Words With Dr. Jayanta Bain

1) in your long experience dealing with trauma and injuries what do u feel is the most challenging part?

2) what in you opinion should the approach of a common man be when approaching a trauma victim?

3) what is the role of a plastic surgeon in a trauma?

4) in our practice we often encounter people coming to us with severed or partially severed limbs, can a severed limb be reattached?

6) how should such a severed/ partially severed limb be transported or preserved for maximum chance of a successful reattachment?

7) please enlighten our readers on the concept of Golden Hour.;

8) what are the common mistakes and pitfalls of approach that you have come accross in ur practice done to a trauma victim with vascular or tissue injury that on later date costs his/her life or limb?

Answers::

1) Most challenging part, I think, is resuscitation of the patient and assessment of the trauma globally. The whole body should be thoroughly checked up, even if a body part may not show any external sing of the injury.

2) Lay down the person on a flat surface; .remove all clothes, especially those around neck and chest and secure airway; give pressure directly over the bleeding point coming through upper/lower limbs; shift the person to nearby Hospital.

3) In management of trauma patient, the Plastic Surgeon’s should be called as soon as possible, so that they can attempt to reattach a amputated body parts, or can do a “Spare Part Surgery” which is not possible after a certain period of time.

4) Yes, reattachment is certainly possible for many instance’s. However, success rate largely depends upon a lot of factors, which is not always in humans control.

6) The amputated body part should be cleaned; wrap it with a clean plastic bag; take half bucket of ice; keep the “plastic wrapped body part” over the ice (don’t put ice over the body part). Transport the part along with the patient to a trauma center as soon as possible.

7) Golden Hours is a treatment concept. It has been seen that, after a certain time (Golden Hours), response to a said treatment in trauma case’s became less responsive, so treatment should be started without delay, preferably within the Golden Hours.

8) Common mistake & pitfalls are: unable to access the extent of non-viable tissue and doing an vascular anastomosis over / near to it. To my experience, this is the most common cause of anastomotic failure.

NB: There were no question number “5”.

Thanks You With warm regards

Dr Jayanta Bain MBBS, MS (General Surgery) MCh (Plastic & Reconstructive Surgery) Fellow (Cosmetic Surgery) Sweden

Qs 4) cross qs: what do u think are the factors the victim or a caregiver present on spot can control?

Psychiatry

Dr. Anindyo Roy

Ans 1.

Most common area of interaction between Orthopedics and Psychiatry is in the area of management of chronic pain at different body parts.

Another area may be in the area of childhood developmental in children having difficulties in both balance-&-walking as well as intelligence-&-behavior.

Ans2.

The word pain comes from a Latin word which means punishment. Prolonged stress for any individual is mostly painful. During pronged stress, there is reduction in the pain-threshold gating mechanism at brain and spinal cord. This results in chronic pain with no apparent local lesion.

Ans3.

Healthy life-style in terms of diet, exercise and relaxation is the key.

Ans4.

These patients are quite common. But the ordeal is lack of proper counselling. When examination and investigation fail to detect any local cause of pain, the patients are termed as ‘mental’. That is highly unacceptable. The patients should be referred for stress and anxiety management with proper counselling that stress reduces the pain-threshold of an individual so there may be aberrant pain sensation at different body parts without any obvious lesion to that particular area.

Ans5.

Post-traumatic stress disorder is a loosely used term in most of the situation. It has very specific features and occurs only after exceptional stress like sexual abuse, major accident or war etc. What we commonly come across are acute stress reaction in terms of anxiety, disturbed mood, sleep and feeding disturbance after any unpleasant event.

Ans6.

Surgery is a common event occurring with almost every other individual in their lifetime for something or other reason. Think in that way and go for it with all necessary precautions as advised by the doctor.

Ans 7,8.

For me, neuro-development is an area of passion. Children’s wellness matters. In this rapidly changing world, the indicators of wellness are changing every day. In previous years their growth, nutrition and illnesses were the only issues of concern. Some other areas were walking and speech. Even in speech it was difficult to distinguish between utterance of words and skill of interaction. But today, children gradually entering from school age to adolescence, are evaluated in terms of so many sensitive indices like attention, activities, emotion, conduct, memory, comprehension, visuo-spacial abilities, so many and so forth. Maturation of different complicated circuits of their brain has become equally important parallel to the development of other basic sensori-motor areas of peripheral and central nervous system. That is the area of neurodevelopment.

Ans9.

In children, for a question whether a child has congenital disease of heart, lung, kidney, digestive system, etc answer is usually in yes or no. But in the area of neurodevelopment it is not an all-or- none phenomenon. Rather it is a spectrum where all of us fit at some end or the other. We all need care in the field of neurodevelopment. Today’s evolving concept of learning and education is also looking for that ‘multiple intelligence’. So today’s children often get referred for professional care from their schools for different difficulties in those areas of neurodevelopment. Where do they go? They can go either in some special or exclusive centres for ‘special children’ or along with other adult patients of different psychiatric disorders. They are tagged with words like ‘special’/ ‘different’ which are absolutely unthinkable for a child with other childhood physical conditions like asthma, tosilitis, rheumatic heart disease, atopic dermatitis etc.

So to come out of that stigma the concept of ‘inclusive neurodevelopment’ came up. But unfortunately that remains only exclusive until it becomes a part of the holistic health care services where any child can visit with any disease. Age group is the only exclusion not the clinical condition.

With this concept, I developed BACHPANA 0-18, which would work as a service group towards the “inclusive neurodevelopment and holistic health services’’ for all within the age group of 0 to 18 years.

Ans10.

In our daily life we always want to go up the ladder but fail to accept the ups-&-downs as integral part of our life. Healthy balance in our day to activities and our future development is the key.

The tag-line of my service logo BACHPANA 0-18 is “scaling the ladder of development and striking healthy balance in the see-saw of life”.

Thanks and regards

Dr Anindya Kumar Ray MBBS, DPM, MD (CIP Ranchi)

Psychiatrist

Coordinator BACHPANA 0-18