Thoracic injuries in Indian Kashmir during earthquake, 2005

Earthquakes cause horrendous devastation with lots of deaths. This study was conducted to determine the patterns of thoracic injuries in the 2005 earthquake victims of Indian Kashmir referred to the CVTS Dept. of Sher-i-Kashmir Institute of Medical Sciences [SKIMS], Soura, India. Of the 468 patients received by SKIMS, 87 patients had either isolated chest injuries or multiple organ trauma. Chest injuries were identified and categorized for appropriate management to be instituted. The patients were followed up for next four years for functional outcome. There were 51 females and 36 males. Their mean age was 35 years. 83.91% had isolated chest injuries while 16.09% had associated injuries. For patients with isolated chest trauma, the Mean Injury Severity Score [MISS] was 8.79 and for multiple organ trauma it was 36.42. 27.59% were treated conservatively, and 41.38% had only chest tube. 31.03% were operated; 37 surgeries were done. 87.36% of the patients showed excellent recovery in functional outcomes. Females have shown more long term PTSD than males. Massive calamities like earthquakes cause multiple types of injuries in the affected population. Categorization of the victims in different groups so as to provide specialized and multi-specialty integrated care is imperative. In accordance with earlier studies, we found that high MISS is associated with high mortality

Missile diaphragmatic injuries: Kashmir experience

Importance of repairing a diaphragmatic tear due to a missile injury cannot be overemphasized.Even a small diaphragmatic rent should be repaired because of morbidity and mortality caused by subsequent herniation and strangulation. Fifty-three cases with diaphragmatic injuries caused by penetrating missiles were studied from January 1997 to January 2007. All the patients were primarily explored either for thoracic or abdominal penetrating trauma; the diaphragmatic injury was an associated incidental intraoperative finding. Thoracotomy was performed in 18 patients, Laprotomy in 33 patients and in two patients combined thorocoabdominal approach was utilised for managing associated visceral injuries. Overall mortality was 37.7%. Mortality was dependent on associated injuries of thoracic and abdominal viscera. Most patients died due to associated injuries and septicaemia. None of the patients had any sequelae of diaphragmatic repair. Immediate repair of diaphragmatic injury is of paramount importance to prevent subsequent complications of herniation and strangulation