Article Text

  1. A. Macnab
  1. Vancouver, BC


Background Autopsy and mortality review, practiced for centuries, preceded the modern discipline of ‘evidence based medicine’ and remain a valuable, but often uninspiring educational medium.

Hypothesis M&M review of the demise of selected historical figures provides novel and fascinating opportunities for medical education. We describe here a case example, which at presentation will be demonstrated as the full teaching module, with electronic versions available to interested participants.

Case Description Admiral Horatio Nelson died 2.75 hours after a gunshot wound at the battle of Trafalgar in 1805. A contemporaneous account by his surgeon and officers present (Surgeon 1807) describe in detail how his wound occurred, his physical signs, evolution of his clinical course and findings at autopsy. (There is also discussion of how to preserve a body at sea!)

Learning Points The musket ball (1cm in diameter) caused a wound track from the acromion, through the upper left lung, dividing a branch of the pulmonary artery and fracturing the T 4 & 5 vertebrae, and carried uniform fragments with it. Nelson’s pattern of sensory and motor loss, enable learners to determine the level of spinal injury; the deterioration in his interactiveness, speech, and response to stimulation plus the changes recorded in his pulse and peripheral perfusion, generate enthusiastic discussion on the evolution of shock, the physiologic mechanisms whereby it progresses, and the relevance of the ‘Golden Hour’. Similarly, learners can determine what care entities he would have needed to potentially survive, identify how he would be managed with the care and technology available today and develop a prioritized plan for investigation and management. Discussion can be expanded to include multiple parallel issues, e.g. optimal transport, infection risk, who to consult, residual permanent disability, psychological impact, communication, and the value of comprehensive documentation.

Implications for Education/Practice This is an educational approach that can generate new excitement and interest into M&M education, and emphasizes key concepts involved in modern ER, trauma, and critical care.

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