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The New Age of Trauma Resuscitation – Introducing Tranexamic Acid in an Accident & Emergency Department in Karachi Pakistan

Vol 5 | Issue 1 | Jan-April 2019 | page: 10-13  |Muhammad Muzzammil, Muhammad Saeed Minhas, Jahanzeb Effendi, Syed Jahanzeb, Muhammad Ovais, Azeem Jamil, Ayesha Mughal, Abdul Qadir


Author: Muhammad Muzzammil[1], Muhammad Saeed Minhas[2], Jahanzeb Effendi[3],   Syed Jahanzeb[2], Muhammad Ovais[1], Azeem Jamil[2], Ayesha Mughal[2], Abdul Qadir[2]

1Department of Orthopedics, Dr. Ruth K M Pfau Civil Hospital , Karachi.
2Department of Orthopedics, Jinnah Post Graduate Medical Centre, Rafiqui Shaheed Road, Karachi.
3Department of surgery, MC 7742, San Antonio.

Address of Correspondence
Dr. Muhammad Muzamil,
Department of Orthopedics, Dr. Ruth K M Pfau Civil Hospital , Karachi.
Email: muzzammil_sangani@hotmail.com


Abstract

Background: In traumatic patients there is increase loss of blood and requires excessive blood transfusion as compared to other diseases. Clinical efficacy and clinical safety of tranexamic acid in decreasing blood loss assess during this study in post traumatic patients.
Method: Prospectively conducted randomized doubleblind placebo controlled study carried out. Patients were blindly randomized into two groups to receive either intravenous 1gm tranexamic acid 20 min or similar volume of 0.9% saline as placebo (P). Inclusion criteria was based on pulse rate >110 per min or systolic pressure level <90mmHg, hemorrhage or in danger of serious hemorrhage.Patients’ total blood loss was measured, needs of transfusion and hospital stay recorded. The post traumatic hemoglobin, hematocrit values, serum creatinine, activated thromboplastin time, prothombin time, platelets count and pulmonary embolism symptoms were comparatively evaluated.
Results: The total measured blood loss in tranexamic acid group (276 ± 53 mL) when comparing to control group (523 ± 74 mL) was less significantly. The requirement of blood transfusion in comparison was high in the control group and post traumatic hematocrit values were higher with in the tranexamic acid group. After administration of tranexamic acid in traumatic patients there have been no clinically relevant differences within the vital signs and no thromboembolic complications were detected in either group.
Conclusion: In traumatic patients, the prophylactic usage of tranexamic acid has effectively decreased blood loss, transfusion needs and hospital stay without any complication or adverse effects of thrombosis. Thus, TXA can be used safely and effectively in trauma subjects.
Keywords: trauma, tranexamic acid, blood loss, transfusion, hospital stay.


References

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How to Cite this article:  Muzzammil M, Minhas M S, Effendi J, Jahanzeb S, Ovais M, Jamil A, Mughal A, Qadir A. The New Age of Trauma Resuscitation – Introducing Tranexamic Acid in an Accident & Emergency Department in Karachi Pakistan. Trauma International Jan-April 2019;5(1):10-13.

 



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Triage in Mass Casualty Incidents: Our Preparedness and Response – A Cross-sectional Study from a Tertiary Care Hospital, Karachi, Pakistan

Vol 4 | Issue 3 | Sept-Dec 2018 | page: 6-10 | Nandkishor B. Goyal, Sayyadshadab S. Jafri, Ashish Vinayak Patil, Aashish Babanrao Ghodke.


Author: Muhammad Qasim Ali [1], Muhammad Muzzammil [2], Zehra Batool [3], Muhammad Saeed Minhas [2].

[1] Intern MBBS, Orthopedics ward 17, Jinnah Postgraduate Medical Centre, Karachi, Pakistan,

[2] Department of Orthopedics Ward 17, Jinnah Postgraduate Medical Centre, Karachi, Pakistan,

[3] Department of Orthopaedics, Medical Student Jinnah Sind Medical University, Karachi, Pakistan.

Address of Correspondence

Dr. Muhammad Qasim Ali,
Orthopedics ward 17, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
Email: m.qasim_ali@hotmail.com


Abstract

Background and Objectives:

Trauma is the major concern of the modern world. The ever-intensifying number of causalities being presented with the scarcity of resources, heavily burdens the emergency departments, which are the fundamental centers of a hospital. For a smooth flow and an efficient ER, implementation of a strong triage system with trained emergency staff personnel remains a dire necessity. The present study is aimed to review the awareness and implication of triage among emergency personnel, to evaluate the preparedness of emergency staff involved in the management of massive trauma casualties and highlight the self-identified deficiencies of the hospital and pre-hospital system.

Methods: A cross-sectional study was conducted to evaluate the preparedness, knowledge, and implication of triage by emergency room personnel at Accident and Emergency Department, Jinnah Postgraduate Medical Center, Karachi. The target population for the survey included casualty medical officers (CMOs), assistant casualty medical officers (ACMOs), nursing staff, and casualty operation theatre staff working in all three shifts morning, evening and night from December 2016 to February 2017.

Results: Of the 126 respondents questioned, 32% had no concept of triage. 70% of the respondents mentioned that they have never witnessed any patient already triaged brought to their ER indicating a poor onsite triage system. Only 23% (n = 29) received any training for triage before in past 5 years. Therefore, 97.61% emphasized the need of refresher training programs. On testing with standard scenarios of triage, it was investigated that 27 out of 126 participants answered all the questions correctly. No training drill or courses had been conducted for disaster management of the surveyed hospital.

Conclusion: Effective and early disposal of patients from accident and emergency needs trained triage team. Thus, it is imperative that training of ER personnel to be conducted as a continuous process. This study finding will be useful for planning future triage awareness programs in the form of classroom courses and hospital drills to curb mass casualties.

Keywords: Triage, Emergency personnel, Trauma, Bomb blast, Mass incidents.


References

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How to Cite this article:  Ali M Q, Muzzammil M, Batool Z, Minhas M S. Triage in Mass Casualty Incidents: Our Preparedness and Response – A Cross-sectional Study from a Tertiary Care Hospital, Karachi, Pakistan. Trauma International Sep-Dec 2018;4(3):6-10.

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