Major challenges in the management of mass casualty have been identified as lack of human resources, lack of material resources, lack of communication and co-ordination. Our hospital has limited resources of manpower and disposable items. The Departments of Anaesthesiology and Intensive Care have been seriously disrupted by the influx of 155 severely injured patients following the collapse of a nine storey building. Such a large, instantaneous influx of injured citizens would overwhelm even the most well resourced health care system.A multidisciplinary team approach was planned to manage the casualties. Senior anaesthesiologists took responsibility for the organisation of different staff members into medical triage team, an immediate care team, an urgent care team, a non-urgent care team and a clerical team. Different teams have accomplished casualty management by addressing four principal issues (the assessment of available resources; ensuring critical but limited care; stocking up on medicine and equipment for the patient surge; and tough rationing of decisions).Assessments of available resources were done by emphasising three #8216;S’s – staff (human resources), stuff (material resources) and structure. Additional human resources (anaesthesiologists, orthopaedic surgeons etc.) and material resources (#8216;H’ type oxygen cylinders, intravenous fluid etc.) were reinforced from nearby hospitals. Additional influxes of critical patients were supported in the postoperative ward and recovery rooms without any monitoring devices. A surgical dressing room without any basic monitoring device was used as an operating room. To do the greatest good for the greatest number of patients, we restricted ourselves to providing “essential rather than limitless critical care”.“Stocking up on medicine and equipment resources” on assessment of the constraints in managing the patient surge, was the next essential step in the management of the casualty load. Patients with life-limiting illnesses were excluded from receiving scarce critical care resources. Thus “Tough rationing of decision” was also an important element.Although the patients that were managed were not large in number, a consideration of the setup with a limited workforce and modern equipment and management experience of a mass casualty addressing the four principal issues in our department, might also help other departments in managing such events.

Caesarean section rates are increasing worldwide. It contributes to substantial maternal and perinatal morbidity and mortality. South Asian countries including Bangladesh have recorded substantial increases in caesarean section rates over the past decade. In Bangladesh, the caesarean incidence rate was 2.6 percent in 2001 and 12.2 percent in 2010. So, the incidence rate increased five times over the last decade. This descriptive cross sectional study was conducted at Combined Military Hospital (CMH), Savar, Dhaka during January 2014 to December 2015, aimed to assess the current trend of mode of deliveries of babies. A total of 1253 pregnant women who attended this tertiary level hospital, for their delivery, were enrolled in the study. The study subjects were selected by simple random sampling. A pretested structured questionnaire was used for data collection. The mean age of respondents was 25.81±4.46 years. Most (72%) of them were between 20-29 years of age. Some thirty nine percent of the respondents completed secondary level of education. The study showed that among 1253 respondents, 70.3% underwent CS and 29.7 % had normal vaginal delivery. Most common indication for caesarean section was previous CS (42.4%) that contributed an increase in total caesarean birth. Lowest incidence was antepartum haemorrhage (0.9%). Prolonged labour and cervical dystocia, hypertensive disorder, malpresentation were also contributing factors for caesarean section. So, previous caesarean birth was the most important factor in making decision about the way of delivery. Based on the study findings, to decrease the rate of caesarean section, careful monitoring of the foetus at all levels of health care facilities for critical decisions are suggested.

Induction of labour is considered justified when the benefits of prompt delivery outweigh the consequences of Caeserian Section (CS). Literature on the effectiveness and safety of surgical induction of labour in term and postdated pregnancy is limited in Bangladesh. This study was aimed to assess the effectiveness and safety of surgical induction of labour in term and postdated pregnancy. This prospective clinical study was conducted in the in-patient Department of Obstetrics and Gynecology, Combined Military Hospital (CMH), Dhaka from July, 2005 to June 2006. A total of 100 pregnant women with term and postdated pregnancy were selected for the study by simple random sampling. The particulars of the patient, detailed menstrual and obstetric history, induction delivery interval, mode of delivery and foetal outcome and maternal complications were recorded. The results were analysed by Statistical Package for Social Science (SPSS) version 16.0.The mean±SD age of the participants was 25.79±6.16 years with a range of 18-38 years. The indication of Induction of labour included term pregnancy (79%) and postdated pregnancy (21%).Normal vaginal delivery was done in 78% cases, CS in 17% cases and vacuum extraction in 5% cases.Ninety three percent babies were born healthy, 6% were asphyxiated, perinatal death 2% and still born 1%. Oxygen inhalation was needed for 6% babies. Prolonged second stage (7%), post-partum haemorrhage (8%), maternal distress during labour (10%) and manual removal of placenta (12%) were the observed maternal complications. No significant difference was observed between term and post term pregnancy in term of normal vaginal delivery, vacuum extraction and lower uterine cesarean section. Induction of labour is beneficial for both term and postdated pregnancy with associated complications. Foetal outcome was good and maternal complications were acceptable.

Background: The worst factory disaster in the history of Bangladesh occurred when a nine-storied commercial building "Rana Plaza" collapsed outskirts of the capital city. In our hospital there were no documented guidelines for dealing with mass casualty incident. Our aim was to share the experience of managing mass casualty.

A thirty six years old woman admitted in ICU following emergency lower uterine caesarean section under subarachnoid block (SAB). After 03 hours of surgical procedure, the patient develops severe respiratory distress. Patient was evaluated and diagnosed as a case of acute pulmonary oedema. In ICU, she was aggressively treated with intravenous Morphine, frusemideand parenteral antibiotic. After 1 hour of intensive care management, respiratory distress decreased but not significantly, in addition, she complains of severe pain on surgical operative site. Post operative analgesia was maintained with parectamol (500 mg) suppositories six hourly and intramuscular pathedine 75 mg 8 hourly. Instead of this her pain scores were 7/10 at rest and 8/10 on coughing along with respiratory distress. Then in ICU under all aseptic precaution bilateral TAP block was performed using landmark technique with 0.25% plain bupivacine 20 ml. Thirty minutes later, her pain subsided significantly and pain score became 1/10 at rest and 2/10 on coughing. Thereafter patient was slept for 4 hours, pain free and could take care of herself. After 48 hours patient was shifted to ward and discharged on 7th post operative day. TAP block is relatively easy, safe techniques. Because of simplicity and low cost, TAP block is likely to be an effective adjunct to multimodal postoperative analgesia for abdominal surgery.