➡️ Antimicrobial therapy has been used for millennia
➡️ Treating severe infections can be lifesaving
➡️ However, the widespread use of antimicrobials also has downsides

A 🧵

1/16 ➡️ Throughout history, honey, herbs & metals were often used
➡️ One of the earliest known antimicrobial therapies was the topical use of mouldy bread
➡️ This intervention has been recorded in many ancient civilisations, including Egypt, China, Serbia, Greece & Rome

2/16

➡️ Throughout history, the most mystical substance of all has been blood
➡️ It has been coveted and desired
➡️ Fought for and defended
➡️ Stolen, yet freely given

A 🧵

1/16 ➡️ Blood has always been a symbol of power
➡️ In Greek mythology, ichor, the blood of the Gods, was a golden fluid
➡️ It was immortal, pure, & untainted by human weaknesses
➡️ The Gods derived their divine powers & longevity from it

2/16

➡️ There are ~ 5.8 million trauma deaths per year globally
➡️ Trauma is the largest cause of death below the age of 50
➡️ One-third of severely injured trauma patients are coagulopathic at hospital arrival
➡️ Fibrinogen is often used, but is it effective?

a short 🧵

1/10 ➡️ Trauma-induced coagulopathy is due to inflammation & shock
➡️ It is worsened by hypothermia, acidosis, and hemodilution
➡️ Coagulopathy due to hemorrhage is strongly associated with mortality
➡️ 1/3 of early trauma deaths are due to uncontrolled haemorrhage

2/10

➡️ Death has always fascinated human civilisations
➡️ Not just the ending of a life, but either preparation for the afterlife or attempts to restore an existing life

A 🧵

1/28 ➡️ Ancient Egyptians preserved corpses via mummification for an afterlife
➡️ They removed internal organs, used embalming fluids, linen bandages, & intricate coffins
➡️ The wealthy had pyramids
➡️ Relatives, staff & pets were buried alive for the journey to the afterlife

2/28

🚩 Tranexamic Acid - it's complicated....

➡️It's widely used for treatment & prevention of haemorrhage
➡️It's in the WHO's List of Essential Medicines & recommended in the European Traumatic Haemorrhage guideline (2023)
➡️But is it as efficacious as we think?

🧵 1/17 🚩 History

➡️Drs. Utako & Shosuke Okamoto invented TXA in 1962
➡️They identified that the amino acid lysine inhibited the degradation of plasmin, a profibrinolytic enzyme
➡️Lysine was modified to first produce Epsilon- Amino-Caproic Acid and later TXA, x 27 more potent

2/17

The Annual Update in Intensive Care and Emergency Medicine 2023 articles have been released to coincide with the Brussels Meeting @ISICEM

10 great papers to enjoy

A thread.....

CCR Journal Watch
criticalcarereviews.com/latest-evidenc… @ISICEM 1/10

Pelaia. The Role of Transcriptomics in Redefining Critical Illness. Crit Care 2023;27:89

CCR Journal Watch
criticalcarereviews.com/latest-evidenc…

1/13

➡️ REBOA is an exciting "new" therapy for non-compressible torso haemorrhage
➡️ It's used across the world, but without robust evidence
➡️ Does it work? Is it beneficial?
➡️ A thread... 2/13

🚩 Uncontrollable haemorrhage accounts for
 ➡️ > 80% of combat deaths
  ➡️ ~ 40% of civilian trauma-related deaths
🚩 Many have been determined to be preventable deaths
🚩 ~ 67% of fatal bleeding occurs in the torso region

➡️There have been several excellent oxygen target trials in critical care over the past few years

➡️However, it's still unclear whether higher or lower targets should be aimed for

A thread....
1/16

@DogICUma @VR_Cornelius @BodilSRasmussen @JonathanCaseyMD @toddrice_ICU @DogICUma @VR_Cornelius @BodilSRasmussen @JonathanCaseyMD @toddrice_ICU The story of the discovery of oxygen is both fascinating & morbid

➡️Carl Wilhelm Scheele, a German-Swedish pharmaceutical chemist, first identified oxygen in 1771
➡️By heating mercuric oxide, silver carbonate, magnesium nitrate, & other salts, he produced “fire air”

2/16

➡️The history of resuscitation in cardiac arrest is long and fascinating
➡️Over time, four components have emerged to provide the central basis for saving an apnoeic, pulseless person just minutes from death

A thread.....

1/30 ➡️Perhaps the earliest reference to artificial breathing comes from the Egyptian Goddess Isis
➡️She resuscitated her dead husband (who was also her brother...) by breathing into his mouth

2/30

A widespread intervention in critical care over the past 20 years has been the use of induced hypothermia post cardiac arrest
➡️ A thread......
1/24 ➡️ Medically induced hypothermia goes back 5000 years
➡️ The oldest known trauma writings, the Edwin Smith Papyrus (1600 BCE), describes how the Egyptian physician Imhotep (2780 BCE) used localised cooling to treat noninfectious chest blisters
(10.3171/2017.10.JNS171282)
2/24

Oxygen is the most abundant chemical element by mass in the Earth’s biosphere and is one of the most used drugs in medicine.
But what are the thresholds for its use in critical care?

A thread...
1/16 Today, oxygen is central to most life on planet earth.
But it wasn't always this way.
As little as 700 million years ago, there was little oxygen on planet earth and most species were anaerobic.

2/16

One of the most outstanding questions in critical care is whether patients benefit from IV fluid resuscitation in septic shock.
A thread...
(image shutterstock)
1/16 In the 1800s, cholera was the scourge of Europe, killing over a million people through its toxin mediated diarrhoea and subsequent cardiovascular collapse
(image shutterstock)
2/16