RESUMO
Two hundred and eighty patients with serious chest injuries were treated at a service hospital during a period of 41 months. Out of 9 patients who suffered cardiac trauma S had penetrating cardiac injuries, 2 had penetrating pericardial injury and 2 patients had myocardial contusions. Myocardial contusions simulated myocardial infarction. All patients except one had polytrauma, associated injury to the lung or intra-abdominal organs. Early evacuation, resuscitation, high index of suspicion for cardiac injury and prompt surgical intervention were the keys to successful management in these patients. Thoracotomy was performed to repair the myocardial perforation and lacerated lung injuries. Associated infra-abdominal injuries were managed with laparotomy. Two patients died due to lack of cardiopulmonary bypass facilities and resistant cardiac arrhythmias. Seven patients had uneventful recovery.
RESUMO
Eighty four out of 2151 militancy trauma patients sustained severe maxillofacial injury from Jan 1990 to March 1993. The resuscitation, stabilisation and intensive care of these patients was based on management priorities of primary resuscitation, care of airway, management of haemodynamics, oxygenation and monitoring. Anaesthesia was administered in a situation when the airway was likely to be compromised and the patients were critically sick. Initial ventilation and oxygenation was the most difficult and could be achieved with satisfactory seal around the face mask by applying water-soaked guaze pieces around the mouth and nose to "fill-in" the defects. Tracheal intubation could be accomplished with intravenous sedation by an experienced anaesthesiologist. Dental occlusion and wiring necessiated the placement of nasotracheal tube for 48-72 hours after surgery.
RESUMO
Histamine releasing activity of chandonium iodide and d-tubocurarine was studied in guinea pig ileum (in vitro), guinea pig peritoneum (in vivo) and in human volunteers (in vivo) by intradermal testing at dilutions of 1:1,000 and 1:10,000 of the clinical dosage of drugs. d-tubocurarine revealed significant histamine releasing activity in in vivo animal experiments and high incidence of positive intradermal reaction, 53.5 per cent and 13.5 per cent, in human volunteers. Chandonium iodide neither showed histamine releasing activity in animals nor in man. In clinical terms, chandonium iodide appears to be a safe neuromuscular blocking agent.
RESUMO
One hundred and forty ASA physical status I and II patients undergoing general or gynaecological surgery were the subjects of this study. Patients were randomly assigned into five groups receiving 100, 150, 180, 200 and 250 µg/kg I.V. of chandonium iodide after induction of general anaesthesia with thiopentone. Neuromuscular blockade was assessed clinically, as well as, with twitch response/train of four using myotest nerve stimulator. Increasing dosage of chandonium iodide decreased the time to onset of jaw relaxation and apnoea (p<0.01) and caused linear increase in the duration of neuromuscular blockade from 10.90 ± 5.31 to 25.18 ± 7.15 min (p<0.01) over the dosage rage of 100 to 250 µg/kg. Intubation conditions also improved with increasing doses of chandonium iodide, so that, although intubation was possible in all the patients, grading of good intubation conditions were achieved in 64, 80, 88, 100 and 100% of patients in groups I to V respectively. 200 µg/kg of chandonium iodide produced ideal intubation conditions. Recovery to spontaneous ventilation was rapid and smooth, further facilitated with neuromuscular antagonists. Short lasting increase in heart rate and blood pressure was seen which was neither dose dependent nor outlasting the duration of neuromuscular blockade.
RESUMO
At a Base Hospital, 2151 patients of militancy trauma were managed from Jan 1990 to 31 May 1993. It involved military, paramilitary, ex-servicemen, civilians, foreigners and antinational elements. The nature of trauma was either gun shot wounds (1333) or blast injuries (818). Polytrauma (multiple injury to soft tissue, hone, parenchyma with shock or injury to more than one body region) was seen in 862 patients. Standard protocol was evolved for initial management in ICU/acute surgical ward. Time taken for initial evaluation of injury, resuscitation, respiratory care and oxygen therapy, analgesics, blood group cross matching, antibiotics and preparation of the part before surgery was usually 45 min. Anaesthesia was induced with ketamine 2 mg/kg or thiopentone 3 mg/kg based on haemodynaemic response and maintained with N2O : O2 (50 : 50 ratio), relaxant controlled ventilation. Mortality was 3.8% including 4 deaths on operation table.