Thoracic injuries are best managed by initial intubation, observation and supportive treatment-Amir Bilal

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 Management of Thoracic War Injuries

Thoracic injuries are best managed by
initial intubation, observation and
supportive treatment - Amir Bilal

Emergency Thoracotomy is indicated in unstable patients

KARACHI: Thoracic injuries are best managed by initial intubation, observation and supportive treatment while emergency thoracotomy was indicated in unstable patients. This was stated by Prof. Amir Bilal a noted Cardiothoracic Surgeon Head of the Department of Thoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar. He was speaking on management of thoracic war injuries at the recently held Health Sciences Research Symposium of Aga Khan University, Karachi. He presented management of perhaps the largest series of 10,836 from a developing country during a period of fourteen years from June 2002 to Dec 2015.


Prof. Amir Bilal

Giving details of these patients Prof.Amir Bilal stated that the record of all trauma patients that had fire arm, bomb blast and drone injuries undergoing surgical intervention over a period of fourteen years was reviewed. It included 10,836 patients which included 10,216 having fire arm injuries chest, 549 had thoracic injuries in 351 bomb blasts and 72 were having thoracic injuries in 153 drone attacks. Male to female ratio was 2:1. All patients were initially managed with tube thoracotomy. Emergency Thoracotomy was performed in four hundred five out of ten thousand two hundred sixteen cases (3.96%) fire arm injury cases, 172/549 (31.32%) in Bomb blast injuries and 16/72 (22.22%) in drone injuries. Rest of the patients i.e. 10232/10836 (94.42%) were stable and treated with low pressure suction and incentive spirometry. Clotted Hemothoraces were successfully evacuated in 561/10216 (5.49%) fire arm injury, 69/549 (12.56%) Bomb blast injuries, 14/72 (19.4%) drone injuries through postero-lateral thoracotomy. Morbidity was 15.27% in drone injury, 14.75% in bomb blast injury, 5.66% in fire arm injury. Mortality was 8.19% in bomb blast injury, 6.94% in drone injury, and 2.91% in fire arm injury.

Emergency Thoracotomy Prof. Amir Bilal opined was indicated in unstable patients (hemodynamically or respiratory wise) regardless of the volume of blood loss. Emergency thoracotomy was maximally done in bomb blast injury, followed by fire arm injury and y drone injury respectively.

Prof. Amir Bilal it may be mentioned here is a keen researcher who had made numerous presentat6ions at various international conferences where he is often invited as guest speaker. The most recent conferences included ICRC Annual War Symposium at Geneva, EACTS in Spain Oct 2016, Vienna 2017 besides ASTS meeting at Beijing held in June 2017.  He has rich experience of trauma including gunshot, bomb blast and drone injuries with limited resources, with better results as compared to many other centers in the developed world. In view of overwhelming support by the community to help the injured, Lady Reading Hospital, he says, has never ran short of anything due to donations of blood by public, supplies by chemists and volunteer staff, both doctors and nurses. Prof. Amir Bilal has the honor of representing Pakistan as Council Member at ATCSA and founding Executive Council Member of Asian Society of Thoracic Surgeons (ASTS). He has one hundred eleven publications to his credit. In recognition of his interest in research and contributions, he has now been appointed Research Director for Pakistan Society of Cardiovascular & Thoracic Surgeons. He is on the Editorial Board of 13 national & international journals.

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