W Indian Med J
-
Gunshot injuries are an escalating social and medical dilemma in many Western and some developing countries. Of 40 patients arriving at the University Hospital of the West Indies (UHWI), Jamaica, from 1993 to 1998, with gunshot wounds of the head, 30 were admitted. Six of those admitted died within 24 hours, five with poor Glasgow Coma scores. ⋯ Fourteen patients had associated injuries, four of which were in the neck. Surgery was considered inappropriate for moribund patients and those with inaccessible bone and bullet fragments. Young males were the most common victims of this devastating form of assault.
-
Controversy has arisen regarding the length and nature of the preoperative fast that should be required of patients with normal gastric emptying time undergoing elective surgery. Various studies and editorials have indicated that the traditional preoperative fasting policy of "NPO after midnight" may be illogical as it makes no distinction between solid foods and clear fluids. Successive National Surveys conducted in the United States of America (USA) have shown an increasing number of Ambulatory Surgery Hospitals adopting more liberal preoperative fasting guidelines. ⋯ Also, 66%, 68%, and 73% of respondents stated that, in the future, they were prepared to allow their patients a solid meal up to eight hours, light breakfast up to six hours, and clear fluids up to three hours, respectively. We concluded that, whilst the traditional NPO policy remained firmly entrenched at the institutional level, many anaesthetists and surgeons show a positive inclination towards more liberal fasting practices. We recommend the formation of a local task force to determine what aspects of the new liberal guidelines may be safely and effectively adopted, taking account of local circumstances.