Effect of Massive Transfusion Protocol on Coagulation Function in Elderly Patients with Multiple Injuries

Objective. To evaluate the effect of massive transfusion protocol on coagulation function in elderly patients with multiple injuries. Methods. In this retrospective cohort study, clinical data were collected from a total of 94 elderly patients with multiple injuries, including 44 cases who received routine transfusion protocol (control group) and 50 cases who concurrently received massive transfusion protocol in our hospital (research group). The changes in platelet parameters, coagulation function, and organ dysfunction scores at admission and 24 h after transfusion were compared between the two groups. The 24-hour plasma and red blood cell transfusion volume, length of stay, complications, and mortality of the two groups were analyzed statistically. Results. Twenty-four hours after blood transfusion, the hematocrit, platelets, and hemoglobin in the research group were higher than those in the control group, while the activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen, and scores of Marshall scoring system and Sequential Organ Failure Assessment were lower than those in the control group ( P < 0.01 ). The 24-hour plasma transfusion volume was higher, and the length of intensive care unit (ICU) stay and total length of stay were lower in the research group compared with the control group ( P < 0.01 ). No significant difference was found in the mortality rate between the research group and the control group (10.00% vs. 13.64%, P > 0.05 ). The incidence of complications in the research group was lower than that in the control group (12.00% vs. 31.82%, P < 0.05 ). Conclusion. Massive transfusion protocol for elderly patients with multiple injuries can improve their coagulation function and platelet parameters, alleviate organ dysfunction, shorten length of ICU stay, and decrease the incidence of complications, which is conducive to improving the prognosis of patients.

Role of state and medical officials in case of sexual assault by an insane person: A case report

Violence against women has been in talks and news every now and then. Various laws are enacted world-over and in India for protection of their rights and dignity with stringent punishments of the offender. But issues arise if the offender is a mentally unsound person or a juvenile. The case is of a four-month pregnant lady who was attacked by a mentally unsound person and was brought to casualty in a low condition with unstable vitals. She had sustained multiple injuries over the body and a wooden roller stuck inside the vagina. The treating physician’s medico-legal duties and the role of state in such cases become very important. The treatment examination of victim and accused along with the legal implications make such cases worth discussing.

PREVALENCE OF MUSCULOSKELETAL INJURIES AMONG TAEKWONDO PLAYERS IN MALAYSIA

To determine the rate and types of musculoskeletal injuries among Taekwondo players from Taekwondo clubs in Malaysia. A total of 490 Taekwondo players from various clubs in Malaysia were involved in a cross-sectional study using a self-response questionnaire adopted from different studies and validated before the commencement of the study. The players were recruited from various clubs in different states of Malaysia. The number of players suffered from injuries was 300 as compared to 190 with no injuries. Males players suffered from musculoskeletal injures more than females (p = 0.019). Also, males complained of multiple injuries more than females (p = 0.019). The rate of the injuries among black belt holders was higher as compared to the colour belt (p < 0.001) and black belt holders more liable for multiple injuries (p <0.001). The semi-professional players complained of sport injures more than others (p = 0.021). The longer the experience the higher rate of injuries (p < 0.001). Most of Taekwondo players have suffered from injuries, these injuries sometimes are dangerous. These injuries are more common among male and semi-professional players. Coaches and players must emphasize on warming-up and stretching before the training/ competitions and cooling-down after, that will help to reduce the rate and severity of the injuries. In addition to that, awareness compaing among the players will help the palyers to become more careful during training and competitions sessions.

Application Evaluation of High-Flow Humidified Oxygen in Patients with Respiratory Failure after General Anesthesia Extubation for Multiple Injuries

Objective. To explore the effect of high-flow humidified oxygen therapy (HFNC) on patients with respiratory failure after general anesthesia extubation for multiple injuries. Methods. 214 patients with multiple injuries in our hospital who underwent general anesthesia and suffered respiratory failure after weaning extubation and received sequential treatment were included. And, they were divided into control group (HFNC group) and observation group (NIMV group) according to the random number table method. Patients in the control group (125 cases) used high-flow nasal cannula (HFNC) after general anesthesia extubation, while patients in the observation group (89 cases) used NIMV. The respiratory rate, heart rate, finger pulse oxygen, oxygenation index (PaO2/FiO2), and re-tracheal intubation rate in the two groups were compared at 2, 8, and 24 hours after sequential treatment, and the mortality rate and hospital stay of ICU time were whole-course observation. And, the effect of conventional oxygen inhalation or HFNC on oxygenation and prognosis was analyzed. Then, SPSS21.0 software was applied for statistical analysis. To analyze the effect of conventional oxygen inhalation or HFNC on the improvement of oxygenation and prognosis, the receiver operating characteristic (ROC) curve can be used to evaluate the feasibility and treatment effect of high-flow nasal oxygen therapy (HFNC) for patients with respiratory failure after general anesthesia extubation for multiple injuries. Results. Compared with the NIMV group, the respiratory frequency and heart rate of the HFNC group were significantly improved after 2 h, 8 h, and 24 h. At the same time, the finger pulse oxygen and oxygenation index increased significantly and returned to normal levels. HFNC can significantly reduce the reintubation rate, ICU hospital stay, and mortality rate. The area under the ROC curve was 0.9102, with 95% CI (0.8256, 0.9949) and P < 0.0001 . Conclusion. For patients with multiple injuries undergoing general anesthesia and respiratory failure after weaning and extubation, the application of HFNC can moderate patients’ heart rate and respiratory rate faster, increase oxygenation index and finger pulse oxygen, and reduce the reintubation rate, mortality rate, and ICU stay. At the same time, it can effectively improve the respiratory failure of patients after extubation and reduce the occurrence of complications.

Early and mid-term outcomes of nonsurgical management of femoral shaft fractures with associated multiple injuries in school-age children

Background Femoral shaft fractures associated with multiple injuries are commonly encountered in school-age children. Clinical outcomes of non-surgical management of pediatric femoral shaft fractures with high-energy multiple injuries are not well characterized. In this study, we evaluated the early and mid-term clinical outcomes of non-surgical management of pediatric femoral shaft fractures with high energy multiple injuries in our setting. Methods Retrospective review of school-age children with femoral shaft fractures managed non-surgically at the orthopedics department over a 3-year period. Results Eleven patients (6 boys and five girls; mean age: 7.2 years) with femoral shaft fractures associated with multiple injuries qualified the inclusion criteria. All fractures in this study population were sustained in road traffic accidents. Seven patients recovered very well. Basic functional recovery of lower limbs was satisfactory. Two patients had residual joint dysfunction, 4 patients showed abnormal gait, while 4 patients showed varying degrees of limp because of lower limb length discrepancy. Conclusion Clinical outcomes of non-surgical management of pediatric femoral shaft fractures at our center were comparable to the outcomes of other management approaches. Conservative management that shortens the duration of hospital stay without increasing cost of management should be encouraged.

INTESTINAL INJURIES IN COMBINED ABDOMINAL TRAUMA

In recent years, there has been a steady increase in injuries all over the world. Man-made and natural disasters, local military conflicts, transport and industrial accidents in 50-60% of cases of all injuries lead to combined and multiple injuries to organs and systems of the human body, and, as a result, to high sanitary losses in the first hours and days [1,2,5,11,16,22,26,].This article discusses intestinal injuries in combined abdominal trauma.Keywords:trauma, gunshot wounds of the colon, closed abdominal trauma