ROLE OF ULTRASOUND IN MANAGEMENT OF PATIENTS WITH HEMOTHORAX FOLLOWING BLUNT TRAUMA CHEST

Aims: To study the Clinical and Ultrasonographic prole of patients presenting with blunt trauma chest and to compare these ndings in patients who underwent either tube thoracostomy or were managed conservatively. This prospect Settings and Design: ive study was carried out in the Departments of Surgery and Radiodiagnosis, Gobind Singh Medical College and Hospital, Faridkot(Punjab). The study was approved by the Institutional Ethics Committee. A total of 60 patients of Blunt Trauma Chest patient presenting to the Department of General Surgery,Guru Gobind Singh Medical College and Hospital,Faridkot were assessed and included in the study based on the Inclusion and Exclusion Criteria of the study. Methods and Material:The vitals,symptoms and signs of all patients were recorded. A Frontal Chest X-ray was performed on all patients after which thoracic ultrasound was done using Philips Afnity 70 and Clearview machines using 3.5-5MHz transducers.Based on the quantity of hemothorax,patients were divided into two groups-One group was managed conservatively and the other group with Tube Thoracostomy.Patients with volume of Hemothorax more than 500ml or with Hemothorax less than 500ml but had respiratory distress were managed by Tube Thoracostomy while rest of the patients were managed conservatively.Serial follow up Chest Xrays and Ultrasound examinations were done on days 3,5 and 7. The present study inferred that a total of 60 patients, out of which 41 Results: patients were managed conservatively and 19 patients were managed by Tube Thoracostomy . Majority of patients (68.33% in present study) with hemothorax following blunt trauma chest, even those with multiple rib fractures did not require tube thoracostomy and could be successfully managed conservatively. Availability of emergency ultrasound helps in diagnosis and quantication of Hemothorax volume, which aids in conservative management of patients who would have otherwise underwent Tube Thoracostomy. Ultrasound signicantly changes the managem Conclusions: ent of patients with Hemothorax following Blunt Trauma Chest.Thus,we recommend routine use of ultrasound thorax for assessment of Hemothorax volume in clinically stable patients.

Effectiveness of transdermal NSAID administration in analgesia for rib fracture patients: a comparative study with intravenous NSAID administration

Background: Simple rib fractures are the most common injuries sustained following blunt trauma chest, accounting for more than half of thoracic injuries from nonpenetrating trauma. Looking into new modalities of administration like transdermal patches helps reduce morbidity in such patients with minimal side effects. The objectives of this study were to assess the effectiveness of transdermal NSAID administration in analgesia for rib fracture patients and to compare the effectiveness with intravenous NSAID administration.Methods: A prospective study comprising of 50 rib fracture patients who presented to the Emergency Medicine Department at RL Jalappa Hospital and Research Centre, Tamaka, Kolar. Study group were administered transdermal NSAID and the control group were administered intravenous NSAID.Results: Of the 50 subjects studied, 9 were female and 41 were male. Group A in which transdermal NSAIDs were administered consisted of 2 females and 23 male subjects while Group B in which intravenous NSAIDs were administered consisted of 7 females and 18 male subjects. The comparison was made between the two groups. The study results showed that the analgesia effect with transdermal NSAID administration is slow in onset as evidenced by higher VAS readings on day 1 whereas it is comparable with analgesia effect of intravenous NSAID administration in the long run as evidenced by VAS readings on day 3.Conclusions: Transdermal NSAID administration is effective in analgesia for rib fracture cases. The analgesia effect with transdermal NSAID administration is slow in onset as evidenced by high VAS readings on day 1 whereas it is comparable with analgesia effect of intravenous NSAID administration in the long run as evidenced by VAS readings on day 3.