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Background : Penetrating injuries to sacrum are rare; only a few reports have been published in literature. We hereby report the first case of low velocity penetrating trauma leading to coccygeal fracture dislocation and exsanguination, without any major abdominal/vascular injury. Case Report : The patient underwent wound packing bedside and hemostatic resuscitation. Wound packing was successful in achieving hemostasis. He stabilized after 1.5 L of fluids, massive hemorrhage protocol institution (12-unit blood components), and vasopressor support. The presentation is unique and not reported in literature published so far. Conclusion : This report is a pertinent example of lifesaving potential of effective wound packing, which is often under-utilized. Possibility of associated neurological injury and residual foreign bodies is there in such cases. They should be duly assessed after stabilizing life-threatening injuries. [ABSTRACT FROM AUTHOR]

Background: Renal trauma is present in 0.5–5% of patients admitted for trauma. Advancements in radiologic imaging and minimal-invasive techniques have led to decreased need for surgical intervention. We used a large trauma cohort to characterise renal trauma patients, their management and outcomes. Methods: We analysed "Towards Improved Trauma Care Outcomes in India" cohort from four urban tertiary public hospitals in India between 1st September 2013 and 31st December 2015. The data of patients with renal trauma were extracted using International Classification of Diseases 10 codes and analysed for demographic and clinical details. Results: A total of 16,047 trauma patients were included in this cohort. Abdominal trauma comprised 1119 (7%) cases, of which 144 (13%) had renal trauma. Renal trauma was present in 1% of all the patients admitted for trauma. The mean age was 28 years (SD-14.7). A total of 119 (83%) patients were male. Majority (93%) were due to blunt injuries. Road traffic injuries were the most common mechanism (53%) followed by falls (29%). Most renal injuries (89%) were associated with other organ injuries. Seven of the 144 (5%) patients required nephrectomy. Three patients had grade V trauma; all underwent nephrectomy. The 30-day in-hospital mortality, in patients with renal trauma, was 17% (24/144). Conclusion: Most renal trauma patients were managed nonoperatively. 89% of patients with renal trauma had concomitant injuries. The renal trauma profile from this large cohort may be generalisable to urban contexts in India and other low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Objective: Uttarakhand is an Indian state in the Himalayan foothills, a favored adventure destination in the country due to abundant natural beauty. However, the terrain has also conferred an increased risk of earthquakes, flash floods, and major road tragedies, resulting in as many as 8 major natural disasters in the state in the preceding 20 years. AIIMS Rishikesh, an autonomous central institute, has been entrusted to build a Level 1 Trauma Center in Uttarakhand, which would help improve the response, coordination, and hence outcome in mass casualty scenarios (MCSs). Methods: As a step toward the achievement of this larger goal, a workshop on MCS and management was conducted by the Department of Trauma Surgery in collaboration with Rambam Hospital, Haifa. We hereby present our template for conducting MCS drills in low resource settings like ours and the lessons learnt. Results: Process, logistics, limitations, workforce, scheduling, overview, and report of the MCS drill conducted are discussed hereafter. Conclusion: This template may be replicated by hospitals that intend to conduct similar MCS drills in low resource settings, realizing the real threat of MCS occurrence in our country at anytime. [ABSTRACT FROM AUTHOR]

Urinary bladder injuries are uncommon, accounting for just 1.6% of all abdominal trauma. The most common presenting symptoms are hematuria, abdominal pain and inability to void. Ascites is the most typical manifestation on CT. We hereby report a case of a 24-year-old male victim of a road traffic injury with an unusual presentation of pneumoperitoneum and "reversal" of FAST positive status as the presenting signs of bladder injury. Prior awareness of urinary bladder injury as the etiology of pneumoperitoneum can possibly decrease morbidity with consideration of minimal access surgery for management. Compared to pneumoperitoneum, "FAST reversal" in catheterized patients is quite peculiar and sufficiently specific per se to warrant a cystogram or thorough intraoperative bladder evaluation. [ABSTRACT FROM AUTHOR]

Background: Postmortem examination is indispensable to ascertain the cause of an unnatural death and as such is mandatory by the law. From ages, traditional autopsy (TA) has proved its worth in establishing the cause of death in the deceased despite some inherent difficulties and challenges and has enjoyed an insurmountable status. The increasing use of application of the modern-day radiology for postmortem examination has however opened a new arena overcoming some of the difficulties of the TA. There are conflicting reports in the published literature regarding superiority of one modality of the postmortem over the other. Objective: The objective of this study was to compare the findings of postmortem computed tomography (CT) scan and TA in the victims of traumatic deaths and to analyze whether postmortem CT can be used to replace TA. Materials and Methods: All patients with a history of trauma that were declared brought dead on arrival in the emergency department were subjected to full-body CT scan. An experienced radiologist reported the findings of CT scan. Subsequently, a forensic expert subjected the patients to TA. The physician who performed autopsy was blinded to the findings of CT scan and vice versa. An individual who was not part of the radiology or forensic team then entered the findings of CT scan and autopsy in a predesigned Pro forma. An unbiased assessor finally compared the findings of the two modalities and analyzed the results. McNemar's test was used to ascertain the level of significance between the findings reported by these two modalities considering P = 0.05 as statistically significant. The agreement or disagreement on cause of death reported by these two modalities was also assessed. Results: About 95% of the deceased were males. The mean age of the corpses was 35 years (range 16–67 years). CT was found superior in picking up most of the bony injuries, air-containing lesions, hemothorax, and hemoperitoneum. However, autopsy was found more sensitive for soft-tissue and solid visceral injuries. Both modalities were equally helpful in identifying extremity fractures. Statistically significant agreement (>95%) on cause of death by both modalities was not achieved in any patient of trauma. Conclusion: Postmortem CT scan is promising in reporting injuries in traumatic deaths and can significantly complement the conventional autopsy. However, at present, it cannot be considered as a replacement for TA. [ABSTRACT FROM AUTHOR]

Context: Thoracic trauma causes significant morbidity; however, many deaths are preventable and few patients require surgery. Intercostal chest drainage (ICD) for hemo/pneumothorax is simple and effective; the main problem is residual hemothorax, which can cause lung collapse and empyema. Aims: Our study aimed to analyze the relationship between radiological chest tube parameters (position and intrathoracic length) and the frequency of residual hemothorax. Settings and Design: This prospective analytical study was conducted in a large tertiary care hospital in north India over 2 years till March 2013. Materials and Methods: Patients of chest trauma aged 18-60 years, with hemothorax or hemopneumothorax requiring ICD insertion were included in the study. Bedside ICD insertion was performed as per current standards. Immediate post-ICD chest radiographs were used to record lung status and ICD position (chest tube zone and intrapleural length). Residual hemothorax was defined as any collection identified on radiological investigations after 48 hours of ICD placement. Statistical Analysis: Univariate analysis was performed with the chi-square test or Student's t-test as appropriate, while multivariate analysis using stepwise logistic regression; a P-value < 0.05 was significant. Results: Out of 170 patients of chest trauma, 154 underwent ICD insertion. Most patients were young (mean age: 31.7 ± 12 years) males (M:F = 14:1). Ninety-seven patients (57.1%) had isolated chest injuries. Blunt trauma (n = 119; 77.3%) and motor vehicle accidents (n = 72; 46.7%) were the commonest causes. Mean hospital stay was 9 ± 3.94 days, and mortality 2/154 (1.1%). Residual hemothorax was seen in 48 (31%). No ICD zone or length was significantly associated with residual hemothorax on univariate or multivariate analysis. Conclusion: Intrapleural ICD zone or length does not affect the frequency of residual hemothorax. [ABSTRACT FROM AUTHOR]

A 13-year-old girl, who did not receive any treatment for few hours following Road Traffic Injury (RTI), reported to the Casualty Department and found to have patent airway with clinically normal C spine, air-hunger (RR 42/minute), trachea deviated to left, distended neck veins and absent breath sounds on the right side. The chest X-ray she carried, done immediately after the injury, showed right sided tension pneumothorax. She was put on oxygen at 11 L/minute and an Intercostal chest tube drainage (ICD) was inserted on right side. Her oxygen saturation (40%) failed to improve. ICD bag showed continuous bubbling and air entry remained absent on the right side. An urgent right thoracotomy was done which revealed right main bronchus tear; the tear was repaired using interrupted Prolene® sutures. Patient recovered well and was discharged 10 days later in a stable condition. [ABSTRACT FROM AUTHOR]

Background: High voltage (>1000 V) electric injuries (HVEI) are rare, and dreaded due to profound myonecrosis and fatal arrhythmias. Trauma Centres are well equipped for acute and definitive treatment of injuries. Paucity of burn centres in Himalayan belt make trauma centres a prudent choice for management of HVEIs. We share our experience of HVEIs managed at our Level 1 Trauma Centre., Methods: Study conducted at All India Institute of Medical Sciences, Rishikesh. Patients enrolled from prospectively maintained Trauma Registry. HVEI defined as an electrical shock from a source running current of or more than 1000 Volts. All patients admitted to department of Trauma Surgery with diagnosis of HVEIs, over 17 months (May 2019-Sept 2020) included. Demographics, clinical course, morbidity and management noted. Data is presented descriptively., Results: Prevalence of HVEIs was 0.5% (n=8) among all trauma admissions; all patients were males with median age 25 years. Mode of injury accidental in 6 (75%). Seven patients (87.5%) had entry points in the upper extremity. All patients suffered thermal burns (median BSA 11%). Three patients (37.5%) had secondary fall, no concomitant injury found. Urine myoglobin & creatine kinase measured in all patients. No dysrhythmias detected in index or follow up ECGs. Four patients required emergent escharotomy, four underwent amputation. There was a median of 3 procedures per patient. Fasciotomy (n=6) and grafting (n=3) were commonest operative procedures. Multisystem involvement was seen in 3 patients. In-hospital mortality nil., Conclusions: HVEIs are rare injuries, predominantly affecting upper extremity of young males. Amputation rates approach 50% despite expeditious surgical management of extremity burn due to progressive myonecrosis. Creatine kinase and urine myoglobin did not correlate with renal failure; ECG monitoring wasn't advantageous in patients with normal index ECG in our study. Modest BSA doesnot rule out visceral damage. Delayed hollow viscus perforation is a possibility in HVEIs involving parietal wall. Vocational loss is common due to high amputation rates of affected extremity, most commonly upper limb. Trauma team is well trained to provide acute, definitive and intensive care, and level I trauma centres with their integrated services are well suited to manage victims of HVEIs in LMICs., Competing Interests: None., (IJBT Copyright © 2021.)