Lost report of Lincoln assassination physician found after 147 years

saw this yesterday on the news...really cool...first PCR for prehospital death?
 
Fascinating. Thanks for posting this.
 
First person who tells me what was going on at 650 am (not what was written but the name for what was being described) gets a sticker.
 
bigbaldguy said:
First person who tells me what was going on at 650 am (not what was written but the name for what was being described) gets a sticker.
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i'll bite.

6.50 A.M. The respirations cease for some time and all eagerly look at their watches until the profound silence is disturbed by a prolonged inspiration, which was soon followed by a sonorous expiration.
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its kussmaul's. at 2400 they note his respiratory rate shoots up to 24. then at 0640 they get more dragged out and labored.
 
Agonal respirations? Random guess
 
azerkail said:
i'll bite.



its kussmaul's. at 2400 they note his respiratory rate shoots up to 24. then at 0640 they get more dragged out and labored.
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Kussmauls is Rapid deep breaths. That is indicative of DKA.

I wouldn't call a resp. rate of 24 and irregular Kussmauls.

More agonal respirations.

That report was very cool though. Very detailed, and you could see where things were going.

I am wondering if he was exhibiting the signs of the Cushings Triad. Without a BP kinda hard to tell. But definitely increased ICP.
 
Dang I was going to post Cheyene Stokes, too late! More opportunities for stickers please! :)
 
Agonal respirations was also a good thought but I think Cheyene Stokes sounds more likely. I've seen it a few times with head injuries and in strokes. If you've ever seen it it's very distinctive.

Agonal respirations generally are only the last few breaths before death. Maybe 60 seconds or so. According to the report Lincoln lived for 30 minutes after this pattern of breathing began.

Biot's breathing is generally lots of short equal breaths followed by apnea then repeating. Also a good answer but from the description it doesn't sound like The president was taking equal breaths during this period but more very short inspirations with long exhalations. This matches up with what I've seen in the field with Cheyen-Stokes.

Kussmaul's Breathing is just very very fast Rapid breathing with I believe lots of gasping. I've never seen this in the field but again it doesn't match the report.

This concludes emtlifes very first semi educational sticker contest :) I'd be interested to hear how this type of injury would have been treated by modern medics. Any ideas?
 
bigbaldguy said:
Agonal respirations was also a good thought but I think Cheyene Stokes sounds more likely. I've seen it a few times with head injuries and in strokes. If you've ever seen it it's very distinctive.

Agonal respirations generally are only the last few breaths before death. Maybe 60 seconds or so. According to the report Lincoln lived for 30 minutes after this pattern of breathing began.

Biot's breathing is generally lots of short equal breaths followed by apnea then repeating. Also a good answer but from the description it doesn't sound like The president was taking equal breaths during this period but more very short inspirations with long exhalations. This matches up with what I've seen in the field with Cheyen-Stokes.

Kussmaul's Breathing is just very very fast Rapid breathing with I believe lots of gasping. I've never seen this in the field but again it doesn't match the report.

This concludes emtlifes very first semi educational sticker contest :) I'd be interested to hear how this type of injury would have been treated by modern medics. Any ideas?
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Backboard, collar, airway management, transport.

Trauma can be messy and boring.
 
RSI. Rapid transport to trauma center. Measurement for a pine box immediately following.
 
You mean we wouldn't go digging around in the guys head with a long metal probe to see if we could find the bullet?

So did anyone else think that maybe the "young" doctor was probably gritting his teeth while the more experienced doctors were digging around in the presidents head with what was basically an ice pick?

Interesting that he mentions that keeping the wound open seemed to help relieve the pressure in the skull. Could this be something to be concerned about when transporting an injury like this? My first instinct would be to cover the wound with gauze and bandage it but it sounds like that might be a bad idea. It would cause faster clotting and possible increase the icp more rapidly.

Here is a link to the type of probe used on lincoln. Sounds like they had it about 5 inches into his skull.

http://news.webshots.com/photo/1002969709000142258HNDRmlZVtB
 
bigbaldguy said:
You mean we wouldn't go digging around in the guys head with a long metal probe to see if we could find the bullet?

So did anyone else think that maybe the "young" doctor was probably gritting his teeth while the more experienced doctors were digging around in the presidents head with what was basically an ice pick?

Interesting that he mentions that keeping the wound open seemed to help relieve the pressure in the skull. Could this be something to be concerned about when transporting an injury like this? My first instinct would be to cover the wound with gauze and bandage it but it sounds like that might be a bad idea. It would cause faster clotting and possible increase the icp more rapidly.

Here is a link to the type of probe used on lincoln. Sounds like they had it about 5 inches into his skull.

http://news.webshots.com/photo/1002969709000142258HNDRmlZVtB
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I think you have to keep in mind what they were working with.

Today we know it is better to leave the projectile in unless it interferes with ongoing function.

But we have things like antibiotics.

During that time, projectiles, particularly passing through hair or clothing, were basically infectious foci.

If you didn't want to die of "fever" aka sepsis, you really had to get those things out and clean the wound tracts.
 
Veneficus said:
I think you have to keep in mind what they were working with.

Today we know it is better to leave the projectile in unless it interferes with ongoing function.

But we have things like antibiotics.

During that time, projectiles, particularly passing through hair or clothing, were basically infectious foci.

If you didn't want to die of "fever" aka sepsis, you really had to get those things out and clean the wound tracts.
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Any thoughts on leaving the wound open to drain in a pre hospital setting Vene? In an extended transport situation say 1 hour would it make a difference in ICP?
 
bigbaldguy said:
Any thoughts on leaving the wound open to drain in a pre hospital setting Vene? In an extended transport situation say 1 hour would it make a difference in ICP?
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I don't think it would matter unless you were using a very well sealed occlusive dressing.
 
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