ResusNation #78

Medieval Fart Jars: A Stinky Solution to the Black Death

In the annals of medical history, we find numerous strange and often misguided attempts to combat deadly diseases. One such peculiar practice from the Middle Ages stands out not for its pain or brutality, but for its unusual... aroma.

The Deadly Vapors Theory

During the time of the Black Death, which ravaged Europe between 1348 and 1350, claiming 30-60% of the population, physicians believed that the disease was spread by "deadly vapors." These vapors, they thought, could be inhaled, leading to infection or worsening of the disease.

Enter the Fart Jar

In a bizarre twist of logic, some medieval doctors came up with an unusual prescription: fart jars. Yes, you read that correctly. Patients were instructed to:

Fart into a jar
Capture others' farts in jars
Seal the jars tightly
When plague threatened, open the jars and take deep breaths

The theory? These stored farts would somehow counteract the deadly vapors of the plague. While ineffective medically, this practice earned the charming name "therapeutic stink."

Other Aromatic Attempts

Fart jars weren't the only olfactory defense against the plague:

Physicians wore masks stuffed with garlic when visiting patients
The mask itself was somewhat effective (as a physical barrier)
The garlic, unsurprisingly, did little to prevent disease spread

A Whiff of Hope?

While these methods did nothing to cure or prevent the Black Death, they may have provided a psychological benefit. In a time of immense fear and uncertainty, even a jar of farts could offer a glimmer of hope to those facing a deadly pandemic.

So, the next time you catch a whiff of something unpleasant, remember: in another era, that might have been considered a life-saving medical treatment!

*Note: This article is based on historical accounts and should not be considered medical advice. Please consult modern medical professionals for current health concerns.

Welcome to the 78th edition of ResusNation!

The Modified Valsalva Technique For SVT

Last week, I duetted a video of a patient in SVT. The doctors in this video demonstrated how a modified valsalva technique could help a patient. This maneuver was studied in the REVERT trial and demonstrated that a modified Valsalva maneuver significantly improves the treatment of supraventricular tachycardia (SVT):

Technique: Standard Valsalva maneuver followed by laying the patient flat and raising their legs
Outcome: Higher success rate in converting SVT to normal rhythm compared to the standard method
Implications: Safe, effective, and low-cost first-line treatment for stable SVT patients
Benefit: Potential reduction in the need for drug interventions like adenosine

Watch the full video here and leave a comment.

Don't forget to like and follow my IG, TikTok, YT, Facebook or Linkedin accounts.

VL Tips and Tricks

In this episode, Dr. Richard Byrne breaks down his best tips and tricks for achieving first-pass success with video laryngoscopy, focusing on the hyperangulated blade technique. Recorded at the ResusX: ReLoaded conference, Dr. Byrne covers the "look-look" method, how to maintain the glottis in the top third of the screen, and the importance of leveraging the blade correctly. His practical insights and easy-to-follow advice make this episode a must-listen for anyone looking to enhance their intubation skills in emergency and critical care settings.

Check out this video now and watch the entire ResusX: ReLoaded conference for more content from Rich and our other all-star faculty!

Watch the Video Now!

Vasoactives 101: Methylene Blue

Steve Schauer, DO, MS (@armyemdoc) had a post on X that reviewed methylene blue in septic shock. Methylene blue (MB), a compound known for its ability to counteract excessive vasodilation. Steve highlighted a recent meta-analysis, examining 11 randomized controlled trials with a total of 556 patients, has shed new light on the potential benefits of MB in these critical care settings. The findings are intriguing and potentially game-changing for patient care.

The most striking result was a significant reduction in mortality among patients treated with MB. In fact, the death rate in the MB group was 15%, compared to 25% in the control group - a substantial difference that could translate to many lives saved. This benefit was particularly pronounced in patients with septic shock and those undergoing cardiac surgery.

But the good news doesn't stop there. The analysis revealed that MB also improved several key physiological parameters. It increased mean arterial pressure and systemic vascular resistance, which are crucial for maintaining organ perfusion in critically ill patients. Importantly, these improvements came without any negative impact on cardiac output, addressing a common concern with vasopressor therapies.

Moreover, patients treated with MB spent less time in both the intensive care unit and the hospital overall, suggesting faster recovery times. There was even a trend towards reduced need for blood transfusions, though this didn't quite reach statistical significance.

Safety-wise, MB appeared to be well-tolerated. While some patients experienced minor side effects like urine discoloration or temporary changes in pulse oximetry readings, no severe adverse events were reported.

However, the researchers are quick to point out the limitations of their analysis. The number of available studies was relatively small, and most were single-center trials with limited patient numbers. The clinical settings varied, which could introduce some heterogeneity into the results.

Despite these caveats, the findings are promising enough to warrant further investigation. The authors suggest that MB could potentially become a valuable addition to the arsenal of treatments for critically ill patients, particularly as part of a multimodal approach to managing conditions like septic shock.

Looking ahead, the research team emphasizes the need for larger, multi-center randomized controlled trials to confirm these findings. If validated, the use of methylene blue could represent a significant step forward in improving outcomes for some of the most vulnerable patients in our healthcare systems.

Another Bonus For ResusX Attendees!!!

If you registered for the ResusX:ReUnion conference you already know about all the great bonuses that we are including with your registration. We're giving you:

Free registration to the ResusEM7: NeuroCritical Care Symposium on September 18
Swag bag stuffed with a mug, pens, stickers, and more surprises
A ResusX t-shirt
Access to all the recorded conference content plus the exclusive virtual lectures not seen by the live audience (Deluxe registration only)
Watch ResusX:ROSC video conference (Deluxe registration only)
Watch ResusX:Golden Hour (Deluxe registration only)
Watch ResusX:Reset conference (Deluxe registration only)
Get 6 months of the ResusNation membership for FREE (Deluxe registration only)
Free 3D printed cric trainer (Airway workshop attendees)

But as if these bonuses weren't enough we have one more gift to give you...everyone who attends live will receive a free copy of the Vasopressor and Inotrope Handbook by Eddy Gutierrez!!! You read that correctly...a free copy of this textbook when you attend ResusX live. We're also gifting this book to anyone who registers for the Virtual conference with the DeluXe upgrade (international shipping fees may apply).

If you manage critically ill patients and you are serious about helping patients survive to hospital discharge then do not miss ResusX. You will watch the Rockstars of Resuscitation live on stage, sharpen your procedural skills with hands on workshop, practice ultrasound on live models, listen to pannels, attend one of our four preconference workshops, and socialize with faculty and fellow attendees after the show.

Don't miss this opportunity to learn, practice, and network with leaders in resuscitation. Register now for ResusX and take your skills to the next level!

Click the button below to secure your spot today. We also have discounts available for residents, fellows, nurses, paramedics and more.

Get Your Ticket NOW!

Could CAPE COD Change Management?

The CAPE COD trial, a large multicenter randomized controlled study, provides compelling evidence for the use of hydrocortisone in severe community-acquired pneumonia (CAP) patients admitted to the ICU. With 800 participants across 31 French ICUs, the study demonstrated a significant reduction in 28-day mortality (6.2% vs 11.9%, p = 0.006) for patients receiving hydrocortisone compared to placebo. This translates to a Number Needed to Treat of 18, indicating a clinically meaningful impact. The trial's results align with recent meta-analyses and have influenced the 2024 Society of Critical Care Medicine guidelines, which now strongly recommend corticosteroid use in severe CAP.

However, the study's limitations warrant consideration. These include a fragility index of 6, early trial termination, stringent inclusion criteria leading to exclusion of 86% of initially screened patients, and potential selection bias. Despite these caveats, the CAPE COD trial represents a significant advancement in CAP management. Clinicians should weigh these findings alongside patient-specific factors when considering corticosteroid use in severe CAP. Future research could focus on optimizing dosing regimens, investigating long-term effects, and improving generalizability across diverse patient populations.

Key takaways from the CAPE COD trial and its implications for severe community-acquired pneumonia (CAP) management:

1. Significant Mortality Reduction: Early hydrocortisone treatment in severe CAP patients admitted to the ICU resulted in a 47% relative risk reduction in 28-day mortality (6.2% vs 11.9%, p = 0.006), with a Number Needed to Treat of 18.

2. Guideline Changes: The trial's results have influenced clinical practice, with the 2024 Society of Critical Care Medicine guidelines now strongly recommending corticosteroid use (5-7 day course of <400 mg IV hydrocortisone or equivalent daily) in hospitalized patients with severe CAP.

3. Limitations to Consider: Despite positive outcomes, the study has important limitations including a fragility index of 6, early termination, and stringent inclusion criteria that may affect generalizability.

4. Corroborating Evidence: The CAPE COD trial aligns with recent meta-analyses supporting corticosteroid use in severe CAP, strengthening the overall evidence base for this treatment approach.

For a more detailed analysis and discussion of the study's implications for medical education, check out the full blog post here

Those Amazing Bronchoscopes

Ready to elevate your airway management game? In this episode, recorded live at the ResusX: ReLoaded conference, Dr. Jim DuCanto dives into the art of using bronchoscopes for fiberoptic intubation. He walks you through every step, from applying local anesthetic to navigating the airway with precision. Whether you're a seasoned pro or just starting out, Dr. DuCanto’s expert guidance will help you achieve smoother intubations and ensure patient safety. Tune in to discover essential tips and tricks that will enhance your practice and boost your confidence in critical situations!

Check out this video now and watch the entire ResusX: ReLoaded conference for more content from Jim and our other all-star faculty!