ABSTRACT
Background: Trauma is a major public health issue and head injury is a frequent cause of morbidity and mortality worldwide. Head injury is the injury on head with alteration in the level of consciousness with or without vomiting. Alcohol is the major contributing factor causing majority of cases. Methods: This study analyzes the increasing occurrence of head injury in the developing rural area in India. Because of increasing trend of head injury, a total of 100 cases were studied from a period of March 2012 to July 2015. Results: Most of the cases were due to road traffic accident, assault and fall from height with maximum cases in young age group. In our study CT scan was decisive in 43% cases which were operated. The role of paramedical staff taking care at the site of accident and on the way up to hospital causing reduction in the death and disability. For the improvement of outcome there should be easily recognition and prevention of secondary insults and for this CT scan has a decisive and important role. Conclusions: By studying the common causes of head injury, identifying the preventable factors causing mortality and morbidity and explaining the important role of pre hospital management, we would like to conclude how we can prevent the morbidity and mortality and improving the overall outcome of head injury from road traffic accident by early treatment in the tertiary hospital.
ABSTRACT
El manejo correcto pre-hospitalario de la crisis asmática sería la medida más provechosa para reducir las muertes por asma. En él influyen el nivel de conocimientos y la aplicación de las guías por parte de los médicos a cargo. Con el objetivo de evaluar la aplicación de guías y su conocimiento, se distribuyó una encuesta anónima a médicos en las reuniones con tele conferencia satelital organizadas por un laboratorio en 2005. La encuesta permitía obtener un puntaje de 0 a 10 para calificar a los participantes. De las 8 regiones del país se obtuvieron 243 encuestas para analizar. El rango del año de graduación fue de 1965 a2005. Los encuestados refirieron atender en total 1523 pacientes en las últimas 4 semanas. El puntaje promedio de toda la muestra fue 7.13 ± 1.83. El promedio más alto fue alcanzado por los neumonólogos (9% del total de encuestados), con una diferencia significativa según el test de Tukey-Kramer de comparación múltiple, entre neumonólogos versus médicos generalistas (6%) y médicos sin especialidad (37%; p<0.05). El 82% manifestó tomar decisiones en base a guías. Aunque, llamativamente, el 50% no usaba medidor de flujo pico; el 45% no administraba anticolinérgicos inhalatorios; el 41% modificaba totalmente sus decisiones ante una crisis asmática en el primer trimestre del embarazo y un 29.5% no indicaba agonistas beta2 inhalados cuando la crisis presentaba un pulso mayorde 120/min. Un 14.9% usaba ansiolíticos sublinguales. La ciudad con mayor puntaje fue Bariloche. Se concluye que exceptuando a los neumonólogos, los resultados de esta encuesta muestran un puntaje no aceptable de calidad de atención pre-hospitalaria.
Asthma mortality could be reduced by improving acute asthma management inpre-hospital setting. Generally, it is difficult to carry out the recommendations of guidelines.In order to assess this issue and the physicians knowledge of acute asthma treatment, we designed a score between cero and ten points in a written survey to be distributed during a satellital conference in 8 regions of Argentina in 2005. We collected a total of 243 samples for analysis. Participants assisted a total of 1523 patients in the last 4 weeks. They had been graduated as MD, between 1965 and 2005. The designed score showed a mean 7.13± 1.83. Strikingly, 82% of the inquired participants answered that they follow the guidelines; while 50% did not use Peak Flow Meters. Furthermore, 45% did not administer inhaled anticholinergic bronchodilators. In case of acute asthma and pregnancy 41% absolutely modified their management. When the pulse was greater than 120/min, 29.5% of theparticipants did not indicate inhaled beta2 agonists and 14.9% used sublingua sedatives.Pulmonologists (9% of all participants) achieved a significant higher mean score in comparison with general practitioners. Bariloche city obtained the highest score. We concluded that with the exception of pulmonologists, these results showed an unacceptablequality of the pre-hospital management of acute asthma.