The injury pattern and outcomes among elephant attack survivors presenting to the emergency department: A retrospective observational study.

BACKGROUND: Human-elephant conflicts (HECs) are becoming a disturbing public health concern in eastern India. This study highlights the pattern of injuries, epidemiological factors, and outcomes among the victims who survived an elephant attack (EA). METHODS: This retrospective observational study was conducted in a tertiary care hospital. Data were retrieved from the medical records of EA victims who presented to the emergency department of the hospital over five years (January 2019-January 2024). Data regarding sociodemographic characteristics, injury mode, injury pattern, radiological findings, emergency procedures, and outcome variables (admission, length of intensive care unit and hospital stay, and death) were collected. RESULTS: In total, 45 EA victims were included in this study. The mean participant age was 45.8 ± 14.57 years. Of the total participants, 35 (78 %) were men. Most EAs [n = 18 (40 %)] occurred in the forest area and during the early morning hours between 4am and 8am [n = 18 (40 %)] of the winter season [n = 37 (82 %)] and were unprovoked [38 (84 %)]. Of the total injuries, 26 (67 %) injuries were due to the direct mode of EA and 13 (33 %) were due to the indirect mode. The most common mechanism of EA was using the trunk and foot [20 (51 %)], followed by the tusk [6 (15 %)]. The median ISS in victims was 20 (13-29). The median AIS score of chest injuries was 1 (0-3). Thirteen (29 %) patients were positive on e-FAST. Of the total EA victims, 12 (26 %) were admitted to the intensive care unit (ICU) and 17 were admitted to the wards. Severe chest injury (AIS score ≥ 3) (p = 0.003), direct mode of injury, and polytrauma (ISS > 16) were identified as significant factors contributing to ICU admission. The median ICU stay of the victims was 6 (3-8) days, and the median length of hospital stay was 7 (0.5-11) days. One inpatient mortality was noted. CONCLUSION: Middle-aged men were the most common victims of EA occurring during the early morning hours. Extremity and soft tissue injuries were most common, followed by chest and abdominal injuries. Severe chest injury resulted in ICU admission and extended hospitalization.

Anesthetic challenges in a patient with Hirayama disease with quadriparesis and autonomic dysfunction undergoing cervical spine surgery.

Hirayama disease is a rare neurological disorder, characterized by muscular atrophy of the distal upper extremities. The occurrence of spastic quadriparesis and autonomic dysfunction is rarely reported and has important perioperative considerations during cervical spine surgery for the treatment of this disorder. The role of the anesthesiologist is vital in the thorough assessment of the patient for the involvement of the pyramidal tract, autonomic dysfunction, gastroparesis, hyperreactive airway disease, and documentation of neurological deficits. Intraoperative concerns include safe manipulation of the airway during mask ventilation and the use of a flexible fibreoptic bronchoscope during endotracheal intubation to prevent neck flexion. It is also essential to avoid drugs, leading to histamine release. The use of multimodal monitoring including bispectral index and neuromuscular monitoring is crucial to prevent delayed recovery. Anticipation and management of exaggerated hypotension in response to anesthetic induction agents and prone position is the key to a successful outcome in patients with autonomic dysfunction.