Tej Prakash Sinha

By Dablu Lal Gupta, Tejparkash Sinha, Sanjeev Bhoi and D.N. Rao

Trauma is a significant problem across the globe with mortality more than 50%. Despite the advancement of pre-hospital care to trauma patients, early resuscitation in the emergency department, surgical interventions and intensive care monitoring mortality rate has not improved yet. The higher rate of mortality in trauma patients is usually associated with development of complications such as sepsis, septic shock, and MOF which may occur due to hysterical immune inflammatory responses. Trauma patients who developed these complications in the ICU have comparatively higher chances of mortality. Cytokines are very important for host immune response against infections and play vital roles in the regulation of innate and adaptive immunity. The slanted expression of cytokines due to trauma may be involved in development of sepsis and related complications. The recently published work from various studies suggested that slanted expression of cytokines correlates with the variations in the promoter and structural regions of cytokine genes, which may be responsible for inter-individual differences in susceptibility to sepsis. Therefore, understanding the variations in cytokine genes and associated outcomes due to trauma would possibly contribute to the event of latest genetically changed diagnostic and therapeutic interventions that will improve the outcome in post-traumatic sepsis patients.

Part of the book: Infectious Process and Sepsis

By Tej Prakash Sinha, Brunda RL, Sakshi Yadav and Sanjeev Bhoi

COVID-19 has affected millions worldwide. To combat the infectious pandemic in resource limited settings, healthcare workers and techies have come up with multiple innovations. Nations with scarcity of resources have resorted to innovative strategies involving optimal utilization and repurposing of available commodities to overcome the demand–supply mismatch. Emergency rooms overburdened with diseased population are resorting to local innovative ideas to overcome obstacles in COVID-19 patient care. Point of care testing strategies in emergency rooms, sampling booths to reduce Personal Protective Equipment (PPE) use, disinfection strategies such as tunnel disinfection and local production of sanitizers, face masks/shields, aerosol containment chambers, novel triage protocols, telehealth care strategies reaching out to remote population and utilizing point for care ultrasound for resuscitation are few of the novel innovations which have benefitted medical fraternity and patient care in testing times. Medical innovations have emerged as the positive outcome of otherwise devastating COVID-19 pandemic. These practice changing innovations could also prove beneficial in future infectious pandemics.

Part of the book: SARS-CoV-2 Origin and COVID-19 Pandemic Across the Globe

By Sakshi Yadav, Anuj Ajayababu, Tej Prakash Sinha and Sanjeev Bhoi

Pain is one of the most common complaints and yet one of the most neglected aspects of management in the emergency department. Optimal pain management is a nuanced skill which focusses on reduction of pain to an acceptable level to allow for safe discharge and return to normal activities, in addition to improving patient satisfaction and comfort during their stay in hospital. Adequate analgesia also improves physiological parameters such as heart rate and blood pressure. The aim is improving rather than eradication of pain altogether while maintaining an acceptable level of adverse effects. This chapter will discuss assessment of pain in the emergency department along with various modalities of pain management with specific focus on newer modalities including ultrasound guided regional nerve blocks. Ultrasound guided nerve blocks are associated with better analgesia and have fewer chances of drug related adverse events, especially in older patients and those with comorbidities where large doses of systemic medications are associated with a significant risk of adverse effects.

Part of the book: Pain Management

By Akshaya Ramaswami and Tej Prakash Sinha

Abdominal trauma is difficult to identify, especially in a patient with multiple injuries. Mechanism of injury can guide us to the likely organs injured, but the extent and location cannot be accurately pinpointed in most cases. Owing to the multitude of structures located in the abdomen, timely identification and appropriate intervention are crucial to ensure the good patient outcomes. Focused assessment with sonography in trauma (FAST) and its extended version (eFAST) has become the standard care as per ATLS guidelines in patient evaluation. The main goal is to identify hemoperitoneum, hemothorax, and/or pneumothorax. However, sonography can be applied to detect varying injuries to abdominal viscera, beyond the elementary eFAST examination. This includes assessment of solid organs, hollow viscus, vascular structures, and even soft tissues. Sonography, when wielded with necessary knowledge and practice, can be an incredible asset at the bedside. This chapter aims to explore these possible applications of point of care ultrasonography (POCUS) in abdominal trauma.

Part of the book: Abdominal Trauma