Trauma aetiology and cost in the Accident and Emergency Unit of the University of the West Indies

Trauma accounted for 37 percent of 22,311 patients seen in the Accident and Emergency Unit (A&E) at the University Hospital of the West Indies (UHWI) during 1996. Thirty-nine percent of injuries were intentional and 18 percent were due to motor vehicle accidents. Knives, machetes and rocks accounted for 75 percent of the injuries compared with 5 percent for gunshot wounds. Passengers were injured in about 40 percent of motor vehicle accidents and pedestrians in 19 percent. The admission rate was 16 percent and the orthopaedic clinic received 75 percent of the patients referred to specialist clinics. Victims of motor vehicle accidents made up a greater proportion of admissions (24 percent) than those of unintentional violence (13 percent). The average cost of caring for each patient in the A&E Unit was US$70 resulting in an annual cost of US$578,000.(AU)

Assessment of 2 preventive antibiotic protocols in burned patients: retrospective and comparitive study between Fort de France (Martinique, FWI) and Lyon (France) - abstract

In a retrospective study, we performed two preventive antibiotic policies in 60 severly burned patients. All patients with a Burn Surface Area (BSA) of > 40 percent received ceftazidime-amikacin in Fort de France and piperacillin-netilmicin in Lyon. In Fort de France, 20 percent of patients developed septic shock with a mortality rate of 67 percent. Gram negative bacilli were always responsible for septic shock, of which 50 percent were resistant to initial antibiotics. In Fort de France, the bacteriological ecology in the burn centre showed less methicillin-resistant Staphylococcus aureus (MRSA) than the hospital (p < 0.05) and the same sensitivity for Pseudomonas aeruginosa. In Lyon, 37 percent of burn patients had septic shock with a mortality rate of 82 percent. In 91 percent, responsible isolates were multiresistant to initial antibiotics (p < 0.05). Bacteriological ecology of the burn centre was different from the hospital with a MRSA rate of 36.6 percent (p<0.02) and 54 percent of multiresistant Pseudomonas aeruginosa ( p < 0.05). Preventive antibiotics appear to be ineffective in severely ill burned patients. (AU)

Early dermabrasion for deep dermal burns by means of sandpaper

Deep dermal burns are initially difficult to evaluate. They sometimes even undergo spontaneous healing. We present our own experience concerning the use of dermabrasion with sandpaper, a veritable alternative to early scar excision. Skin grafts are not always called for. The aesthetic results are excellent. Dermabrasion should be systematically considered for all deep dermal burns and particularly for scalding burn mechanisms or facial burns (AU)

Laryngeal mask airway and burned patients - abstract

During general anaesthesia of burned patients, airway control raises specific problems in patients with facial burns, when anaesthesia is required every other day and when grafts are done on the scalp. We studied 20 patients who required a total of 65 insertions of the laryngeal mask. There were no observed failures of insertion of the mask by either trained or untrained staff. Insertion of the mask is therefore easy even for untrained staff. Adequate ventilation was possible in all cases. There were no serious complications. The observed adverse effects were: sore throat, gastric dilation and dislodgement of the mask. It is concluded that this type of equipment should replace endotracheal intubation or facial masks in these clinical situations (AU)

Admissions for trauma at the University Hospital of the West Indies

Trauma accounted for 20 percent of all admissions to the general surgery wards of this University Hospital in a developing country. It was the most common reason for admission. This condition affects the young, males more commonly than females, and results in the need for operation in almost 40 percent of admitted trauma patients. Trauma surgery accounts for 17 percent of all operations done. Hospital stay and age are significantly greater in those requiring operation. The head, chest and abdomen are, in order of frequency, the most commonly affected areas of the body, and injury is mainly the result of interpersonal violence (52 percent), accidental injuries including burns (20 percent), and road traffic accidents (20 percent). In-patient mortality was 4.5 percent, significantly higher in older patients and mainly in those with head injuries and burns. Scarce resources and resource allocation mandate preventive measures to minimize the human and economic waste (AU)