Progress of golden hour strategy in preterm infants / 国际儿科学杂志

The "golden hour" strategy is an important measure to improve the short-term and long-term prognosis of neonates.It refers to optimizing interventions within one hour after birth, including neonatal resuscitation, transportation and early active treatment measures.Preterm birth and its complications are one of the main causes of neonatal death.Studies about "golden hour" strategy in premature infants have confirmed that it can increase the early stability, reduce complications and improve prognosis of preterm infants.This article reviews recent progress of "golden hour" in preterm infants and provide more information about quality improvement in premature infants care.

Evaluation of Signs of Inflammation that Can Kill score in predicting mortality in an urban tertiary care centre for children in South India

Background: Mortality in critically ill children is maximum in the first 24 hours. Need of the hour is a rapid clinical scoring system that predicts mortality on admission. This study aims at using the Signs of Inflammation that Can Kill (SICK) score in a tertiary care pediatric hospital in India, to evaluate its usefulness in predicting mortality on admission.Methods: The study design is a hospital based prospective study for evaluation of diagnostic test for a duration of one year.' The assessment using SICK score was done on arrival prior to initiation of treatment for children admitted through the emergency room and paediatric ward. The variables of SICK score - temperature, heart rate, respiratory rate, systolic BP, oxygen saturation, CRT, sensorium by AVPU scale were measured using standard guidelines.Results: The study includes a population of 369 children. Children between 1 month to 12 years were included in the study. Out of 369 children studied 24 died. The mortality in the study is 6.5%. The area under the ROC curve is 0.94, which indicates the scores based on regression could predict mortality in 94% subjects correctly. Further a score of 2.5 showed maximum discrimination with a sensitivity of 87.5% and specificity of 87.2%.Conclusions: The assessment of SICK score in the population will provide objective measure of severity of illness on admission, prediction of mortality, early triage of patients, effective allocation of resources and personnel, enables early intervention, which helps in reducing mortality.

Immediate Revascularisation of Borderline Ischemic Limbs Followed by Replantation

Introduction: Salvage of complex limb injuries is not onlydependent on the skill, experience and attitude of the surgeonbut also on the ischemia time. If the revascularisation isnot possible within the golden period then the outcomeis unfavourable. There are very few reports of delayedreplantation. We are presenting a case series of replantationbeyond the golden hours i.e. 6 hours of warm ischemia byimmediate revascularisation before undertaking definitivereplantation. The definitive sequence of replantation is carriedout after the limb gets revascularised and the viscious cycle ofischemia is broken. Study aimed to salvage amputated limbs inthe borderline ischemia time by immediate revascularisation.Material and methods: A study was conducted between April2013 to March 2018 at SBM Plastic Surgery Hospital, cuttackand included all patients with limb amputations of 6-10 hoursduration. In this study the artery was anastomosed first to haltthe sequence of prolonged ischaemia. Temporary stability tothe repair was provided by taking deep bites to the proximaland distal muscle group with 2.0 vicryl sutures adjacent tothe anastomosis. After the limb was adequately revascularisedand proper hemostasis was achieved then the proper sequenceof replantation was started.Result: out of 31 patients presenting during this period, 9patients were excluded for poor preservation of the limb andpresenting after 10 hours of warm ischamia. Total no of casesincluded in the study were 22 patients who presented between4 to 9 hours of cold ischemia time. The break up accordingto the nature of injury was, 19 patients had avulsion injuries,two had assault with heavy sharp weapons and one hadcrush injury. Out of 22 cases of replantation 2 cases requiredamputation at a later date due to complications.Conclusion: In our country majority of patient come tohospital after 6-8 hrs of warm ischemia which is the upperlimit of ishaemia. If the ideal sequence of replantation willbe followed these limbs will undergo irreversible ischaemicdamage due to further delay. So the concept of immediatearterialisation gives the best opportunity for limb survival.

Smart use of smart phones in severe TBI (Traumatic Brain Injury) – A miniature Tele therapy.

This is the era of Smart phones. Smart phones have revolutionised all the fields including the field of medicine. Absence of internet coverage in the remote rural areas which was a constraint and limitation for their use has also been overcome by the technological advancements in the yesteryears. Simultaneously the availability of CT and MRI scan has seen the light in the District Headquarters hospitals of North Coastal Andhra Pradesh. In trauma care, the ubiquitous concept of the “golden hour” suggests that the time between the occurrence of an accident and the receipt high quality, appropriate treatment is a critical factor in patient survival. Therefore, saving time from the moment of occurrence all the way through to the moment of appropriate treatment is critical. Introduction of various APPs in Smart phones has made transmission of visual images instant and easy from any remote corner of the world. This advancement in function, applied to the health care sector in India made an enormous difference in providing emergency specialist care services to the remote areas of India.

Road Traffic Accidents - Throwing Care and Caution to the Wind.

It was observed, for last ten years, that the Road Traffic Accidents causing morbidity and mortality has increased significantly in rural area. The economic growth in this area along with development of SHIRDI and SHANI- SHINGANAPUR was noted. Objectives: We were interested to know the incidence of trauma and any remediable factors that could be suggested and implemented. The aim was to document the predominant mechanism of injury and to determine temporal relationship between the final outcome, types of injury, and time taken since injury to hospitalization. Methods: The study, carried out in rural area, hospital based included 2,154 patients of polytrauma, who were admitted, diagnosed and treated out of a total number of 4,638 patients of polytrauma who visited the causality of the hospital. Proforma was designed and data recorded and analyzed. Results: Predominantly young male population was affected by trauma. There was a gross delay in arrival to the hospital in considerable number of patients. Mortality was 32.66% when patients reached hospital within two hours of injury. Mortality increased to 51.51% when patients reached the hospital after eight hours of injury! Conclusions: In majority of patients the mechanism of injury was the result of motor vehicle accident. The patients who have multi-system involvement have poorer outcome to our country due to accidents amounts to Rs.5000 crores annually2. In a developing country like India, public health facilities are scarce. Only 0.9% of GDP is spent on public medical services6. In higher income countries, RTA are already among the top ten leading causes of disease burden in 1998 as measured in DALY (Disability–Adjusted Life Years). According to a WHO / World Bank report, “The Global Burden of Disease’’, deaths from non communicable diseases are expected to climb from 28.1 million a year in 1990 to 49.7 million by 2020 and RTA being the main cause of this rise. On an average in the industrialized countries and also in many developing countries, one hospital bed in ten is occupied by trauma victim7. Member countries of South East Asia region, during the past two decades, are passing through significant Urbanization, Motorization, Industrialization and changes in the socio - economic values of societies. Injuries on roads, at homes and in the work place have increased due to lack of safety related policies and programmes. Children saved today from nutritional and infectious diseases are killed and/or maimed by injuries tomorrow. In fact RTA injuries are ranked as number one cause of burden of diseases among children in 2000. This heavy burden at such an early age has long – term implication on the qualities of life and economy of the nation8.

Delayed Transfer of Major Trauma Patients Under the Current Emergency Medical System in Korea

PURPOSE: Major trauma patients should be transferred to a definitive care facility as early as possible because prompt management will prevent death. This study was designed to discover the obstacles leading to delayed transfers under the current emergency medical system in Korea and whether there are any negative outcomes associated with conducting procedures at primary care hospitals prior to transferring patients to higher levels of care. METHODS: The medical records of major trauma patients with an Injury Severity Score above 15 within the past year were reviewed. Patients were divided three groups as follows: (A) came directly to our emergency center, (B) were transferred without CT or MRI scan at the primary care hospital and (C) transferred with CT or MRI scans. The transfer time of each group were compared and analyzed statistically. Additionally, the number and type of imaging performed at the primary care hospital were analyzed. RESULTS: All qualified patients (n=276) were enrolled in this study: 121 patients in group A; 104 in group B; 51 in group C. There was a statistically significant difference in the transfer time between the three groups (p-value<0.001), and 79 (28.6%) were transferred to an emergency medical center within one hour. In group C, CT or MRI scans were performed an average of 1.86 times at the primary care hospital, and the median transfer time was 4 hours 5 minutes. CONCLUSION: Only 28.6% of the cases in the study arrived within the golden hour at a definitive care facility. Such delays are in part the result of prolonged times at the primary care hospital for radiologic examinations, such as CT or MRI scans. Major multiple trauma patients should be transferred to a definitive care facility directly or as soon as the primary survey and the resuscitation of Advanced Trauma Life Support guideline are completed at the primary care hospital.

Time efficiency of first-aid to war wound and trauma / 解放军医学杂志

Objective To approach the directive function of time efficiency of first-aid to war wound and trauma. Methods To analyse the relationship between time and war wound or trauma death based on the statistical data of those wounds, then to define the time window of first aid aiming at the peak value of death. Results Bleeding and asphyxia should be virtually controlled in “emergency platinum 10 minutes”, resuscitation from shock should be within 30 minutes, at the same time, a definite operation to save life should be performed in “golden an hour”. Conclusions It is important to raise the time efficiency in each stage by training and improving the military affairs. To spread the first-aid knowledge may decrease cripples and mortality.