Association of injury pattern and entrapment location inside damaged buildings in the 2016 Taiwan earthquake.

BACKGROUND/PURPOSE: To explore the association of patient injury patterns and entrapped locations inside damaged buildings in the 2016 Taiwan earthquake. METHODS: A retrospective analysis was conducted using the Tainan incident registry system. Residents inside nine conjunctive, 16-story (49.3 m in height) reinforced concrete buildings were categorized as non-injured, injured, and dead. Residents were classified into different groups according to their entrapped locations in height and the severity of building damage. The field triage acuity and trauma severity among groups were compared. Statistical significance was set at the level of 0.05. RESULTS: There were 309 enrollees with 76 (24.6%) non-injured, 118 (38.2%) injured, and 115 (37.2%) dead. Residents either in the high floors (odds ratio [OR] = 2.9, 95% CI: 1.5-5.8, p = 0.003) or in the collapsed buildings (OR = 18.2, 95% CI: 7.6-43.6, p < 0.001) were more likely to be dead. Injured patients who were located in the high floors were more likely to have severe field triage acuities (adjusted OR = 14.7, 95% CI: 1.8-118.0, p = 0.012); intracranial hemorrhage (12.5%), intrathoracic injury (18.8%), or intra-abdominal damage (12.5%) (All p < 0.05); the need for emergency surgical intervention (31.3%, p = 0.035); and major trauma (18.8%, p = 0.001). Residents in the collapsed buildings were more likely to have a crush injury (80.0%, p < 0.001) or crush syndrome (80.0%, p < 0.001). CONCLUSION: People entrapped at different heights of floors or in differently damaged buildings could have a distinct pattern of injury. Our findings may facilitate strategic approaches of patients entrapped in damaged buildings and may contribute to future training for field searches and rescues after earthquakes.

Pneumatic colon injury following high pressure blow gun dust cleaner spray to the perineum.

INTRODUCTION: A pneumatic tool or air tool such as blow gun dust cleaner is a tool driven by compressed air and spraying of the perineum can insufflate the colon due to its high pressure and high flow rate. PRESENTATION OF CASE: We present a case of 4 year old boy who developed sudden onset of tense abdominal distention and developed peritonitis. Patient's family initially denied a history of trauma. Radiologic examination showed pneumoperitoneum and colon dilatation. Exploratory laparotomy revealed a tension pneumoperitoneum, bloody ascitic fluid, multiple site of ecchymosis and serosal tear of the colon and a minute perforation of transverse colon. Postoperative reinvestigation revealed that the patient's perineum was sprayed, using blow gun dust cleaner. DISCUSSION: Air from pneumatic tools produces column of air at pressure of 3.5-8.8kg/cm(2) and pressure greater than the resting anal pressure of 0.109kg/cm(2) force air to enter the colon when the perineum is sprayed. Different degree of colon injury results when airflow is greater than 1.46L/m, and/or intraluminal pressure greater than 0.109kg/cm(2). In most children, initial anxiety to tell the truth result in difficulty to obtain good history. CONCLUSION: Spraying of the perianal with excessive pneumatic force of greater than the resting anal pressure and high air flow rate causes multiple site colon injury and tension pneumoperitoneum due to colon perforation. Parent should be caution in children playing with high pressure pneumatic tool, and the importance of history is emphases for early correct diagnosis.