Background and Purpose:The purpose of this study was to assess factors causing delay in treatment of acute stroke in a tertiary care institute in South India.Methods:All clinically suspected cases of acute stroke presenting to the emergency department over a period of 1 year were prospectively followed up and data collected as per a preset pro forma. The various time intervals from stroke onset to definitive management and other pertinent data were collected. The time delays have been evaluated in the decision tree model: Chi-squared Automatic Interaction Detection. Significance was assessed at 5% level of significance (P < 0.05).Results:The mean prehospital time delay for all clinically suspected stroke (n = 361) in our institute was 716 min and the median time 190 min. The mean total in-hospital delay was 94.17 ± 54.5 min and median time being 82 min. The onset of symptoms to first medical contact was the main interval that influenced the prehospital delay. Computed tomographic (CT) diagnosis to stroke unit admission influenced the in-hospital delay the most.Conclusions:Lack of awareness regarding stroke leads to delayed seeking of treatment for the same. The factors that contribute to the in-hospital delay included patient admission procedure delay, lack of staff to transport the patient, and the distance between the stroke unit and CT room. Educating the community with regard to “stroke” and implementation of a better pre- and in-hospital stroke care system is a need of the hour in the country.
Introduction Knowledge about basic life support (BLS) is mandatory for healthcare professionals. This study aims to evaluate the knowledge among medical students who have completed their MBBS course and have enrolled for internship. Materials and methods A questionnaire pertaining to BLS before and after the BLS workshop (pretest and posttest 1) was distributed among the 50 participants consented for the study. The questionnaire was again given to the same participants at the end of their 1 year of internship (posttest 2) and were analyzed. Results Among the participants, 96% of students had attended nonstructured BLS classes in the past but the knowledge and skill in BLS and ability to recognize arrest were very low. Knowledge about the essential components of effective cardiopulmonary resuscitation (CPR) was poor among students, which improved to near 100% in posttest 1. Awareness about cervical spine stabilization, log rolling, and management of choking was poor among the students, which improved after the class. Although attrition had occurred, the knowledge in posttest 2 was significantly better than pretest ( p value < 0.05). Conclusion The BLS knowledge among young doctors in India is very low as evidenced by poor performance in the pretest. Regular BLS courses are necessary to improve the knowledge among them and to prepare them to respond to a medical emergency. Clinical significance Knowledge and skills pertaining to BLS are not usually taught in medical schools in India. This study indicates the lack of knowledge among medical students about BLS and the need for improvement and regular update. This study can serve as a guide for policymakers to consider inculcating BLS knowledge into the medical school curriculum in the near future. How to cite this article Vineeth Chandran K, Abraham SV. Basic Life Support: Need of the Hour—A Study on the Knowledge of Basic Life Support among Young Doctors in India. Indian J Crit Care Med 2020;24(5):332–335.
Background and Objectives:Central venous catheter placement is a frequently performed procedure in emergency medicine as well as critical care unit. We aimed to compare real-time ultrasonography (USG)-guided and the traditional anatomical landmark (AL) technique for the insertion of internal jugular vein (IJV) catheters in an emergency department (ED) setting.Materials and Methods:Patients requiring IJV catheterization were prospectively recruited over a period of 1 year at a single center. Cannulation was done either by the AL or USG technique, according to ED physician's discretion. A preset pro forma was completed for each central line placed. Variables were compared using the independent t-test, Fisher's exact test, and the nonparametric Mann–Whitney U-test.Results and Discussion:Seventy patients were enrolled, of which 35 patients underwent IJV cannulation by USG-guided technique (USG group) and 35 patients by the AL technique (AL group). There were a 100% success rate (35/35) for cannulation in the USG group and a 91.4% success rate (32/35) in the AL group. The catheter was placed on the first attempt in 17 (48.6%) patients in the AL group and 32 (91.4%) patients in the USG group. In th AL group, there were three failed cannulation attempts in comparison to the USG group. The mean start to flash time for the AL technique was 16.59 s (±10.67) and 4.86 s (±2.18) in the USG group. The mean cannulation time was 305.88 s (±66.84) in the AL group and 293.03 s (±71.15) in the USG group. A total of seven acute complications were noted, of which 2 (5.7%) in the USG group and 5 (14.3%) in the AL group.Conclusion:The real-time USG guided technique significantly reduces the number of attempts to cannulate, has a higher first-pass success rate, a quicker flash time, and fewer complications when compared to the AL technique. In EDs equipped with USG, insertion of IJV catheters under real-time USG guidance should become the standard of care.
Aim:Snakebite injuries are common in tropical India among those who are involved in outdoor activities. These injuries results in cellulitis, gangrene at the bite area, bleeding manifestations, compartment syndrome, regional lymphadenopathy, septicemia, hypotension, and disseminated intravascular coagulation (DIC) resulting in significant morbidity and mortality. The purpose of this study is to share our experience of multidisciplinary approach in the management of snakebite injuries of the extremities with various treatment modalities including hyperbaric oxygen (HBO) therapy, surgical debridement, and soft tissue reconstruction to provide an effective treatment for snake bite injuries.Methods:The study was conducted in the Department of Plastic Surgery, during the period October 2012–December 2014, wherein all the patients who were admitted with snakebite injuries were enrolled and the patients treated in plastic surgery department were included into the study. Out of total 766 patients, there were 323 patients treated with anti snake venom (ASV) and 29 died among the treated patients; 205 patients belonged to pediatric age group.Results:Out of 112 patients referred to Department of Plastic Surgery, 50 cases presented with cellulitis, 24 patients with compartment syndrome, and 38 patients were referred for the management of soft tissue cover over the extremities. Among 112 patients, 77 involved the lower extremity and 35 the upper extremity.Conclusion:Multidisciplinary approach including hyperbaric oxygen (HBO) therapy improves outcome in the management of snakebite injuries of the extremities.
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