Mortality from Burn: An Autopsy Based Study from Nepal

Introduction: In developing countries like Nepal burn deaths are a major public health problem due to their increased mortality, morbidity and long-term disability. A few clinical studies on burns have been reported from Nepal however, autopsy based studies on burns are limited. Objectives: To study the socio-demographic characteristics of victims of burns and evaluate the cause and magnitude of fatal burn injuries retrospectively. Methodology: A two years retrospective analysis of burn deaths brought for autopsy was conducted from January 2017 to December 2018 in a central level hospital of Nepal. Results: Out of 775 total cases autopsied 38 (4.90%) cases were burn related deaths. The majority of the deaths 17(44.70%) occurred in the age group 21-30 years with a preponderance in females 22(57.89%). Majority of the victims were married females 25(65.78%) and most of them were housewives 14(36.84%). Flame burn 23(60.52%) was the most common cause of all burns. The Total Body Surface Area (TBSA) Burn between 50-69% was observed in majority of the cases 27(71.05%).Most of the victims 15(39.47%) survived over 10 days post injury. Burn incidents were mainly accidental 33(86.84%) in nature followed by suicidal burns 5(13.15%). The main cause of burn death was septicemic shock 16(42.10%) followed by neurogenic shock 10(26.31%). Conclusion: The results of this study show that burns injuries are mostly accidental in nature; therefore, the risks of burn injuries should be rightly addressed and appropriate burn prevention strategies should be developed to reduce the frequency and burn related deaths.

Sốc thần kinh do viêm tủy leo cấp: một trường hợp rất hiếm gặp

Giới thiệu: Sốc thần kinh là một tình trạng đe dọa tính mạng, phần lớn liên quan đến chấn thương cột sống cổ hoặc cột sống ngực cao; trong khi đó, viêm tủy cắt ngang gây ra sốc thần kinh rất hiếm gặp. Chúng tôi trình bày một trường hợp sốc thần kinh do viêm tủy leo cấp ở trẻ em. Báo cáo trường hợp: Trẻ nam 11 tuổi nhập viện với biểu hiện liệt mềm cấp tính và bí tiểu, sau đó liệt tiến triển leo cấp gây liệt chi trên và suy hô hấp nặng. Kết quả dịch não tủy cho thấy tăng protetin và tăng số lượng bạch cầu (chủ yếu tế bào lympho). Trẻ được chẩn đoán viêm tủy cắt ngang và điều trị với methylprednisolone. Sau đó, bệnh nhân có biểu hiện của sốc thần kinh với các triệu chứng hạ huyết áp (63/45 mmHg), nhịp chậm (60 lần/phút), thời gian đổ đầy mao mạch nhanh (Refill < 2s), giảm tri giác. Sau khi được điều trị với hồi sức dịch, vận mạch (Noradrenalin) và Atropin, tình trạng sốc được cải thiện. Trẻ tiếp tục được điều trị viêm tủy cắt ngang cấp và tình trạng liệt chi trên và cơ hô hấp bắt đầu cải thiện dần. Kết luận: Sốc thần kinh cần chú ý chẩn đoán trên những bệnh nhân viêm tủy thể leo cấp. Sử dụng các thuốc vận mạch thích hợp là điều trị nền tảng trong sốc thần kinh. Từ khoá: Sốc, thần kinh, viêm tủy cắt ngang, liệt Landry. ABSTRACT NEUROGENIC SHOCK DUE TO TRANSVERSE MYELITIS WITH LANDRY’S ACUTE FLACCID PARALYSIS: AN EXTREMLY RARE CASE Introduction: Neurogenic shock is a life-threatening condition that is mostly associated with cervical and high thoracic spine injury. In fact, transverse myelitis leading to neurogenic shock is extremely rare. This is the first case of neurogenic shock due to transverse myelitis with Landry’s acute flaccid paralysis in a child we have experienced so far. Case report: An 11 - year - old boy was admitted to our center with Landry’s acute flaccid paralysis and urinary retention, which led the patient to severe respiratory distress. Test indicated high level of protein and white blood cells in cerebrospinal fluid. He was diagnosed with transverse myelitis and then treated with methylprednisolone. The patient developed hypotension (63/45 mmHg), bradycardia (60 beats per minute), warm flushed skin, and decreased consciousness as a result of neurogenic shock. Fluid resuscitation, noradrenalin, and atropin were ndicated, and the shock was well controlled. The transverse myelitis was maintainly treated, and the muscle power of upper extremities, as well as respiratory muscle were gradually improved. Conclusion: Neurogenic shock occurring from transverse myelitis should be considered in the patient with Landry’s acute flaccid paralysis. Keywords: Shock, neurogenic, transverse myelitis, Landry’s paralysis.

Damage control approach to refractory neurogenic shock: a new proposal to a well-established algorithm

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is commonly used as an adjunct to resuscitation and bridge to definitive control of non-compressible torso hemorrhage in patients with hemorrhagic shock. It has also been performed for patients with neurogenic shock to support the central aortic pressure necessary for cerebral, coronary and spinal cord perfusion. Although volume replacement and vasopressors are the cornerstones of the management of neurogenic shock, we believe that a REBOA can be used as an adjunct in carefully selected cases to prevent prolonged hypotension and the risk of further anoxic spinal cord injury. This manuscript aims to propose a new damage control algorithmic approach to refractory neurogenic shock that includes the use of a REBOA in Zone 3. There are still unanswered questions on spinal cord perfusion and functional outcomes using a REBOA in Zone 3 in trauma patients with refractory neurogenic shock. However, we believe that its use in these case scenarios can be beneficial to the overall outcome of these patients.

An unusual cause of polymorphic ventricular tachycardia: Acute cervical cord injury.

Cardiovascular disturbances are the leading causes of morbidity and mortality in patients of spinal cord particularly cervical cord injury accounting for approximately 30% of deaths. Most common cardiovascular dysfunctions are sinus bradycardia, hypotension, cardiac arrest, supraventricular tachycardia and all these occurs due to sympathetic withdrawal and unopposed vagal action. Here we are reporting a case of acute cervical cord injury with neurogenic shock in a 25 year young patient who developed polymorphic ventricular tachycardia, which degenerated to ventricular fibrillation and cardiac arrest. We described all possible mechanisms of development this arrythmia and its management.