Trauma surgery 2012

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JPNATC trauma surgery 2012

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Trauma surgery 2012

  1. 1. ANNUAL CENSUS 2012
  2. 2. Overview of EDTOTAL ED VISITS - 53454Red6%(3136)Yellow20%(10950)Green73%(38964)Brought death1%(404)
  3. 3. DISTRIBUTION OF RED AREA PATIENTSTRAUMA SURGERY PTS. (N=923)ADMITTED TRANSFER OUT DISCHARGED918 NIL 05
  4. 4. Admissions &InterventionsSurgery Admissions (N=1299 )Area No. admitted Transfer-outRed 918 NilYellow 381 5Green Nil NilED Interventions (N=22496)Procedure No.Suturing 22188ICDT insertion 265Cricothyroidotomy 15Venous cut-down 4SPC 24
  5. 5. DEMOGRAPHICPROFILETOTAL 1299 %MALE 1062 81%FEMALE 237 19%1162032793261891174920050100150200250300350
  6. 6. MODE OF INJURIES55%(709)25%(320)16%(210)3%(42)1%(18)RTIFFHASSAULTRAILWAYTRACTSUICIDAL1138 115 46BLUNT 90% STAB/ LV (9%) GSW(1%)
  7. 7. MODE OF RTIs212333328227212050100150200250300350RTIRIDER(n-270)PILLON(n-63)HELMET 167 29WITHOUTHELMET-41%103 34
  8. 8. Anatomical Distribution103 12139043377919688160100200300400500600700800900Head & Neck Face/ MF Thorax Abdomen Extremity& softtissueVascular Pelvis OtherNO. OF INJURIES - 2126
  9. 9. Abdominal TraumaPart involved NO.Solid Organ(Liver&Spleen)Single Organ 247MultipleOrgans33Hollow Viscera 154Genito-urinary 78Pancreatico-duodenal 19
  10. 10. LIVER TRAUMA -150MANAGEMENTOM 29OM + EMB. 9EMBOLIZATION 6NOM 87Laparotomy forother injuries1905101520253035404550I II III IV V16%(24)24%(36)31%(47)21%(32)8%(11)LIVER GRADEMORTALITY (12.7%) 19H.SHOCK/COAGULOPATHY11SEPSIS 08
  11. 11. SPLENIC TRAUMA - 130MANAGEMENTSPLENECTOMY 35EMBOLOZATION 15NOM 80SPLENORAPHY 00510152025303540I II III IV V5%(7)22%(28)28%(37)23%(30)22%(28)SPLEEN GRADE
  12. 12. HOLLOW VISCUS TRAUMA154HOLLOW VISCUSPROCEDURESEsophagus Primary Repair 2Cervicalesophagostomy3Stomach Repair 7Jejunum Repair +FJ 20RA + FJ 25Ileum Repair 12RA 13Ileostomy 9Colon+rectum Repair 10RA 9End colostomy 10Loop colostomy 8Stoma closure(routine - OT )Ileostomy reversalColostomy reversal1217Smallbowel56%(86)Largebowel25%(38)Esophagus3%(5)Stomach4%(7)Mesentictear12% (18)Region wise
  13. 13. PANCREATICODUODENAL TRAUMA-1930 085 3024681012OPERATIVENON OPERATIVEOPERATIVEDISTAL PANCREATECTOMY 06DISTAL PANCREATECTOMY WITH SPLENECTOMY 02DEBRIDMENT + NECROSECTOMY 02WHIPPLES’ PROCEDURE 00TRIPLE TUBE DRAINAGE 05UNCINATE PROCESS EXCISION +RESECTION OF D4 PART OFDUODENUM01MORTALITY = 03
  14. 14. Pancreatic Transections at Neck27 yr Male- Blunt trauma Abdomen
  15. 15. GENITOURINARY TRAUMA(79)MANAGEMENTKIDNEY Nephrectomy 5NOM 26NOM + PCN 5AE 0URETER DJ stenting 1REPAIR&DJ 1BLADDER NOM 3REPAIR&SPC 17URETHRA NOM 2SPC 13OTHERS Orchidectomy 2penile repair partial 3Hysterectomy 146%(36)3%(2)26%(20)19%(15)6%(5)KIDNEYURETERBLADDERURETHRAOTHERS
  16. 16. LAPROSCOPIC AND ENDOSCOPICPROCEDURES 19Diagnostic lap 8Lap foreign body removal(needle) 1Lap small bowel perf. repair 1Lap diaphragm repair 2Lap. ventral hernioplasty 2Upper GIendoscopydiagnostic3PEG 2
  17. 17. Thoracic Trauma (n=390)Non-operative – 358 (91.8%) Operative n=32With ICDT 335 INDICATIONFORTHORACOTOMYMassiveHemothorax06Resuscitativethoracotomy05Decortication 05Pneumonectomy 03Lobectomy 01Bronchial repair 01Thoracoplasty 02F.B removal 03With out ICDT 23 VATS 06Epidural 93FOB 12Descending thoracic aorta stenting (open access) 1Diaphragmatic repair(4-abdominal approach and 2-laproscopic)06
  18. 18. Cardiac injuries 7Site of injuryMechanisms of injuryBlunt 3Penetrating Stab 2GSW 2• LV + RV = 1• RV+RA = 1• RV =2• RA = 1• RV cardiac contusionbleeding from LIMA = 1• LV=1Mortality -3
  19. 19. PERIPHERAL VASCULAR TRAUMA112TIME SINCE INJURY <6HRS >6 HRSUPPERLIMB(n=77)CASES 49 26AMPUTATION 00 02LOWERLIMB(n=47)CASES 22 15AMPUTATION 01 09SUCCESS RATE 89.9%
  20. 20. MAJOR VASCULAR INJURY(16)VESSELINVOLVEDNO MANAGEMENTSUB CLAVIAN 03 REPAIR , STENTING , NOMIVC 02 REPAIRIJV 02 LIGATIONEXT. ILIAC VEIN 02 REPAIR, LIGATIONSUP GLUTEAL A 01 LIGATIONA V FISTULA(EIA-EIV)01 ENDO VASCULAR STENTINGEXT. ILIAC ARTERY 01 REPAIRIIA 01 LIGATIONAORTA 03 NOM -2 , STENTING
  21. 21. IVC RENT25 year male stab injury right lower hypochondrium
  22. 22. NECK INJURIES 25• ZONE I –(n- 01)• ZONE II – (n-22)• ZONE III –(n- 02)OPERATIVE =16SUB MANDIBULAR GLAND EXCISION 01TRACHEAL REPAIR + TRACHEOSTOMY 02LIGATION OF INT JUG VEIN 02F.B REMOVAL 02NON THERAPEUTIC EXPLORATION 03CERVICAL OESOPHAGOSTOMY 02PRIMARY REPAIR OF HYPOPHARYNX 02TRACHEAL REPAIR +CERVICALESOPHAGOSTOMY01HEMI THYROIDECTOMY 01NOM =08BRONCHOSCOPY+GLUE 01
  23. 23. 60Y male fall from 4th floor water pipe impalement
  24. 24. EXTRAHEPATIC BILIARY SYSTEM5CBD injury (blunt) 1 ERCP stentGB perforationGB Penetrating 2 CholecystectomyBlunt 1 CholecystectomyIncidental GB stones 1 cholecystectomy
  25. 25. MAXILLO FACIAL INJURIES(92)ORIF61%CONSERVATIVE26%INTRA DENTALWIRING13%ORIFCONSERVATIVEINTRA DENTAL WIRING
  26. 26. PROCEDURES FOR EXTREMITYINJURIESAK33%(35)BK16%(17)AEB9%(10)BEB4%(4)DISARTICULATION8%(9)REVISION30%(32)FASIOTOMIES57AMPUTATIONS107
  27. 27. PLASTIC PROCEDURES- 864• STSG - 518• DEBRIDEMENT – 147• STSG + D - 74• VAC - 151FLAPS. 69ABDOMINAL 9ROTATION 15GASTRONEMUS 11GROIN 4SURAL 10FREE 3CROSS LEG FLAP 7CROSS FINGER FLAP 4SCALP FLAP 2TRAM 2GRACILLIS FLAP 2RECONSTRUCTION SURGERY 31V-Y PLASTY 5CONTRACTURE RELEASE 12LOBULOPLASTY 8RHINOPLASTY 2OCULOPLASTY 1LIP REPAIR 2ECTROPION REPAIR 1
  28. 28. NERVE AND TENDONREPAIR -24MEDIAN NERVE 04ULNAR NERVE 09RADIAL NERVE 03TENDON REPAIR 07FACIAL NERVE 01REIMPLANTATION 12CASES(THREE CASES WERESUCCESSFUL- thumb ,distalfoot and hand at the level ofwrist)
  29. 29. Operative ProceduresTotal 1919Type of Ax No.GA 1307Spinal 481LA 29REGIONAL 102
  30. 30. Surgery mortality 14132 337601020304050607080<6Hrs 6-24Hrs LATEED1%(2)OT14%(19)ICU85%(120)
  31. 31. Overview ED mortalityMortality (N= 510)ED Death (0.2%of total)(3.44% of red area)Brought DeadSurgeryNeuroSxmedicine2 103 1 404
  32. 32. Early mortality( < 6Hrs )32HS88%(28)Severe Headinjury6%(2)Cardiac Injury6%(2)MEAN ISS – 48.61
  33. 33. EARLY MORTALITY (6-24HRs)Mean ISS – 29.62HS & sequelae94% (31)Severe Headinjury6% (2)
  34. 34. LATE MORTALITY >24HrsSepsis & sequelae31% (24)VAP to ARDS8% (6)Braininjury9% (7)ARF8% (6)DIC12% (9)ARDS7% (5)sepsis25% (19)HS Sequelae51%(39)
  35. 35. 015304560751 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89 93 97 101 105 109 113 117 121 125 129 133 137 141EXPIRED INDIVIDUALINJURY SEVERITY SCORE (ISS)MEDIAN = 27
  36. 36. We have dealt 12 multiple casualties.DATE MECHANISM NO OF VICTIMS2/2/2012 RTA(GRAMIN SEWA NOSE TOTAIL WITH A BUS)66/3/2012 RTA(nose to tail between twoRTV)928/3/2012 RTA(turn over of tempo) 1111/4/2012 RTA(nose to tail of RTV withbus)1325/4/2012 RTA(tempo turnover) 97/6/2012 RTA(side to side collision of2cars and then one car run over4 pedestrian)87/6/2012 RTA(side on collision of carwith an auto)57/7/2012 RTA(truck hit a fixedobject(pole))56/8/2012 RTA(bus hit a tree) 3810/10/2012 RTA(bus hit a tree) 1114/10/2012 RTA(minibus turnover) 625/11/2012 RTA(head on collision of twotruck)52/12/2012 ASSAULT 14
  37. 37. Summary• Change in trend in solid organ injury –liver more common thanspleen compared to previous years• Increase in non-operative management of solid organ injuries• Increase in limb salvage rate from 74.4 to 89.9%• Introduction of Upper GI endoscopy and Uretheroplasty• Decrease in overall mortality
  38. 38. Thank you

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