# Funtabulously Frivolous Friday Five 216

Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF, introducing the Funtabulously Frivolous Friday Five 216

#### Question 1

Where was this photo taken and what is the significance of this “Trauma Room 1”?

Parkland Hospital.

Now a radiology department but this was previously Trauma Room 1 where John F. Kennedy was taken on November 22, 1963 after he was shot.

Texas Governor John Connally was also wounded on that day and he was treated in Trauma Room 2.

2 days later Lee Harvey Oswald went through the trauma bays and was operated on for over 90 minutes but died in Operating Room 5.

Jack Ruby who shot Oswald in the abdomen also died in Parkland on January 3rd, 1967 of a pulmonary embolism associated with his lung cancer. [Reference]

#### Question 2

Parkland hospital not only has a deep history in the JFK assassination but also a burn’s formula. Who invented the Parkland formula and what was the original calculation?

Dr Charles Rufus Baxter (1929-2005). Dr Baxter was also one of the doctors involved in trying to save JFK.

A clinical series of 277 patients averaged 3.5ml/kg/%TBSA which formed the basis of Baxter’s experiment on dogs with a radio-isotope to monitor fluid leak.

From his original paper the experiments concluded 3.7-4.3ml/kg/%TBSA burn over 24 to 30 hours would be sufficient to maintain cardiac output. However, it was noted that the lactic acidosis and cardiac output took 24 hours to return to normal with the nadir in cardiac output dropping at 4 hours.

As an example of fluid creep the formula was simplified to 4ml/kg/%TBSA over 24 hours and the first half within 8 hours based on a series of 12 dogs which were noted to have the best cardiac output with this regimen.

In 1979, Baxter reported results of his formula in the resuscitation of 954 patients. He found that 70% of adults and 98% of children were resuscitated successfully with 24 hour volumes ranging from 3.7 – 4.3 ml/kg/%TBSA. Only 12% required more and 18% required less. [Reference]

Listen to Lewis Macken at SMACC talk about burns.

#### Question 3

Who invented aspirin?

Charles Frédéric Gerhardt (1816-1856), a french chemist.

Medicines made from willow leaves and other salicylate – rich plants appear in clay tablets from ancient Sumer as well as the Ebers Papyrus from ancient Egypt. Hippocrates also referred to the use of salicylic tea to reduce fevers around 400 BC.

In 1853, Charles Frédéric Gerhardt treated acetyl chloride with sodium salicylate to produce acetylsalicylate acid for the first time. In 1897 Bayer began synthesising acetylsalicylate and called their new drug, Aspirin.

Charles Frédéric Gerhardt died aged 39 by poisoning from his own experiments.

#### Question 4

The concurrence of hiatal hernia, diverticulosis, and cholelithiasis.

Saint’s triad is named after the British Surgeon, Charles Frederick Morris Saint (1886 – 1973), who established the first school of surgery in South Africa.

He emphasized the importance of considering the possibility of multiple separate diseases in a patient whenever his or her history and the results of the physical examination were atypical of any single condition. His triad provides a counterexample to the commonly used diagnostic principle that:

the explanation of any phenomenon should make as few assumptions as possible

Occam’s Razor

#### Question 5

Who said…

The art of medicine consists in amusing the patient while nature cures the disease

Voltaire

…and finally

## FFFF

Funtabulously Frivolous Friday Five

##### Neil Long

Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Kelowna hospital, British Columbia. Loves the misery of alpine climbing and working in austere environments (namely tertiary trauma centres). Supporter of FOAMed, lifelong education and trying to find that elusive peak performance.

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