One thing that should be evident to all of us is the swing of the pendulum of medical care. Medical management that is first thought to be state of the art eventually falls out of favor, replaced by a more promising therapy. Look at drowning victims. In the late 1700s, rectal insufflation of tobacco smoke, administered with the aid of a bellows and rectal tube, was used in attempts to reanimate those who had drowned. My assumption is that this technique did not work. As the pathophysiology of drowning became better understood, the pendulum swung to the point where we now perform rescue breathing (with intubation and CPR, if necessary). Another example is resuscitation of the bleeding patient. In my lifetime, we have gone from using whole blood transfusion to resuscitate trauma victims, to crystalloid administration (with com-ponent blood therapy, as needed) and back to whole blood.

What we now...

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