Disasters and mass casualties: II. explosive, biologic, chemical, and nuclear agents

Terrorists' use of explosive, biologic, chemical, and nuclear agents constitutes the potential for catastrophic events. Understanding the unique aspects of these agents can help in preparing for such disasters with the intent of mitigating injury and loss of life. Explosive agents continue to be the most common weapons of terrorists and the most prevalent cause of injuries and fatalities. Knowledge of blast pathomechanics and patterns of injury allows for improved diagnostic and treatment strategies. A practical understanding of potential biologic, chemical, and nuclear agents, their attendant clinical symptoms, and recommended management strategies is an important prerequisite for optimal preparation and response to these less frequently used agents of mass casualty. Orthopaedic surgeons should be aware of the principles of management of catastrophic events. Stress is less an issue when one is adequately prepared. Decontamination is essential both to manage victims and prevent further spread of toxic agents to first responders and medical personnel. It is important to assess the risk of potential threats, thereby allowing disaster planning and preparation to be proportional and aligned with the actual casualty event.     

Level I center triage and mass casualties

The world has been marked by a recent series of high-profile terrorist attacks, including the attack of September 11, 2001, in New York City. Similar to natural disasters, these attacks often result in a large number of casualties necessitating triage strategies. The end of the twentieth century was marked by the development of trauma systems in the United States and abroad. By their very nature, trauma centers are best equipped to handle mass casualties resulting from natural and manmade disasters. Triage assessment tools and scoring systems have evolved to facilitate this triage process and to potentially reduce the morbidity and mortality associated with these events.     

成批烧伤病人的救治体会

目的 探讨保证成批烧伤病人救治顺利进行的方法和措施。方法 从成批烧伤的现场、休克期处理,以及抢救工作的组织领导、伤员的转送时机、事故的预防几个方面,总结了１９７０年至今２２批４０３例成批烧伤的救治经验和体会。结果 ２２批４０３例病人中治愈３８２例,治愈率９４．７９％。结论 只要组织、措施和治疗方法得当,成批病人的救治,可以取得满意的效果。     

Traditional artificial ventilation. General principles

Mechanical ventilation is generally applied on patients affected by acute respiratory failure (ARF) on the basis of hemogasanalysis, hemodynamics and X-ray features. The modification of ventilatory pattern is based on problem the modification of data concerning mechanical variation. In this study the most important mechanical measures and their consequences on ventilatory strategy are discussed.     

Amputations in natural disasters and mass casualties: staged approach

Amputation is a commonly performed procedure during natural disasters and mass casualties related to industrial accidents and military conflicts where large civilian populations are subjected to severe musculoskeletal trauma. Crush injuries and crush syndrome, an often-overwhelming number of casualties, delayed presentations, regional cultural and other factors, all can mandate a surgical approach to amputation that is different than that typically used under non-disaster conditions. The following article will review the subject of amputation during natural disasters and mass casualties with emphasis on a staged approach to minimise post-surgical complications, especially infection.     

Prenatal testicular torsion: principles of management.

To assess our experience with in utero testicular torsion, we retrospectively studied all newborns presenting in the newborn nursery with a diagnosis of neonatal testicular torsion. A total of 25 consecutive cases of torsion of the spermatic cord in 23 patients was identified and explored on an emergency basis. To our knowledge this represents the largest single institution series and 40% of all of the confirmed cases reported in the literature. No viable testicles were found. We strongly believe that torsion of the testis presenting at birth represents an irreversible intrauterine event best treated in an early elective setting. We suggest an inguinal approach with contralateral orchiopexy in all patients who present with signs and symptoms of prenatal (in utero) testicular torsion.     

General principles for the clinical organization and management of a surgical unit

Because health-care costs and demand for services are both rising, appropriate management of resources is yet another essential consideration in efficient clinical practice. Surgical units, with their special features, are a particular focus of attention. Although it is possible to study the circumstances of each hospital individually, in fact surgical units often share the same management concerns. Currently, surgical units are often reorganized and provided with an Operating Room Committee, a Medical director or coordinator and operational protocols, such that the unit is considered a system rather than a sum of its individual parts. Work is goal-oriented, with starting and ending points, flexibility in use of surgical theaters, reserve capacity for unscheduled surgery, low cancellation rates and good output; the use of time indicators is considered essential. Other factors to bear in mind when managing a surgical unit are the universalization of information, which should be accurate and up to date, the involvement of teams such as that of anesthesia and recovery, scheduling that is realistic and tight, the appropriate design and use of circuits, and the use of techniques for continuous improvement and problem solving. Some programs, such as that of major outpatient surgery, orthopedic surgery and others may have special needs.