Militancy Trauma : Anaesthesia and Critical Care Management

Abstract

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, bone. parenchyma with shock or injury to more than one body region) was seen in 862 patients. Standard protocol was evolved for initial management in lCU/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 mgJkg or thiopentone 3 mgJkg based on haemodynaemic response and maintained with N20 : 02 (50 : 50 ratio). relaxant controlled ventilation. Mortality was 3.8% including 4 deaths on operation table.

Management of Vascular Injuries in a Forward Hospital

“…This forward zonal hospital located in the Northern region of the country, has been treating casualties since the onset of insurgency in this area 17 years ago. These experiences and management protocols have been standardised and reported elsewhere [2][3][4]. The mangement of vascular injuries during a 25-month period in late nineties forms the basis of this report.…”

Militancy Trauma : Penetrating and Nonpenetrating Cardiac Injury

“…Traumatic penetrating lesions of the heart are usually associated with injury to the lungs and other-abdominal organs. Management priorities in trauma victims have been reported by us [12]. High degree of suspicion of cardiac penetrating in an apparently noncardiac trauma will prevent unanticipated catastrophe.…”

“…All were male between the ages of 21 and 42 years. The casualties were managed in the intensive care unit by implementing a standard protocol based on managemeni priorities as, reported by ,us earlier [12]. Cardiac penetrating injury was suspected clinically when s~veJ:e degree of shock was associ-, ated with missile injury ofthe chest or upper abdomen.…”

Treatment of Casualties in a Forward Hospital of Indian Army : Nine year Experience

“…Pressure bandages if already applied under field conditions were usually opened in operation theatre just prior to surgery to prevent blood loss. The trauma protocol practised in the hospital has been published earlier [3].…”