emedinews
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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos …

eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial …

23rd February 2013, Saturday

Health Sector is demanding and is not a 9 to 5 Job: P K Pradhan

In an interaction with IMAS, Sh P K Pradhan Former Health Secretary Govt. of India said that MCI should be reconstituted this year, reports Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal National Vice President Elect IMA.

The interaction was held on Wednesday at IMA 20th Feb IMA hall and was moderated by Dr Narender Saini Secretary General IMA. I too was present at this interaction.

Other present were Dr D R Rai, Dr Atul Arora, Dr S Roy, Dr V K Narang, Dr Ajay Gambhir, Dr Ghulam Abbas Zaidi and Dr Zainab Zaidi.

Following is the gist of the interaction.

About the health budget

  1. Government of India under NRHM and other schemes gives 75% grants to the States and 25% has to be raised by them. Many states are not being able to utilize the funds quickly and avail their grant in full. Bihar has come up very well in healthcare infrastructure during last few years. Performances as well as health care in UP, Chhatisgarh and Jharkhand are still a matter of concern.
  2. When it comes to release of funds under health schemes, the releases are made purely on performance and no other considerations. If money is not used by the states, it is due to lack of performance and inefficiency. There are no political considerations.
  3. Many States like Madhya Pradesh, Orissa, Tamil Nadu, Karnataka, Haryana, Himachal Pradesh, J & K and Rajasthan were provided additional funds under NRHM during the last few years.
  4. Most of the Plan budget of the States, even up to 80%, goes towards salaries.

About health infrastructure in different states

  1. Tamil Nadu health services are one of the best in the country. Health care is available at the lowest cost. Governance is a good factor for implementation of healthcare services. Assam, Madhya Pradesh, Rajasthan and Orissa among the high focus states have picked up very well. Andhra Pradesh needs to improve the primary healthcare system.
  2. The quality of services in medical colleges needs to improve substantially. In some of the district hospitals, the care may be better than medical colleges as senior doctors in medical colleges are often busy in private practice.

About vacant posts at rural setups

Wherever medical officer posts are to be filled by state PSCs, there is considerable delay. Many States have started doing selection directly to overcome this problem and to place doctors in position.

IMA image

  1. It is not correct that IMA has an image of anti-governance.
  2. It is only that IMA representatives and documentation do not reach the right people in the right time.
  3. In the eyes of the government, IMA is at a high standing image.
  4. Since IMA is taking up various projects, it should build a stronger partnership with Government both at the Center as well as State level to build capacity and improve the health care in the country.

About MCI

As things stand, Medical Council of India should be reconstituted after the term of the present BoG is over. There is need for two amendments in its old format.

  1. One will not be able serve for more than two terms.
  2. More representation from state health science universities where there are a large no. of medical colleges.

About Dr B C Roy Awards

Dr. BC Roy Awards issue needs to be raised with the Medical Council of India.

About Capacity building and BSc community health courses

  1. Everybody in the hospital, from ward boy, person doing waste disposal and other service providers need to be skilled and can be provided six months courses by accredited institutions.
  2. The need is to constitute a paramedical council. IMA can facilitate this, prepare a draft and approach the health ministry.
  3. The Government today is proposing BSC Community Health Programme to create mid level health providers who can be groomed as public health personnel.
  4. IMA point of view is that MCI or DNB should not develop the curriculum and become an accredited institution to impart such courses and register them. Government however is envisaging the same as there is no council at the moment available for the same. The government is choosing them on the philosophy unless you register you cannot be de-registered. IMA feels that a separate paramedical council should be made to recognise them.
  5. A community health worker will provide better preventive health care than an ANM.
  6. The introduction of the courses will depend on States. It is possible that southern and western States may not go for BSC Community Health Courses.
  7. The BSc Community Health workers will be required more in the remote rural areas to strengthen the public health and where it takes more than few hours to reach for primary care.
  8. IMA approved paramedical courses can be recognized by states and the centre.

About public health

  1. Non-doctors should also be allowed to become public health professional.
  2. The burden of diabetes, old age problem and mental health are going to assume very high proportion in the coming years and it is time be fully prepared to cope with the situation.

About IMA as NGO

IMA can think of building dialyses centers and blood banks in different district and can approach State Govt. and Center for support. The government is planning to have diagnostic centre in each district hospitals.

About Generic Drugs

The MRP of drugs is not controlled by the government. Government is trying to regulate prices of only essential drugs.

About Medical colleges

Several reforms have been undertaken to facilitate setting up new medical colleges and augment both UG and PG seats. This includes rationalization of land and infrastructure requirements, having colleges in two campuses etc. The no. of seats should go up substantially now.

What about an offer to be a friend of IMA

I can support activities of IMA to improve health care in the country as “Friends of IMA”.

Requirement of Heath Sector

  1. Health sector is extremely complex, demanding and is not a 10 to 5 job.
  2. It requires passion and commitment to work for long hours.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

What are the risk factors for chronic constipation?

The risk factors for chronic constipation include female gender, older age, physical inactivity, low caloric intake, low-fiber diet, low educational level and income, concurrent medication use and depression.

For comments and archives

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

Avoid these foods for a healthier heart

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

CPR 10 VIP Sensitization

Dr Sanjay Gupta, Bone and Joint Specialist doing CPR 10

 
Dr K K Aggarwal
    National News

Tackling Bomb Blasts (Dr K K Aggarwal)

Powerful bomb exploded in Hyderabad took over 15 lives. Heart Care Foundation of India today releases guidelines for the medical practitioners and the public as to how to handle a bomb explosion.

  1. Half of all early casualties seek medical care over first hour. To know the total number of casualties, double this number after one hour. This formula is often used by the media and the authorities to predict the tolls. It is also useful to predict demand for care and resource needs.
  2. The most severely injured arrive after the less injured who need transport to the closest hospitals, so always expect upside down triage.
  3. It is important that we as doctors know how bomb blast cause injuries in order to tackle its repercussions of bomb blasts.
  4. Bomb blast injuries can be categorized into four types:
    1. Primary blast injuries are a direct result of the impact of the over pressurized blast wave on the body. It involves injuries to the hollow gas filled organs like the lungs, ear drum or intestines leading to their rupture.
    2. Secondary blast injuries occur due to flying debris and bomb fragments causing penetration or penetrating injuries to organs such as eyes.
    3. Tertiary blast injuries occur when individuals are thrown by the blast wind leading to fractures due to the fall.
    4. Quaternary blast injuries are due to direct effect of burn or crush injuries.
  5. The most important aspect is not to waste energies and resources on patients with non-serious injuries.
  6. Look for eardrum rupture and signs of respiratory imbalance. Their absence indicates a non serious injury.
  7. If the ear drums are intact, the patient can be discharged with first aid treatment.
  8. If ear drum is ruptured, immediately do an X ray chest. Keep the patient under observation for eight hours as primary blast injuries may have a delayed presentation.
  9. Otoscopic ear exam is the screening procedure for triage. Decreased oxygen saturation on pulse oximetry signals early blast lung injury, even before symptoms become apparent.
  10. Doctors should therefore focus only on two exams: otoscopic ear exam and pulse oximetry. Blast lung injury is unlikely without tympanic or ear membrane rupture.
  11. With the increasing use of explosives in terrorist events in our country in recent times, doctors, especially Emergency Doctors, should undergo orientation training every six months so that they are prepared and better equipped to manage several casualties all at one time.

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    Be Human Stop Child Abuse (Team IMA for CMAAO)

(http://behumanstopchildabuse.emedinews.in/)

Working definition of child abuse

Child abuse refers to the intended, unintended and perceived maltreatment of the child, whether habitual or not, including any of the following: Psychological and physical abuse, neglect, cruelty, sexual and emotional maltreatment.

For comments and archives

 
    Valvular Heart Disease Update

What is low gradient severe aortic stenosis?

Some patients with severe AS (aortic valve area <1.0 cm2) have a low gradient (mean gradient <30 mmHg) across the aortic valve that can reflect one of two different abnormalities:

  • True stenosis with secondary left ventricular dysfunction induced by a severe stenotic lesion that reduces the stroke volume and the transvalvular pressure gradient.
  • Pseudostenosis in which there is both moderate AS and a low cardiac output due to myocardial disease that is unrelated to the valvular lesion. The calculated valve area may mistakenly suggest severe stenosis in this setting because of valve area equation limitations when applied to low flow rate conditions.

It is important to distinguish between these disorders because surgical correction of the valve lesion in pseudostenosis is associated with a high mortality rate and is unlikely to be beneficial.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

 
    From the Desk of Vice President (Elect) IMA

Abusive head trauma

  1. It is an important cause of morbidity and mortality in young children.
  2. Mortality is higher among those younger than 12 months of age.
  3. Abusive head trauma (AHT) occurs most often in the first year of life.
  4. Cranial injury can result from
    1. Direct blows
    2. Shaking (infant)
    3. Dropping
    4. Throwing the child
  5. Shaking injury pattern includes subdural hemorrhage, retinal hemorrhage and brain injury.
  6. Most will have history of previous abuse, and the diagnosis is frequently delayed.
  7. The perpetrators of AHT are usually male and most commonly, the father of the infant.
  8. The mechanism is angular deceleration, with or without impact resulting in differential movement of intracranial contents that causes axonal injury and intracranial bleeding in a susceptible infant brain.
  9. Normal handling and minor trauma cannot cause serious injury.
  10. Hypoxic-ischemic injury can add on to the insult.
  11. Injuries associated with AHT
    1. Skull
    2. Metaphyseal
    3. Rib fractures
    4. Retinal hemorrhages
    5. Intracranial bleeding
    6. Subdural hemorrhage

For comments and archives

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

'Choosing Wisely' targets 90 more dubious tests, therapies

Seventeen medical societies today released a list of almost 90 common but often unnecessary tests and procedures, many of them ordered for a peculiar kind of patient — the one without symptoms. No fewer than 12 of the guidelines issued as part of the "Choosing Wisely" campaign of the American Board of Internal Medicine Foundation caution physicians that asymptomatic patients probably do not need a given treatment. A few examples follow, along with the society that recommended them: (Source: Medscape)

  • Don't screen for carotid artery stenosis in asymptomatic adult patients (American Academy of Family Physicians).
  • Don't automatically use computed tomography scans to evaluate children's minor head injuries (American Academy of Pediatrics).
  • When prescribing medication for most people aged 65 years and older who have type 2 diabetes, avoid attempting to achieve tight glycemic control (American Geriatrics Society).
  • Don't routinely order imaging tests for patients without symptoms or signs of significant eye disease (American Academy of Ophthalmology).
  • Don't screen for ovarian cancer in asymptomatic women at average risk (American College of Obstetricians and Gynecologists).
  • Avoid using stress echocardiograms on asymptomatic patients who meet "low-risk" scoring criteria for coronary disease (American Society of Echocardiography).

Diet plan helps obese moms

Diet programs with light exercise helped obese women avoid gaining too much weight during pregnancy, two trials showed. (Source: Medpage Today)

Combat PTSD tied to intensity of fight

Whether soldiers in combat develop post-traumatic stress disorder (PTSD) depends on their perception and attention to threat, the intensity of combat they are exposed to, and genetic susceptibility, a prospective study determined.(Source: Medpage Today)

Open-angle glaucoma: Still unclear which treatment is best

A systematic review commissioned by the US Preventive Task Force (USPSTF) confirms that treatment of open-angle glaucoma can lower intraocular pressure and reduce the risk for optic nerve damage. However, the reviewers were unable to determine which medical or surgical treatment is best able to prevent visual disability and improve patient-reported outcomes. (Source: Medscape)

Fast response to IV Simponi in active arthritis

Patients with active rheumatoid arthritis despite treatment with methotrexate showed significant -- and rapid -- response to intravenous golimumab (Simponi), a multicenter phase III trial found. (Source: Medpage Today)

 
  Twitter of the Day

@DrKKAggarwal: 6% of young Indian suffer from heart disease http://bit.ly/UP1BYU #Health

@DeepakChopra: How we create reality http://www.youtube.com/watch?v=czVe5tBknzY …#CosmicConsciousness

 
    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Direct all your energy towards the should and nor the ego

The epic Mahabharata can also be understood as a science of inner Mahabharata happening in everybody’s mind.

Lord Krishna here symbolizes with consciousness and the five Pandavas with five positive qualities of a person and they are – righteousness (Yudhishthir), being in focus (Arjuna), power to fight injustice (Bheem), helping others (Sahdev) and learning to be neutral in difficult situations (Nakul). Panchali symbolizes the five senses, which can only be controlled when these five forces are together.

For comments and archives

 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What are the legal issues related to the surrogacy?

There are a number of legal issues that concern third party reproduction. Written consent should be obtained for any procedure. In situations of known sperm or egg donors, both donors, as well as intended parents, are advised to have separate legal counsel and sign a legal contract that defines the financial obligations and rights of the donor with respect to the donated gametes. With surrogacy arrangements, legal contracts, in addition to delineating financial obligations, may include details regarding the expected behavior of the surrogate to ensure a healthy pregnancy, prenatal diagnostic tests, and agreements regarding fetal reduction or abortion in the event of multiple pregnancies or the presence of fetal anomalies. Finally, many states allow for a declaration of parentage prior to the child’s birth obviating the need for adoption proceedings. The laws regarding third party reproduction are either non–existent or different from one state to another.

 
    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Does a person suffer from any harmful effects after donating blood?

Absolutely not, rather a donor after having given blood voluntarily experiences a feeling of great pleasure, peace and bliss. Soon within a period of 24 – 48 hours the same amount of new blood gets formed in his body, which helps the donor in many ways. His own body resistance improves, the circulation improves and he himself feels healthier than before.

For comments and archives

 
    An Inspirational Story

God Created The Teacher

On the 6th day, God created men and women. On the 7th day, he rested. Not so much to recuperate, but rather to prepare himself for the work he was going to do on the next day. For it was on that day – the 8th day – that God created the FIRST TEACHER.

This TEACHER, though taken from among men and women, had several significant modifications. In general, God made the TEACHER more durable than other men and women. The TEACHER was made to arise at a very early hour and to go to bed no earlier than 11 PM, with no rest in between.

The TEACHER had to be able to withstand being locked up in an air–tight classroom for six hours with thirty–five "monsters" on a rainy Monday. And the TEACHER had to be fit to correct 103 papers over Easter vacation. Yes, God made the TEACHER tough…but gentle, too. The TEACHER was equipped with soft hands to wipe away the tears of the neglected and lonely student… those of the sixteen–year old girl who was not asked to the prom.

And into the TEACHER God poured a generous amount of patience. Patience when a student asks to repeat the directions the TEACHER has just repeated for someone else. Patience when the kids forget their lunch money for the fourth day in a row. Patience when one–third of the class fails the test…patience when the text books haven’t arrived yet, and the semester starts tomorrow.

And God gave the TEACHER a heart slightly bigger than the average human heart. For the Teacher’s heart had to be big enough to love the kid who screams, "I hate this class – it’s boring!" and to love the kid who runs out of the classroom at the end of the period without so much as a "goodbye," let alone a "thank you."

And lastly, God gave the TEACHER an abundant supply of HOPE. For God knew that the TEACHER would always be hoping. Hoping that the kids would someday learn how to spell… hoping not to have lunchroom duty… hoping that Friday would come… hoping for a free day… hoping for deliverance.

When God finished creating the TEACHER, he stepped back and admired the work of His hands. And God saw that the TEACHER was good. Very Good! And God smiled, for when he looked at the TEACHER, he saw into the future.

He knew that the future is in the hands of the TEACHERS. And because God loves TEACHERS so much… on the 9th day God created… SNOW DAYS!

For comments and archives

 
  Cardiology eMedinewS

In patients with cardiac arrest, common IV fluid associated with reduced likelihood of full recovery Read More

Women's heart disease awareness still needs improvement Read More

 
  Pediatric eMedinewS

NICU medical device use linked to bisphenol A exposure Read More

Maternal obesity may alter fetal brain Read More

 
    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

Why do some people fear for vaccine?

In the past, rabies vaccine was a sheep brain derived Nerve Tissue Vaccine (NTV) and was associated with considerable side effects. Large volumes and a number of injections were required. So, rabies vaccine acquired the dubious reputation of a dangerous vaccination. However, these fears are no longer justified with modern rabies vaccines that are very safe.

 
    IJCP Special

Dr Good Dr Bad

Situation: A diabetic patient was found to have high ESR and elevated CRP.
Dr Bad: You are suffering from an inflammatory disease.
Dr Good: This may be a part of diabetes.
Lesson: In diabetes, both ESR and CRP can be high at the same time and this can be due to IL–6 secretion by adipose tissue.

Make Sure

Situation: A patient on dialysis and on oral antacid developed aluminum toxicity.
Reaction: Oh my God! You should have put him on magaldrate preparations?
Lesson: Make sure to remember that magaldrate preparations do not cause aluminum toxicity in patients undergoing dialysis.

 
  Quote of the Day (Dr GM Singh)

Men are like steel. When they lose their temper, they lose their worth. Chuck Norris

 
    Legal Question of the Day

((Ex)Prof. M C Gupta, Advocate & Medico-legal Consultant)

Q. A woman comes to a hospital in labor for the first time. She has contracted pelvis. The doctor advises urgent cesarean section to save life. She is ready to sign informed consent. The husband refuses permission for surgery. What should the doctor do?

Ans.

  1. It is a basic principle that the duty of a doctor is to save life. However such duty is subject to the principle that a doctor cannot force treatment on anybody.
  2. In the present case, the patient herself is willing to give consent. Husband’s consent or refusal is immaterial. The doctor should go ahead with surgery.
  3. The outcome may not be the best. The mother or the child may die or the child may be found to be suffering from some congenital anomaly or hypoxic encephalopathy. The father may even know that it is a girl child. He may even be having dowry grudge and may prefer that the wife dies. Later on, the father may sue the doctor. For these reasons, the doctor would be well advised to:
    1. Keep proper, well documented records including consent.
    2. Inform the police at his discretion.
 
    Mind Teaser

Read this…………………

An older adult patient is discharged from the hospital with nortriptyline (Pamelor) for neuropathic pain. Which statement indicates the patient's need for additional education?

a. “I will chew sugarless gum and mints.”
b. “I will drink carbonated beverages.”
c. “I will take my medication at breakfast.”
d. “I will use a humidifier at bedtime.”

Yesterday’s Mind Teaser:A 35-year-old male patient with testicular cancer is joking and playing cards with his roommate. When assessed by the pain management nurse, the patient rates his pain as a 7 on a numeric pain rating scale of 0 to 10. The nurse concludes that the patient's behavior:

1. Is an emotional reaction to the anticipated pain.
2. Is in anticipation of future pain.
3. Is more indicative of the need for pain medication than the pain rating.
4. May be in conflict with the pain rating, and accepts the report of pain.

Answer for Yesterday’s Mind Teaser: May be in conflict with the pain rating, and accepts the report of pain.

Correct answers received from: DR ARPAN GANDHI, DR. P. C. DAS, DR KANTA JAIN, DR.K.RAJU, DR.RAGHAVENDRA JAYESH., DR PANKAJ AGARWAL, DRJELLA, DR CHANDRESH JARDOSH, DR. THAKOR HITENDRSINH G, DR AVTAR KRISHAN, Dr Valluri Ramarao, Dr.Jayashree Sen & Dr.Bitaan Sen, priyank chelawat

Answer for 21st February Mind Teaser: d. Using a bowel stimulant and stool softener

Correct answers received from:Dr.Jayashree Sen & Dr.Bitaan Sen, priyank chelawat

Send your answer to ijcp12@gmail.com

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    Laugh a While (Dr GM Singh)

A wife was making a breakfast of fried eggs for her husband. Suddenly, her husband burst into the kitchen. ‘Careful,’ he said, ‘CAREFUL! Put in some more butter! Oh my gosh! You’re cooking too many at once. TOO MANY! Turn them! TURN THEM NOW! We need more butter. Oh my gosh! WHERE are we going to get MORE BUTTER? They’re going to STICK! Careful. CAREFUL! I said be CAREFUL!

You NEVER listen to me when you’re cooking! Never! Turn them! Hurry up! Are you CRAZY? Have you LOST your mind? Don’t forget to salt them. You know you always forget to salt them. Use the salt! USE THE SALT! THE SALT!’

The wife stared at him. ‘What in the world is wrong with you? You think I don’t know how to fry a couple of eggs?’

The husband calmly replied, ‘I just wanted to show you what it feels like when I'm driving.’

 
    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

How can exit and entry wounds be identified?

  • Entry wound are small and neat in most cases. But, with ultra–high velocity small bullets or bomb splinters, the entrance wound may be of the ‘blowout’ type.
  • Exit wound are generally big. The size of the exit wound depends upon the shape of the local track, the temporary cavitation effect at the site of the exit, the impact velocity and type of bullet. If the missile has remained stable in the tissues, or alternatively has expended most of its energy, a relatively small exit wound results.

Handgun wounds such as revolver and semiautomatic pistol bullet wounds are very important in medicolegal practice. As the wounds caused by pistol and revolver bullets are similar, and the caliber of bullets used in the weapon is roughly the same, it should be noted that the muzzle velocities of magnum revolvers are higher than those of modern pistols.

For comments and archives

 
    Public Forum

Public Forum (Press Release for use by the newspapers)

Guidelines issued on tackling bomb blasts

Two powerful bombs that exploded in Hyderabad yesterday took over 15 lives. Heart Care Foundation of India and eMedinewS today released guidelines on how to handle a bomb explosion for the medical practitioners and the public.

Releasing the guidelines Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India and National Vice President Elect Indian Medical Association said that half of all the early casualties seek medical care within the first hour. To know the total number of casualties, double this number after one hour. This formula is often used to predict the death toll. It is also useful to predict demand for care and resource needs.

The most severely injured arrive after the less injured who need transport to the closest hospitals, so always expect an upside down triage.

It is important that we as doctors should know how bomb blast cause injuries in order to tackle its repercussions of bomb blasts. Bomb blast injuries can be categorized into four types:

  • Primary blast injuries are a direct result of the impact of the over pressurized blast wave on the body. This involves injuries to the hollow gas filled organs like the lungs, ear drum or intestines leading to their rupture.
  • Secondary blast injuries occur due to flying debris and bomb fragments causing penetration or penetrating injuries to organs such as eyes.
  • Tertiary blast injuries occur when individuals are thrown by the blast wind leading to fractures due to the fall.
  • Quaternary blast injuries are due to direct effect of burn or crush injuries.

The most important aspect is not to waste energy and resources on patients with non-serious injuries.

When a patient of blast injury comes in, the triage doctor should look for only two things, an eardrum rupture with an otoscope and signs of respiratory imbalance using the pulse oximeter. If the ear drums are intact, the patient can be discharged with first aid treatment. Blast lung injury is unlikely without tympanic or ear membrane rupture.

If ear drum is ruptured, do an X-ray chest immediately and keep the patient under observation for eight hours as primary blast injuries may have a delayed presentation. Decreased oxygen saturation on pulse oximetry signals early blast lung injury, even before symptoms become apparent.

With the increasing use of explosives in terrorist events in our country in recent times, doctors, especially Emergency Doctors, should undergo orientation training every six months so that they are prepared and better equipped to manage several casualties all at one time, added Dr Ramesh Hotchandani incoming president IMA New Delhi Branch.

 
    Readers Response
  1. Dear Sir, reading emedinews is very informative. Regards: Dr Suruchi
    Announcement

Apollo Centre for Advanced Pediatrics is organising a five day comprehensive course in pediatric Gastroenterology, Hepatology, Nutrition and Liver Transplantation in Delhi from 28 August to 1 September. This course has been designed for trainees in pediatric gastroenterology and general pediatric trainees interested in gastroenterology from the region. Renowned international and Indian faculty has been invited. For more details contact Prof Anupam Sibal at profanupamsibal@gmail.com, Dr Akshay Kapoor akshaydr80@yahoo.co.in and Dr Vidyut Bhatia at drvidyut@gmail.com.

Prof. Anupam Sibal, Group Medical Director, Apollo Hospitals Group, Senior Consultant Pediatric Gastroenterologist and Hepatologist, Indraprastha Apollo Hospitals, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi Mathura Road, New Delhi–110076,

PH:+91 11 26925858 Extn:2054,2053,Email:anupamsibal@apollohospitals.com

 
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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta