Browsing by Author "Maharjan, Ramesh K"
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Publication Airway Management Skills in Emergency Services(Institute of Medicine, 2021) Shrestha, Jukel; Shakya, Yogendra M; Maharjan, Ramesh K; Neupane, Ram P; Shakya, Yagya L; Prasad, Pratap NABSTRACT Introduction: Endotracheal intubation in critically ill and injured patients is a high-risk procedure in an Emergency Room (ER). The risk of complications increases with repeated or prolonged attempts, making first attempt success primary goal for airway management in these patients. The primary objectives were to compare first pass success during intubation among various specialties with different level of airway management training and education. Methods: This was a quantitative, observational, cross-sectional study conducted at Tribhuvan University Teaching Hospital for one year. The intubators completed an intubation data collecting form post intubation. After a failed first attempt, alternative methods such as using experienced intubators for subsequent intubation attempts were performed. Results: In the emergency room, 265 attempts of endotracheal intubation were made on total 224 patients. Most common causes for intubation were stroke (49 [21.8 %]), sepsis (39 [17.20 %]), COPD (28 [12.20 %]), and head traumas (24 [10.90 %]). During endotracheal intubation, 185 (82.58%) patients had a successful first-attempt success, and 39 (17.41 %) patients required ≥2 attempts. First pass success was least among medical officers (13/20 (65%)), compared to other senior specialties (p=0.01). Conclusion: With more training and education on the airway, first-pass success during endotracheal intubation increased. All front-line workers should consider it an ethical commitment to stay updated through lifelong learning, an obligation that should be made easier by governing bodies enforcing a thorough airway management training programs. Keywords: Airway, complications, emergency physicians, emergency intubation, first attempt success, techniquePublication Emergency Transport, Diagnosis and Resuscitation of Penetrating Injury Caused by Iron Rod: A Case Report(Institute of Medicine, 2021) Shrestha, Jukel; Bastola, Hemanta; Koirala, Dinesh P; Shakya, Jasmine; Bom, Rabin; Maharjan, Ramesh K; Shakya, Yogendra M; Prasad, Pratap NABSTRACTForeign bodies with their long edges that penetrate the body are potentially life-threatening, owing to the resulting hemorrhagic shock and visceral damage. In an under-resourced environment, the outcome after major impalement injury can be improved by (a) rapid transport with the impaled object in situ (b) quick assessment and resuscitation in the emergency room (c) transport to operating room for definitive care. We report here the successful management of penetrating long iron rod injury from the perineum to the loin of pediatric patient, including transport from rural to tertiary hospital, diagnosis and, resuscitation. Keywords: Fall injury, iron rod, penetrating injury, perineal impalement injury, prehospital carePublication Etiology and Demographic Profile of Medico-legal Cases in Emergency of a University Hospital in Nepal(Institute of Medicine, 2022) Khatri, Pratima; Munikar, Anita; Pandit, Pooja; Rai, Lalita; Maharjan, Ramesh K; Sharma, Mohan RABSTRACT Introduction: Any injury or ailment where investigations by the law-enforcing agencies are crucial are considered as medico-legal cases. The objective of this study was to describe the profile of medico-legal cases presenting to the Emergency Room (ER) of Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. Methods: A retrospective review of medical records was done to include all medico-legal cases presented from July 2018 to June 2019. Results: Medico-legal cases comprised 1805 (3.8%) of all cases (47,289) in the study period. The category of 25- 39 years was the commonest age group involved [659 (36.5%)] followed by 15-24 years group [582 (32.2%)]. Males were almost twice (65.8%) in number compared to females (34.2%). The top three reasons for the ER visit were road traffic accidents (RTAs) [757(41.94%)], physical assaults [356 (19.72%)] and poisoning [239 (13.24%)]. Other causes were burns, falls, sexual assaults, hanging, injuries (gunshot, electrical and machinery) and drug overdose. Conclusion: There are significant numbers and wide varieties of medico-legal cases that present in the ER of TUTH. Young males are the most high-risk population and RTAs are the commonest etiology. This study will help the hospital in capacity strengthening of the ER, based on the volume of individual case types. Keywords: Emergency room, medico-legal cases, road traffic accidents, university hospital