11 March 2004: The terrorist bomb explosions in Madrid, Spain--an analysis of the logistics, injuries sustained and clinical management of casualties treated at the closest hospital.

At 07:39 on 11 March 2004, 10 terrorist bomb explosions occurred almost simultaneously in four commuter trains in Madrid, Spain, killing 177 people instantly and injuring more than 2000. There were 14 subsequent in-hospital deaths, bringing the ultimate death toll to 191. This report describes the organization of clinical management and patterns of injuries in casualties who were taken to the closest hospital, with an emphasis on the critically ill. A total of 312 patients were taken to the hospital and 91 patients were hospitalized, of whom 89 (28.5%) remained in hospital for longer than 24 hours. Sixty-two patients had only superficial bruises or emotional shock, but the remaining 250 patients had more severe injuries. Data on 243 of these 250 patients form the basis of this report. Tympanic perforation occurred in 41% of 243 victims with moderate-to-severe trauma, chest injuries in 40%, shrapnel wounds in 36%, fractures in 18%, first-degree or second-degree burns in 18%, eye lesions in 18%, head trauma in 12% and abdominal injuries in 5%. Between 08:00 and 17:00, 34 surgical interventions were performed in 32 patients. Twenty-nine casualties (12% of the total, or 32.5% of those hospitalized) were deemed to be in a critical condition, and two of these died within minutes of arrival. The other 27 survived to admission to intensive care units, and three of them died, bringing the critical mortality rate to 17.2% (5/29). The mean Injury Severity Score and Acute Physiology and Chronic Health Evaluation II scores for critically ill patients were 34 and 23, respectively. Among these critically ill patients, soft tissue and musculoskeletal injuries predominated in 85% of cases, ear blast injury was identified in 67% and blast lung injury was present in 63%. Fifty-two per cent suffered head trauma. Over-triage to the closest hospital probably occurred, and the time of the blasts proved to be crucial to the the adequacy of the medical and surgical response. The number of blast lung injuries seen is probably the largest reported by a single institution, and the critical mortality rate was reasonably low.

Casualties treated at the closest hospital in the Madrid, March 11, terrorist bombings.

BACKGROUND: At 07:39 am on March 11th, 2004, ten terrorist bomb explosions occurred almost simultaneously in four commuter trains in Madrid, Spain, killing instantly 177 people and injuring >2,000. There were 14 subsequent in-hospital deaths, bringing the definite death toll to 191 victims. This article describes the organization of the clinical management and patterns of injuries in casualties who were taken to the closest hospital, with emphasis on the critical patient population. RESULTS: There were 312 patients taken to that center, and 91 were hospitalized, 89 of them (28.5%) for >24 hrs. Sixty-two patients only had superficial bruises or emotional shock, but the remaining 250 patients had more severe lesions. The data on 243 of the latter form the basis of this report. Tympanic perforation occurred in 41% of 243 victims with moderate-to-severe trauma, chest injuries in 40%, shrapnel wounds in 36%, fractures in 18%, first- or second-degree burns in 18%, eye lesions in 18%, head trauma in 12%, and abdominal injuries in 5%. Between 8:00 am and 5:00 pm, 34 surgical interventions were performed on 32 victims. Twenty-nine casualties (12% of the total or 32.5% of those hospitalized) were deemed in critical condition, and two of them died within minutes of arrival. The other 27 survived to be admitted to intensive care units, and three of them died, bringing the critical mortality rate to 17.2% (5/29). The mean Injury Severity Score and Acute Physiology and Chronic Health Evaluation II scores of critical patients were 34 and 23, respectively. Among these critical patients, soft-tissue and musculoskeletal injuries predominated in 85% of cases, ear blast injury was identified in 67%, and blast lung injury was present in 63% (17 cases). Fifty-two percent suffered head trauma. CONCLUSIONS: There was probably an overtriage to the closest hospital, and the time of the blasts proved crucial for the adequacy of the medical and surgical response. The number of blast lung injuries seen is probably the largest reported by a single institution, and the critical mortality rate was reasonably low.

[Magnetoencephalographic study in patients with cognitive impairment]. / Estudio magnetoencefalográfico en pacientes con deterioro cognitivo.

INTRODUCTION: In early stages, dementia is a neurodegenerative process with difficult diagnosis. Although well defined clinically, its neurophysiological, neuroradiological and metabolic diagnosis is still unsuccessful. PATIENTS AND METHOD: A MEG study using a 148 channel whole head magnetometer (Magnes 2500 WH) and evaluation by mini mental state examination (MMSE) was performed in 31 subjects. Statistical analyses was made to correlate number of dipoles of slow waves and neuropsychological variables. RESULTS: The 63.3% (21 patients) show slow waves dipoles in temporal lobes (52.3% were bitemporal). Right temporal lobe has 119.5 23.3 dipoles (averaged value), and left temporal lobe has 126.2 19.8 dipoles (averaged value). The 25% (8 patients) shown slow waves dipoles in parietals lobes, 5 of them biparietal. Correlation between MMSE averaged scores and temporal lobe dipoles was r= 0.84. CONCLUSION: MEG results show that slow waves dipoles number in temporal lobes is related with low scores in the mini mental state examination. MEG could be a usefully complementary method in evaluation and following of degree of cognitive impairment in these patients

Estudio magnetoencefalográfico en pacientes con deterioro cognitivo / Magnetoencephalographic study in patients with cognitive impairment

Introducción. La demencia es un proceso neurodegenerativo de difícil diagnóstico en su fase precoz. Se ha definido bien clínicamente, aunque su diagnóstico neurofisiológico, de neuroimagen y metabólico es todavía insuficiente. Pacientes y métodos. Se realizó registro magnetoencefalográfico (equipo whole-head de 148 canales Magnes 2500 WH) y valoración mediante examen minimental en 31 sujetos. Se realizó análisis estadístico para correlacionar el número de dipolos de ondas lentas con las variables neuropsicológicas. Resultados. En el 63,3 por ciento (21 pacientes) se objetivaron durante el análisis MEG dipolos de ondas lentas en lóbulos temporales, y en un 52,3 por ciento de éstos la localización era bitemporal. La media de los dipolos en lóbulo temporal derecho fue de 119,5 ñ 23,3, y en lóbulo temporal izquierdo de 126,2 ñ 19,8. Un 25 por ciento (ocho pacientes) presentaron dipolos de ondas lentas en lóbulos parietales y en cinco de ellos la localización fue biparietal. La correlación entre las puntuaciones medias del examen minimental y los dipolos en lóbulo temporal fue r= -0,84. Conclusión. Los hallazgos de la MEG indican que el número de dipolos de ondas lentas en lóbulos temporales se relaciona con puntuaciones bajas en el examen minimental. La MEG puede ser un método complementario útil en la evaluación y seguimiento del grado de deterioro cognitivo en estos pacientes (AU)

Introduction. In early stages, dementia is a neurodegenerative process with difficult diagnosis. Although well defined clinically, its neurophysiological, neuroradiological and metabolic diagnosis is still unsuccessful. Patients and method. A MEG study using a 148- channel whole-head magnetometer (Magnes 2500 WH) and evaluation by mini mental state examination (MMSE) was performed in 31 subjects. Statistical analyses was made to correlate number of dipoles of slow waves and neuropsychological variables. Results. The 63.3% (21 patients) show slow waves dipoles in temporal lobes (52.3% were bitemporal). Right temporal lobe has 119.5 ± 23.3 dipoles (averaged value), and left temporal lobe has 126.2 ± 19.8 dipoles (averaged value). The 25% (8 patients) shown slow waves dipoles in parietals lobes, 5 of them biparietal. Correlation between MMSE averaged scores and temporal lobe dipoles was r= -0.84. Conclusion. MEG results show that slow waves dipoles number in temporal lobes is related with low scores in the mini mental state examination. MEG could be a usefully complementary method in evaluation and following of degree of cognitive impairment in these patients (AU)