response we've already received, we expect tickets to be claimed quickly during this priority registration period.
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