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Famous Assassinations in History and Would They Survive Today? Joseph S

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Famous Assassinations in History and Would They Survive Today? Joseph S. Blansfield, MS, NP, TCRN Trauma & Acute Care Surgery Program Manager Boston Medical Center Learning Objectives • Review the historical aspects of several famous assassinations that have occurred in history. • Apply the standard of care at that time to the treatment these individuals received. • Compare the current state of the art in trauma care to these same cases and determine outcome Disclosure Statement • I have no financial disclosures • However, I’m available Successful Completion • To successfully complete this course, participants must attend the entire event and complete/submit the evaluation at the end of the session. • Society of Trauma Nurses is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Assassination: to kill suddenly or secretively, especially a politically prominent person; murder premeditatedly and treacherously Steeped in political / cultural context Alter history Wrought with conspiracy Historical data presented is a representative of the mainstream opinion / account of events Fame by military conquest Contemporary of Pompey and Cassus Known for his elegant speeches –and his arrogance Dictator of the Roman Republic Was declared dictator perpetuo by the Senate Caesar crosses the Rubicon 49 B.C. Wins Civil War in Rome Consolidates power in Greece and Egypt Becomes Dictator Perpetuo Plot to Kill At the Senate meeting Only senators admitted Daggers hid beneath togas Beware the Ides of March Calpurnia had visions in her dreams Medical doctors advised against Senate meeting Marc Antony slipped a warning note into Caesar’s hand Brutus, “The Senate is waiting.” Gaius Cassius Longinus Marcus Junius Brutus Servius Sulpicius Galba Quintus Ligarius At least 44 Roman senators the Liberatores Lucius Minucius Basilus Gaius Servilius Casca Gaius Cassius Longinus Publius Servilius Casca Longus Marcus Junius Brutus Decimus Junius Brutus Albinus Lucius Tillius Cimber Gaius Trebonius Lucius Cassius Longinus Caius Cassius Parmensis Caecilius Bucolianus Rubrius Ruga Marcus Spurius Publius Sextius Naso Lucius Pontius Aquila Petronius Decimus Turullius Pacuvius Antistius Labeo • Near the Theatre of Pompey • Senators surround Caesar •1st strike by Casca to Caesar’s neck defensive block by Caesar • Senators stab Caesar • “Et tu Brute?” • Caesar attempted a get-away, but was blinded by blood • Lay defenseless on the steps Non‐conspirator senators flee Conspirators rejoice in the city with no audience Grandnephew Gaius Octavius named sole heir Brutus and Cassius warred against Octavius and Antony Defeated at Phillipi Antony marries Cleopatra and wars again Octavias Octavius triumphs and becomes the first Roman Emperor, Caesar Augustus End of the Roman Republic 1st recorded autopsy by Physician Antistius 23 stab wounds 1st blow to the neck, 2nd blow to the chest Only one determined to be “fatal” Cause of death likely hemorrhagic shock Hemopneumothorax? Great Vessel Injury? Hemorrhagic Shock: • 1/3 of in‐hospital trauma deaths Massive Transfusion (>10u in 24 h) Mortality 30‐50% Must try to avoid the lethal triad Component Transfusion Therapy Improve Resource Utilization Reduce infectious disease transmission Waters JH. Role of the massive transfusion protocol in the management of haemorrhagic shock. British Journal of Anaesthesia. 2014; 113(2):ii3-ii8. Higher plasma : RBC ratio independently improves survival Primarily decreases EARLY death Borgman MA, Spinella PC, Perkins JG, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. Journal of Trauma. Oct 2007; 63(4):805-813 • 1:1:1 decreased Hemorrhagic Death • Give Plasma and Platelets First • Redefine MTP from 10 units in 24 hours to 3 units in 1 hour LIVED DIED Post‐Civil War Reconstruction Era Republican Party split between Grant and Blaine Won the presidential election as a Dark Horse Candidate (10,000 votes) Peacetime in the U.S. Presidential security had become lax Shot four months into presidential term Failure; Insane; Committed by family but escaped Claimed his (undelivered) speech won the election Loitered at the White House requesting diplomatic job Banned by the Secretary of State Bought a revolver and spent a month of target practice and stalking Garfield Believed the assassination would re‐unite the Republican Party “In the President’s madness he has wrecked the grand old Republican party, and for this he dies.” ‐ Charles Guiteau • Garfield arrived at the Baltimore and Potomac Railroad Station • Was on his way to alma mater, Williams College to deliver a speech • Was the start of his summer vacation • Accompanied by 2 sons, Secretary of State, and Secretary of War • Garfield entered the waiting room of the station Guiteau fired 2 shots from behind • A united country mourns Garfield’s death • Larger than Lincoln… liked by both North and South • Vice President Chester A. Arthur succeeded as President • Approved the Pendleton Civil Service Act • Guiteau was tried, found guilty, and hanged • Argued that the doctors, not his bullet killed Garfield • First use of Insanity defense in criminal court Shot twice in back close range 1st grazed shoulder 2nd to back, just right of L1 Brought upstairs in the train station T 99.4 HR 108 RR 19 Abdomen peritoneal Taken to the White House Daily medical bulletins Physicians probed the wound to extract the bullet With unsterilized metal instruments or bare hands A.G. Bell devised a metal detector Internal bleeding ensued Thought to be due to probing the liver Local operations to remove the bullet Placed drains Persistent fevers, unable to tolerate oral intake Weight loss: >200 lbs to 135 Given nutrient enemas Brought to Jersey Shore in hope cooler climate would aid recovery Pneumonia Bacteremia Abdominal abscesses Died September 19th, 1881 Bilateral pneumonia Multiple abdominal abscesses Bullet transversed L1 Lodged in retroperitoneal fat just behind pancreas Ruptured splenic artery pseudoaneurysm Trimodal distribution of Prehospital Care Immediate Deaths trauma deaths: Late deaths: Early Resuscitation Multi‐organ system Early Deaths failure Critical Care Late Deaths Sepsis Trunkey DD. Trauma. Accidental and intentional injuries account for more years of life lost in the U.S. than cancer and heart disease. Among the prescribed remedies are improved preventative efforts, speedier surgery and further research. Scientific American. Aug 1983; 249(2):28-35. Moving to a bimodal distribution? Gunst M, Ghaemmaghami V, Gruszecki A, Urban J, Frankel H, Shafi S. Changing epidemiology of trauma deaths leads to a bimodal distribution. Baylor University Medical Center Proceedings. Oct 2010; 23(4): 349-354. Hospitals were “Houses of Death” Surgical mortality around 50% White coats were “badges of honor” and never washed between cases Sterile technique introduced by Joseph Lister in the mid‐1860s Hand‐washing before procedures and cleaning of instruments Not widely accepted in the U.S. at that time William Halsted creates surgical gloves in 1890 Initially to impress the chief nurse, who later became his wife First surgeon in chief at Johns Hopkins Hospital Which antibiotics? Duration of antibiotics EAST Guidelines for penetrating abdominal wounds Single pre‐operative prophylactic antibiotic dose Should not be continued for >24h in presence of hollow viscus injury Absence of hollow viscus injury requires no further antibiotics 1. Goldberg SR, Anand RJ, Como JJ, et al. Penetrating abdominal trauma, prophylactic use in. Journal of Trauma. Nov 2012; 73(5):S321-S325. 2. Kirton OC, Oneill PA, Kestner M, Tortella BJ. Perioperative antibiotic use in high-risk penetrating hollow viscus injury: a prospective randomized, double-blind, placebo-control trial of 24 hours versus 5 days. Journal of Trauma. Nov 2000; 49(5):822-832. Trauma / Burn patients require higher nutritional support Hypermetabolic state 1.5x caloric need Enteral feeding is better than parenteral feeding Nutritional protein markers restored better with enteral feeding Decreased infectious complications Specialized feeding Immune‐enhancing formulas: Arginine, Glutamine, Omega‐3 Oxepa: showed improved outcomes in critically‐ill patients with ARDS Moore FA, Moore EE, Jones TN, McCroskey BL, Peterson VM. TEN versus TPN following major abdominal trauma – reduced septic morbidity. Journal of Trauma. Jul 1989; 29(7):916-922. LIVED DIED Archduke of Austria Heir to the throne Appointed Inspector General of the Armed Forces of Austria‐Hungary Married Sophie (Duchess of Hohenberg) Franz had been forbidden to be seen in public with Sophie because she was a lower class royalty Traveled to Sarajevo in Bosnia Army Inspection 19 year‐old Part of a group of 6 assassins Motives consistent with the movement that later became known as Young Bosnia Weapons supplied by the Black Hand, a Serbian terrorist organization • Archduke Franz Ferdinand and Sophie arrive in Sarajevo at 9:28am • First conspirator throws a car bomb and misses at 10:10am • Visit shortened, alternate route taken home • Driver has to make a U-turn stopped in front of Princip • 2 shots fired • Killed both Franz Ferdinand and his wife Sophie Austria‐Hungary ultimatum to Serbia Rejected by Serbia Austria‐Hungary declares war July 28, 1914 Leads to the First World War 9 million soldiers
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