EDITORIAL
Learn
from us
The knowledge that
Pakistan is eventually wary of glorification of
terrorists as heroes will give many of us a sort of
vicarious pleasure. It proves that the wearer alone knows
where the shoe pinches. One may find easy to ride the
tiger of the terror and spread mayhem but one cant
but become aware of ones own vulnerability while
trying to get off it. Nevertheless, the remedy proposed
by Pakistan Information Minister Sheikh Rashid to stop
the veneration of the killers is worse than the disease.
According to a newspaper report, he has held out a
warning to his countrys print and electronic media
against perpetuating the cult of the worship of the
terrorists and threatened to take ...........more
Jammu
Press Club
The Jammu Press Club has
added a feather in its cap by organising an extremely
warm and highly successful reception during the recent
visit of the Pakistan journalists. It has splendidly
risen to the big occasion. As the only elected body of
media persons from all regions of the State, the Club no
doubt holds a unique position, which nobody can and
should ignore. Its location on the bank of the Tawi also
gives it a distinctive look. At a time when such
institutions are unfortunately threatening to become
merely waterholes in at least some places in the country
it is a matter of immense satisfaction that our Press
Club has shown the capability to be outstandingly
different. It should keep up its good work by actively
involving its members......more
|
|
SAFMA's
face to face with realisation
Men, Matters & Memories
By M L Kotru
Interesting indeed it was
for me to be able to attend some of the sessions of the
South Asian Free Media Association (SAFMA) over the
week-end. The three-day session spilled over to Monday.
The most remarkable thing was to see journalists from
India, Pakistan, Bangladesh, Nepal and Sri Lanka, each in
.......more
Odd
solution and evened men!
Yours Randomly,
By Dr. R. L. Bhat
A tale is told of a blind
man walking of a dark night, with a lighted lamp in hand.
A wise one laughed at his folly and asked,
"Night and day are all the same to you. What do you
need this lamp for?" The blind man replied
earnestly, "It is not for me; it is for thee lest
you stumble against me". It is instructive to
remember this tale when talking of the visit of Pak
journos and its after math. It may be that the visiting
.......more
Resuscitation
of trauma
Brig. (Dr.) Yudhvir Suri, VSM
Trauma is considered the
disease of the 21st century with revolutionary
industrialization and time save high speed transport
system. It is the leading cause of morbidity and
mortality in India today, more so, in the younger
population, leaving many families financially ....more
|
EDITORIAL
Learn from us
The knowledge that
Pakistan is eventually wary of glorification of
terrorists as heroes will give many of us a sort of
vicarious pleasure. It proves that the wearer alone knows
where the shoe pinches. One may find easy to ride the
tiger of the terror and spread mayhem but one cant
but become aware of ones own vulnerability while
trying to get off it. Nevertheless, the remedy proposed
by Pakistan Information Minister Sheikh Rashid to stop
the veneration of the killers is worse than the disease.
According to a newspaper report, he has held out a
warning to his countrys print and electronic media
against perpetuating the cult of the worship of the
terrorists and threatened to take action against them if
they failed to fall in line. To quote his exact advice to
the media: Dont present terrorists as heroes,
we warn you. Terrorists want to live by the media.
Dont play into their hands. He has left no
doubt that if his plea is not heeded then
well see what we can do. In tune with this
thinking, the Pakistan Government has reiterated in a
statement that it would not be averse to using the
Anti-terrorism Amendment ordinance of 2001against those
not following its suggestion. What appear to have
offended the official machinery in the neighbouring
country are the interviews of al-Qaeda sympathisers
carried out by certain private television channels. In
the government parlance it obviously means an attempt to
praise the terrorists and criminals. As is
the case with the governments in these instances, one in
Pakistan also wants the help of the media in exorcising
the land of the evil. It is presently in the thick of a
battle against the militancy and, therefore, is
confronted with a situation in which it regards a
spokesman of the terrorists groups as also a terrorist
and any publicity of their activities as anti-national.
It is not surprising that the Pakistan Government regrets
having garlanded the terrorists in the past
which as Mr Rashid has stated now was a wrong
decision.
If Mr Rashids words
have a familiar ring it is because we in this country
have gone through the worst form of the terrorism
sponsored and patronised, ironically, by Pakistan first
in Punjab and then in our State. The people in the
authority would time and again advise us not to eulogise
the destroyers of peace. At times they would go to the
extent of verbally telling us to completely shut all
information about the militant outfits. An interview with
one militant leader or the other would cause them
sleepless nights. However, they were by and large
helpless in dictating their terms to the media because of
the enormous freedom we enjoy under our Constitution. How
can the newspapers or television channels ignore one
section of players in the field when there are only two
of them at a given point of time? Of course, responsible
media persons would never laud or publicise the acts of
violence. To the contrary they would condemn them
straightway as many have done it in this country boldly
and bravely making a supreme sacrifice in the process.
Applying the same logic as in the case of the terrorists
quite a few newspaper commentators have expressed their
strong disapproval of the Kuka Parray cult encouraged at
one time by the official machinery in the Valley in
particular. On several occasions, the terror at its peak
had virtually gagged many newspapers and their editors
and publishers. One has seen this dastardly occurrence
both in Punjab and on the home turf. Its practitioners
would dictate what is fit to print even though it may
have been totally untrue and unpalatable to reason. There
are examples of the editors sitting at home and their
newspapers being printed in their absence carrying the
information that they would have normally spiked. They
have suffered the pain and anguish of their names in
print lines being disgustingly misused and at the same
time not being allowed to close their shop.
This is not to say that
there were no newspapers simply cheering the militants
all the way. Indeed, some of them had been helpful in
building the larger-than-life images of those holding
guns in their hands. What has been their fate? If one
were spared the trauma of naming them, one would find
that they are eating their words. They are not able to
retain the circulation they had built in the immediate
aftermath of the eruption of the terrorism. Their heroes,
if they have survived, have themselves fallen by the
wayside. These newspapers have also immensely lost their
credibility. All this happens in an open society because
the ordinary citizens who are the arbiters in such
situations can always distinguish the right from the
wrong even though they are too helpless to speak in the
face of a vicious tussle of the gun. People understand
everything. The experience in our State as well as Punjab
has shown that they react silently withdrawing their
patronage to newspapers and television channels they are
convinced are out of touch with reality. Therefore, the
Pakistan Government will do well to learn from what has
happened in this country. Ban on newspapers or the
imposition of restrictions does not help. In real life it
has the tendency to boomerang on the administrative
system itself. For the Pakistan Government the best
choice will be to ensure that there is no let-up in its
well-intended and overdue fight against the terrorism. It
must go ahead with its spirited battle to restore sanity
and order. Its key functionaries should not waste their
time and energy by picking up frivolous controversies.
They can rest assured that the demons dont become
gods just because their pictures are published or
televised too often. If they pursue their mission with
single-mindedness they will find that they are the
deserving recipients of the applause of one and all in
the end.
Jammu Press Club
The Jammu Press Club has
added a feather in its cap by organising an extremely
warm and highly successful reception during the recent
visit of the Pakistan journalists. It has splendidly
risen to the big occasion. As the only elected body of
media persons from all regions of the State, the Club no
doubt holds a unique position, which nobody can and
should ignore. Its location on the bank of the Tawi also
gives it a distinctive look. At a time when such
institutions are unfortunately threatening to become
merely waterholes in at least some places in the country
it is a matter of immense satisfaction that our Press
Club has shown the capability to be outstandingly
different. It should keep up its good work by actively
involving its members from the Kashmir region. Of course,
the Clubs young leaders and members are well aware
of their responsibilities. They have proved beyond any
shadow of doubt that they can live up to the toughest of
challenges and can carry out their job efficiently and
effectively. This augurs well for journalism in this city
in particular and the State as a whole. There can hardly
be any doubt about this.
|
SAFMA's
face to face with realisation
Men, Matters & Memories
By M
L Kotru
Interesting
indeed it was for me to be able to attend
some of the sessions of the South Asian
Free Media Association (SAFMA) over the
week-end. The three-day session spilled
over to Monday. The most remarkable thing
was to see journalists from India,
Pakistan, Bangladesh, Nepal and Sri
Lanka, each in his own way, trying to act
as a bridge builder in an area riven by
disputes.
SAFMA by
itself is an innovative phenomenon which
provides a platform for journalists from
the region to discuss issues face to
face. It is obvious the success or
failure of the nascent institution will
depend on how straight and honest the
participants are in stating their
positions and also on how strong is their
commitment to the cause of building
permanent bridges.
During the
discussions in New Delhi one was glad to
notice the seriousness which a majority
of participants tried to bring to their
discussions. It is a pity though that the
discussions for the most part remained
unreported by the capitals's media, bar
one or two exceptions and with at least
one paper deciding to yield a few inches
of space to the deliberations for two
days. A reflection perhaps of the fact,
as stated at one of the sessions by Arun
Shourie, that Indian papers, unlike in
the past, are now known by the name of
their owners and not, as in the past, by
the names of their Editors. If this be
the case in India, it should not be
difficult to imagine the media scene in
the neighbourhood. Yet, one does not have
to go whole hog with Shourie. The
journalist community can still influence
decision-making in a manner that no
prorietor or proprietor's body can.
Polemcis
aside, the most interesting aspect of the
SAFMA regional conference was that it
enabled the large Pakistani contingent to
score a first as it were after 1947. It
made them the first Pak journalists to
visit Jammu and Kashmir after the
partition. This by itself was a
significant achievement, one that needs
to be persisted with on both sides of the
border. The Pakistani scribes returned to
Delhi a happier and somewhat sober lot,
to end their visit with three days of
speechifying at New Delhi's Ashoka Hotel.
For one
thing, they were face to face with the
realization that most Kashmiri Muslims
they interacted with were not
particularly in favour of acceding to
Pakistan. Almost everyone, except
hardened separatists like Syed Ali Shah
Geelani and his ilk, wanted to join
Pakistan. There were some tough
encounters as well, one at least that
witnessed a bizarre display of bad
manners by the host at their meeting with
the irascible JKLF leader, Yaseen Malik
in Srinagar. This man has over the years
come to think of himself as the ultimate
martyr to the cause of Kashmiri Muslims'
emancipation. Characteristically he chose
to question the Pakistani's integrity
''and their indifference to the
sufferings of Kashmiri Muslims''. A woman
member of the Pak delegation ticked him
off for his insolence and the JKLF leader
was also reminded of the opulence he was
surrounded by.
Bar this
incident and another on their visit to
the Kashmir University, the visiting
journalists obviously had a
professionally rewarding experience.
Apart from the overwhelming support for
'Azadi' which the visitors
''discovered'', the only major pro-India
presentation was the one made by the
National Conference and, of course, by
the Congress Party.
An
''eye-opener'', one which obviously did
not open all Pakistani eyes, was the
presentation made on behalf of the
Kashmiri Pandit migrants in Jammu. A
senior Pakistani journalist told me later
that he was totally unaware of this
aspect of the problem. The very
articulate and persistent Dr Ajay
Chrangoo of Panun Kashmir, insisted on
the visitors having a session with
migrants; he later joined the journalists
in New Delhi where he once again took up
the cudgles on behalf of the displaced
Pandits. Not that there were many takers
for his views among the Pakistanis but
that never deterred him.
Talking to
another Pak journalist on the last day of
the conference I was astonished when he
told me that Kashmir was essentially a
Muslim problem. Pakistan was not
concerned about demographics it just
wanted that all Muslim majority areas
come to it. Which brings one to the point
raised in another conversation on the
sidelines. Why wasn't Pakistan addressing
the problem of cross-border terrorism?
Why did it allow training camps, run by
seemingly banned fundamentalist outfits,
to operate in areas under its control ?
Wouldn't CBMs, like the proposed opening
of the Srinagar-Muzaffarabad or
Jammu-Sialkot roads, be rendered
pointless in a situation wherein Pakistan
is unwilling to call the militants to
order ?
The most
''positive'' response one heard was that
''having seen with my eyes, and having
heard with my own ears, Pakistani
intervention in an 'Azad' Valley may not
at all be necessary; an 'azad' valley
will work out its own future.'' Which in
other words represents the view endorsed
by some track-twoers that the solution
lies in Pakistan keeping what it has,
India retaining Jammu and Ladakh and the
valley getting independence. Another Pak
visitor whispered 'azadi' is what all
Muslims leaders seemed to want. ''You
know'', he confideds, ''even the odd
leader from the National Conference and
the PDP, whom we met, favoured
independence.. but that was said strictly
on a 'between - you- and me' basis''.
This
longing for freedom from both India and
Pakistan, he admitted, was a revelation.
It changes the whole perspective and the
people of Pakistan must be informed of
it, he said. If only for the sake of this
part of the revelation having got across,
the Pak journalists' visit to Kashmir may
have been worth their while.
There was
no point in expecting them to seriously
consider the possible consequences of a
''Muslim Kashmir'' seceding from the
Indian Union for the future of the
world's second largest Muslim population
living in India. Salman Khurshid, the
Congress leader, raised the question in
the open session of the conference. It
went unanswered except for some protests
by a few Pakistanis. Which reminds me of
the answer provided to the same question
many years ago by Gen Ziaul Haq's Foreign
Minister, Gen. Yaqub Ali Khan at a
background briefing at the Pakistan High
Commissioner's house in New Delhi. Said
he : ''I have great confidence in the
magnanimity of the great Indian people.
They surely won't dump the Muslim
population into the Arabian Sea''. Have
the cake, will eat it too.
|
 |
Odd
solution and evened men!
Yours Randomly,
By Dr.
R. L. Bhat
A tale is
told of a blind man walking of a dark
night, with a lighted lamp in hand. A
wise one laughed at his folly
and asked, "Night and day are all
the same to you. What do you need this
lamp for?" The blind man replied
earnestly, "It is not for me; it is
for thee lest you stumble against
me". It is instructive to remember
this tale when talking of the visit of
Pak journos and its after math. It may be
that the visiting team did take back some
impressions. They may even have chanced
upon an eye-opener or two. But the great
question is whether the
wise-ones on this side have
seen some light from the lamps that shone
all along. Many people have asked how
many of our journalists would have the
gumption to tell to the face of the
elected government installed
in PoK that it was an illegal entity,
that they did not recognize as the leader
of the visiting delegation told the
deputy chief minister after he had gone
to great lengths welcoming them and
swearing peace and amity.
Nor did
the people attending the
welcomes miss the tell-tale
docility of the many
fire-brand ideologues who
quietly chanted the bhai-bhai
mantra when in the august
presence of the Pak journos. To say
that they were looking for visas, visits
and invites is to stoop to petty levels.
They as well as others know that the
visas and visits are arranged not gotten;
they also know which wires to pull for
that purpose. For, they are doing it all
the time! So why do the firebrands go mum
when necessary corrections are to be put
in place? That is one odd question that
would never be answered straight away.
The other question could well be what
Geelani meant by calling his
only solution one
odd solution. Did he realize that
his Pak-solution evoked odd looks in the
Pak establishment, or that he was the odd
man in the jungle of Kashmir politics
where all opinions flourished evenly?
There Omar paid put to all points of
fundamentalist Geelani saying that they
promoted only his own cause. But that
does not tell what all
Kashmiris supported in 1990-94 when
Kashmir had been flooded with terrorists
of all hues. It was not the third option,
the second but the first thing that
Geelani has been saying all these years.
Probably,
it is not what impression the Pak journos
took back with them but what lessons the
Indian journos have learnt from it all.
Onkar Singh of the Kashmir Bar may be an
odd man, yet it would be important to
reckon how many odd men and women around
keep prattling principles and theories
that have nothing to do with realities of
the case or solving the problem or
anything. They are pushing forth personal
cause, promoting private interests and
making useful noises all around.
Sometimes they support the good sense; at
other times they make the strategic
points to make a more effective pitch.
All these are at variance with what is
mouthed privately in the security of bars
and chambers. Rarely are the public
posture and the private position
reconciled. Often they are not even asked
to be reconciled. The powers and
promoters are content to project lines
suited to the occasion without caring
what that ultimately means in the long
term. In the long term, as Keynes said in
an economic context, all are dead. But
nations live and are condemned to carry
the burden of these indiscretions.
Centuries are punished for the wrongs of
moments in consequences and corollaries.
Indeterminate masses pay for the definite
gains of individuals and persons. And,
often go unredeemed.
It was
left to the displaced of Kashmir living
in the camps around Jammu to connect the
salient support and approval of the Pak
media men to the turmoil and turbulence
in the valley and the state. It was the
representative of the Pak refugees to
reiterate that the Pak occupation of
parts of the state since independence is
what the dispute in Kashmir is all about.
Neither the rebuffed deputy chief
minister nor the committed ideologues
raised one voice that would have irked
the smooth conduct of the
tour. The Indian point, the
Indian case was conspicuously given the
slip by the people who represented this
nation and people. It is would not be
amiss to recall that historic hand-shake
between Rajiv and Farooq in the city
Parade Ground in the winter of 1987.
Farooq took Rajivs hand and
announced that he the Muslaman of Kashmir
joined hands with the Hindu of India to
seal a solution of Kashmir. Rajiv gave
him his reluctant hand but muttered that
he was not a Hindu of India. Few Indians
are ready to acknowledge in exchanges of
this sort that they are Indians or that
they stand for Indian case and cause.
Politicos
fight shy of saying that they support the
stand of their nation; editors get
visibly irritated at the mention of
Indian case and analysts are at pains to
show that they are more concerned with
understanding the other side than putting
forth their position. A Laloo posits
Jinnah as an icon of Indian nation and
compares the Bombay blast criminals with
the accused of the ephemeral Jinnah
murder case. Of course, others have been
doing it for more viciously. Indian
establishment has un-written Iqbals
address to Allahabad session of Muslim
League, where he had demanded a separate
Muslim nation for the first time, out of
the history books and public memory. Had
Pakistan done so, it would have been
understandable. No nation wants to carry
such a crass blemish. Yet she is at pains
to emphasize it while Indians want, not
to forget it but, to un-write it, denying
that it ever happened. Indians also want
to un-write Pak aggression, Pak
occupation, Pak position and posturing.
It is left to the people who have
suffered pointed wrongs - like Pandits
exiled from Kashmir, like Refugees ousted
from the PoK - to reiterate these
positions and raise the prickly points.
Often, they go unheard as the all-seeing,
all-wise keep stumbling against the blind
post. Knowingly. Willingly. Pray, why?
|
|
Resuscitation
of trauma
Brig. (Dr.) Yudhvir Suri,
VSM
Trauma is
considered the disease of the 21st century with
revolutionary industrialization and time save
high speed transport system. It is the leading
cause of morbidity and mortality in India today,
more so, in the younger population, leaving many
families financially and emotionally crippled. In
Jammu and Kashmir State, besides increased motor
vehicle accidents, civil society is badly
affected with social criminal violence and
militancy of low intensity war from across the
border.
In India,
pre-hospital medical care is almost non-existent,
even, Armed Forces failed to provide basic life
support resuscitation at the site of militant
attacks and evolved the concept of "Scoop
and Run" to the nearest hospital. It is
suggested pre-hospital medical care to trauma
victims, particularly in the rural areas, can be
provided by the medical manpower and volunteers
of the primary health care system with the
availability of ambulance and network system. It
should be attached with large Government
hospitals for administrative and financial
support linked with other services such as police
and fire departments. Highway road system should
have integrated trauma hospitals to provide life
saving resuscitation at the shortest possible
time based on "Golden Hour" concept of
trauma resuscitation management.
Trauma victims
suffer from shock due to variable degree of blood
loss. This causes insufficient oxygen delivery to
sustain the energy metabolism in vital cells of
essential organs of the body. Blood supply in the
tissues decreases to produce tissue hypoxia.
Heart may be depressed as indicated by decrease
in blood pressure, rapid low volume pulse and
oxygen saturation of the blood, lungs fails to
supply sufficient oxygen to the blood because
blood circulation to the lungs decreases to come
in contact with the air in the alveoli, so
called, mismatch of ventilation - perfusion in
the lungs. Kidneys produce less urine because of
decrease of blood supply to the kidneys. Brain
hypoxia causes altered sensorium or loss of
consciousness. Body metabolism is affected by
lack of oxygen to accumulate acids in the blood.
The survival of the patient depends on the degree
of blood loss, haemorrhagic shock, and its
secondary effects on the various body systems.
The most common
situation is usually seen at the Accident
Emergency Department of the Hospital, that a
trauma victim may be conscious, spontaneously
breathing with intact airway reflexes, but
showing restlessness, agitation and low oxygen
saturation in the blood (SPO2<90%). Head and
chest injury is ruled out patient will improve
with reassurance, oxygenation with face mask,
conscious sedation, analgesic and intravenous
fluids. In average normal adult 3.0 - 5.0
lit.O2/min. will provide 30-40 percent and 6.0 -
8.0 lit. O2/min. 45-60 percent O2 with air.
Sedation analgesic needs to be tailored to
individualized patient without compromising
consciousness, respiration, haemodynaemics
(cardiac function and circulation) and protective
reflexes.
First priority in
trauma resuscitation management is oxygenation in
spontaneously breathing patients with intact
airway otherwise airway management with
compromised airway and oxygenation takes over the
priority. There is need to balance the increased
oxygen demands of the body, so called shock
induced oxygen debt, with the oxygen supply and
delivery to the cells of the vital organs of the
body. If this balance is not maintained during
the sublethal reversible phase of injury, hypoxia
and ischaemia will produce irreversible necrotic
phase of anoxic injury with mortality. Oxygen can
be administered by face mask connected with the
oxygen cylinder, delivered directly to the lungs
through an endotracheal tube in the trachea
connected with the oxygen source on a mechanical
ventilator for artificial respiration, or oxygen
may be delivered under high pressure when the
patient is laced in the "hyperbaric
chamber" oxygen delivered to the patient can
be monitored by "Pulse Oximeter" a
non-invasive device to monitor to the patient can
be monitored by "Pulse Oximeter" a
non-invasive device to monitor the heart rate and
arterial xoy-haemoglobin saturation (SPO2).
Morbidity and mortality of the trauma victim can
be predicted by estimating the blood gases
(oxygen and carbon dioxide) and acid-base status
with the help of arterial blood gas machine.
These facilities are available in Medical
College, Jammu, Srinagar, Skims (Kashmir) and ASC
Medical College, Jammu.
All trauma
patients should be assessed for adequacy of
ventilation immediately upon arrival at the
emergency room of the hospital to determine the
urgency of intervention. The upper airway
consisting of the nose, the mouth, the nasal,
oral and laryngeal portion of the pharynx (inner
back part of mouth) and the larynx is
particularly vulnerable to obstruction. The
obstruction of the upper airway may be due to
secretions, blood, dentures, fall back of the
tongue in unconscious patients and swelling of
the soft tissues of the mouth. Trauma victim may
regurgitate the stomach contents with the oral
cavity to obstruct the upper airway. Suction of
the oropharynx will be life saving to the
patient.
The other simple
menoeuvers may be 1.) Chin Lift - which is
performed by placing the fingers on one hand
under the anterior base of the mandible (Chin
Portion) while gently lifting upward to move the
chin forward. 2) Jaw Thrust - by securing the
angles of the mandible bilaterally to displace it
forward and lower lip to be displaced downward to
open the mouth. These procedures should be done
gently to protect the cervical spine which might
had sustained injury.
The initial airway
control and adequate oxygenation of the trauma
patient needs highest priority. Further,
inadequate ventilation should be corrected with a
bag-valve mask (Ambu-bag) ventilation. Majority
of the patients will improve their saturated
oxyhaemoglobin levels, however, if frank
desaturation persists, orotracheal incubation
should be performed to deliver 100 percent
oxygenation and artificial ventilation by
mechanical ventilator. Laryngeal mask (LMA) and
oropharyngotracheal double lumen tubes
(combitube) are the alternatives of orotracheal
intubation in difficult situations and lack of
expertise. Surgical airway such as Tracheostomy
and cricothyroidectomy may be required whenever,
there is direct trauma to the upper airway. The
difficult situations to maintain upper airways
may be maxillofacial injuries, missile injuries
of the next, cut throat injuries,
temporomandibular joint and bimandibular
fractures. Majority of the trauma patients die of
uncorrected loss of blood, so called,
haemorrhagic hypovolaemic shock, secondary to
visceral injuries, extensive fractures and soft
tissue injuries. Sometimes, fluid loss remains
under estimated due to the collection in the body
cavities, extensive swelling of the soft tissues
because of injury, swelling of the tissues as
after effect of the blunt trauma, penetrating
injuries of the retroperitoneum (back portion of
inside abdomen) this is called "Third
Space" or the "Hidden" loss of
extra cellular space.
The acute loss of
blood decreases the blood volume with the
circulatory system, less blood will be available
to the heart for pumping (venous -return), less
blood will be pumped out from the heart into the
circulation (cardiac output) which initiate the
vicious cycle of haemorrhagic shock. Acute blood
loss upto 20 per cent can be tolerated in healthy
adult individuals by compensatory defense
mechanism of the body called Compensatory
Haemorrhagic shock. More than 15-20 percent of
the blood loss needs replacement of fluid volume
or blood to prevent progressive haemorrhagic
shock (30 - 40 percent blood loss) or
irreversible haemorrhagic shock (>40 percent
blood loss).
Emergency doctors
usually adopt a practical approach to treat shock
resuscitation with rapid intravenous infusion of
1-2 litres of lactated ringers solution for all
trauma victims. This is modified according to the
patient's injury later on. However, isotonic
nature of normal saline make it the ideal fluid
of choice in patients with head trauma. The
patient with head injury will need less
intravenous fluids to prevent further swelling of
the brain. Similarly caution is exercised in
pre-existing heart disease, diabetes and extremes
of age who sustain trauma. Three volumes of
crystalloids or 2 volumes of colloids (starch
solutions) for one volume of blood loss is
recommended for initial resuscitation. This is
called "Haemodilution Concept" of fluid
replacement without blood transfusion even in
polytrauma resuscitation management. No adverse
effect have been seen with this method. Author of
this article has managed more than 3,000 missile
injuries patients in low intensity war
successfully with haemodilution technique of
fluid resuscitation from 1991-1993 at Base
Hospital Srinagar, Kashmir.
We recommend that
early resuscitation, early surgery is as
important as monitoring the successful
resuscitation of the polytrauma patient in the
intensive care unit, clinical parameters, central
venous pressure, urine output, arterial blood
gases and oxygen delivery and consumption indices
should be monitored to prevent mortality.
(The author is
former president International Trauma Anaesthesia
and Critical Care Society.)
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