Background:Fat embolism syndrome (FES) is a clinical problem arising mainly due to fractures particularly of long bones and pelvis. Not much literature is available about FES from the Indian subcontinent.Materials and Methods:Thirty-five patients referred/admitted prospectively over a 3-year period for suspected FES to a north Indian tertiary care center and satisfying the clinical criteria proposed by Gurd and Wilson, and Schonfeld were included in the study. Clinical features, risk factors, complications, response to treatment and any sequelae were recorded.Results:The patients (all male) presented with acute onset breathlessness, 36-120 hours following major bone trauma due to vehicular accidents. Associated features included features of cerebral dysfunction (n = 24, 69%), petechial rash (14%), tachycardia (94%) and fever (46%). Hypoxemia was demonstrable in 80% cases, thrombocytopenia in 91%, anemia in 94% and hypoalbuminemia in 59%. Bilateral alveolar infiltrates were seen on chest radiography in 28 patients and there was evidence of bilateral ground glass appearance in 5 patients on CT. Eleven patients required ventilatory assistance whereas others were treated with supportive management. Three patients expired due to associated sepsis and respiratory failure, whereas others recovered with a mean hospital stay of 9 days. No long term sequelae were observed.Conclusion:FES remains a clinical challenge and is a diagnosis of exclusion based only on clinical grounds because of the absence of any specific laboratory test. A high index of suspicion is required for diagnosis and initiating supportive management in patients with traumatic fractures, especially in those having undergone an invasive orthopedic procedure.

Objective: Postanaesthetic shivering is a recognised complication of general and regional anaesthesia. Pharmacological and nonpharmacological methods have been used to prevent shivering. This study was conducted to determine the efficacy of ketamine when compared with pethidine and placebo for the prevention of postanaesthetic shivering.Design: A randomised, double-blind study was conducted.Setting and subjects: This study was conducted on 90 American Society of Anesthesiologists (ASA) I and II patients of both genders, aged 18-70 years, who were to undergo surgery under general anaesthesia. Patients were randomised into three equal groups: Group S received a saline placebo, Group P received pethidine 20 mg and Group K received ketamine 0.5 mg/ kg. The study medication was given within 20 minutes of the estimated end of surgery.Outcome measures: Haemodynamic parameters were noted before, during and after anaesthesia. Tympanic temperature was recorded during the intraoperative period, on arrival in the recovery room (T0) and subsequently at 10 minutes (T10), 20 minutes (T20) and 30 minutes (T30). Shivering was graded on a four-point scale. Pain was assessed and recorded by means of a visual analogue scale. Any untoward side-effects were also noted. Results:The demographic profile of the patients was similar. The number of patients shivering at T0 and subsequently at T10 and T20 was significantly less in Group K and Group P than in Group S (p-value < 0.005). However, there was no difference between Group P and Group K (p-value > 0.005). Thirty minutes after the end of the anaesthetic, there was no difference between the groups (p-value > 0.005). Haemodynamic parameters were similar throughout. The incidence of adverse effects was similar. Conclusion:Ketamine was found to be as effective as pethidine in preventing postanaesthetic shivering without increasing the risk of side-effects.

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Introduction:Traumatic brain injury (TBI) is a major cause of death and disability throughout the world. Commonly used predictors of outcome both individually or in combination include age, Glasgow Coma Scale score, pupillary reactivity, early hypoxia, and hypotension. Most of the studies previously done to examine risk factors for mortality in severe TBI were done in the setting of polytrauma.Aims and Objectives:The aim and objective of this study was to do an in-depth analysis of various factors associated with the management and outcome of patients with isolated TBI admitted in an Intensive Care Unit (ICU).Materials and Methods:A total of seventy adult patients who were admitted to Intensive Critical Care Unit (ICU) with isolated TBI were selected during a 12-month period from January 2016 to December 2016. This is a prospective analytical study and parameters studied included age, sex, cause of admission classified by type of trauma, premorbid functional status, acute and chronic comorbidities, brain noncontrast computed tomography scan data, Glasgow Coma Scale (GCS), hemodynamic status, respiratory status, and mechanical ventilation, blood gases, serum electrolytes, serum glucose, hemoglobin, leukocyte and platelet counts, renal function, and urinary output.Results:The study population consisted of 46 (65.7%) males and 24 (34.2%) females. The mean age was 35.5 years (range, 18–65 years). The most common mode of trauma was road traffic accident (43.6%) followed by fall from height (35.7%). Statistically insignificant relationship (P < 0.05) was seen with sex and mode of injury among survivors and nonsurvivors; however, 61.9% of patients with age ≥40 years died (P < 0.005). Among clinical parameters at admission to ICU, low GCS, hypotension (mean arterial pressure ≤80 mmHg), hypoxia (pO2 ≤60 mmHg, spO2 ≤90 mmHg), and nonreacting pupils were significantly associated with increased mortality (P < 0.05).Conclusion:Isolated TBI still continues to have a good amount of morbidity and mortality which perhaps can be reduced by strict adherence to guidelines of management.

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