1/6. Argentine Jewish community institution bomb explosion.BACKGROUND: Descriptive study of physical injuries and implemented organization from a nearby, unwarned university hospital after the July 18, 1994, bombing of the seven-story Argentine Israeli Mutual association (AMIA) building in Buenos Aires. Data were obtained from hospital medical records. RESULTS: A total of 86 victims arrived at the emergency department, 2 victims were dead on arrival, 41 victims were admitted, and 43 victims with minor injuries were assisted and allowed to go home. The explosion caused a total of 86 deaths and left more than 200 people injured. mortality rate among hospitalized survivors was 8.3% and among critically injured victims was 28.6%. CONCLUSION: The total collapse of a multiple-story building immediately kills most of its occupants. In the present study, the few surviving victims were located at the lower floors. The majority of hospitalized victims were outside the building at the moment of the blast. Rapid overcrowding of the emergency department with minor and moderate injuries that do not require hospitalization should be anticipated by disaster management plans. Centralization of severely injured patients in critical areas seems appropriate, because this method keeps major cases from spreading through different wards.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. Injuries from hand grenades in civilian settings.Four cases of hand grenade detonations in civilian life with homicidal intent are reported. The detonations always occurred in close proximity to the victims but there were only two fatalities out of seven victims directly attributable to the hand grenades. The relatively low mortality rate results from the ballistic characteristics of hand grenade missiles such as low mass and sectional density. This leads to rapid deceleration and thus to a poor penetration capacity of intermediate targets and tissue. Window glass at a distance of 2 m was not perforated in one case and the vast majority of fragment wounds showed a short wound tract of small diameter. The potential for physical activity can be unaffected even after a detonation inside a car. However, body parts almost in contact with the hand grenade, such as in a struggle, suffer large lacerations and comminuted fractures. At a distance, the chance of striking a vulnerable body region is increased by the multiple missiles but the wounding potential clearly decreases with increasing distance due to rapid deceleration and decreasing fragment cloud density. The effective range of detonation shock waves from hand grenades is very short and can only contribute to wounding in close-to-contact detonations. The forensic reconstruction is based on the directed radial character of the forces generated and on the sharply decreasing intensity of these forces with increasing distance from the detonation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/6. Nonterrorist suicidal deaths involving explosives.Suicidal deaths involving explosives unconnected to terrorism are rare. The investigation of deaths from explosive devices requires a multidisciplinary collaborative effort, as demonstrated in this study. Reported are 2 cases of nonterrorist suicidal explosive-related deaths with massive craniocerebral destruction. The first case involves a 20-year-old man who was discovered in the basement apartment of his father's home seconds after an explosion. At the scene investigators recovered illegal improvised power-technique explosive devices, specifically M-100s, together with the victim's handwritten suicide note. The victim exhibited extensive craniofacial injuries, which medicolegal officials attributed to the decedent's intentionally placing one of these devices in his mouth. The second case involves a 46-year-old man who was found by his wife at his home. In the victim's facial wound, investigators recovered portions of a detonator blasting cap attached to electrical lead wires extending to his right hand. A suicide note was discovered at the scene. The appropriate collection of physical evidence at the scene of the explosion and a detailed examination of the victim's history is as important as documentation of injury patterns and recovery of trace evidence at autopsy. A basic understanding of the variety of explosive devices is also necessary. This investigatory approach greatly enhances the medicolegal death investigator's ability to reconstruct the fatal event as a means of separating accidental and homicidal explosive-related deaths from this uncommon form of suicide.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/6. Suicidal bus bombing of French Nationals in pakistan: physical injuries and management of survivors.BACKGROUND: Suicidal bombing is particularly devastating and an increasingly common form of terrorist violence. In this paper, we present an epidemiologic description of the physical injuries of patients who survived the suicidal bombing attack in the context of the limited medical resources of a developing nation. methods: The management of individual patients was reviewed from a preprinted trauma form. Information on the nature of injuries, operative management and hospital course was recorded and data analyzed using the Trauma Registry. RESULTS: Twelve survivors out of 36 bomb blast victims brought to the Aga Khan University Hospital were transferred from primary receiving hospitals. The average number of injuries per patient was eight. The mean injury severity score was 10.8. The majority of patients had secondary and tertiary blast injuries. Most of the survivors had calcaneal injuries; these have not been reported in the literature in similar terrorist attacks. Twelve operative interventions were undertaken. All of the 12 patients were stabilized and evacuated within 24 h of admission. CONCLUSIONS: All of the 12 patients transferred to the Aga Khan University Hospital survived. Unlike the reported injuries, calcaneal fractures were most commonly encountered in the survivors.- - - - - - - - - - ranking = 5keywords = physical (Clic here for more details about this article) |
5/6. Physical medicine and rehabilitation in the military: Operation Iraqi freedom.This article describes the role of a physical medicine and rehabilitation (physiatry) physician (physiatrist) as a general medical officer within a forward support battalion during the invasion and nation-building phases of Operation Iraqi freedom. Between March 10 and May 3, 2003 (invasion phase), 364 patients were evaluated. Thirty-two percent had musculoskeletal noncombat injuries, 9% had combat-related traumatic injuries, and the remaining 59% had nontrauma/nonmusculoskeletal conditions. Between May 4 and July 25, 2003 (nation-building phase), 1,387 patients were evaluated. Of these, 19% had musculoskeletal injuries, 1% had combat-related traumatic injuries, and the remaining 80% had nontrauma/nonmusculoskeletal conditions. During this nation-building phase, the musculoskeletal workload seen at the division-level combat support hospital was 4 times the workload seen in the forward support battalion. This experience underscores the role of physiatry in wartime casualty management and profiles the combat support hospital as the most suitable place for the physiatrist during wartime. Interventions focused on acute management and rehabilitation counseling for all musculoskeletal injuries, as well as consultation services to the combat support hospital and local civilian hospitals for the evaluation of complex neuromusculoskeletal trauma cases.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/6. Acute myocardial infarction caused by blast injury of the chest.A 51-year-old healthy man was hit in the chest by the shock-waves generated by an explosion, without being injured by any physical object. He felt immediate chest pain, but, in spite of electrocardiographic tracings highly suspicious for an acute anteroseptal infarction in the emergency room, he was discharged from hospital. The electrocardiogram recorded three weeks later was pathognomonic of anteroseptal infarction. Coronary arteriography performed four months later showed a complete obstruction of the left anterior descending coronary artery, with retrograde filling from the right coronary artery. It is assumed that the myocardial infarction was caused by the blast injury which induced an intimal tear and/or a subintimal haemorrhage in the left anterior descending artery with subsequent thrombosis. The lack of atherosclerosis in any other coronary arteries in this patient is noteworthy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |