Facial Trauma Among Patients With Head Injuries

Facial Trauma Among Patients With Head Injuries Facial Trauma among patients with head injuries Dr. Shazia Yasir*, Dr. Faisal Moin, Dr. Muneer Sadiq ABSTRACT Introduction: Facial trauma is without a doubt a most challenging area for any emergency physician. Despite many researches and advances in the understanding of multiple techniques; initial assessment and management of facial injuries in emergency and early stages remained a complex area for patient care. Objective: The purpose of this study is to determine the prevalence of facial trauma among patients with head injuries that may help emergency department physicians to deliver accurate and quick diagnosis and decision. Trauma to this region is often associated with mortality and morbidity and varying degree of physical and functional damage. Study Design: Prospective Cross-sectional Descriptive Study. Place and Duration of Study: Department of Emergency Medicine, Ziauddin University Hospital, Karachi from four months from Feb 2014 to May 2014. Methodology: This study was conducted at Ziauddin university hospital emergence medicine department. It is a prospective cross sectional descriptive hospital based study. 115 patients who were diagnosed of having head injuries were included in this study. Information on age, sex and cause of injury was taken for each case. Each patient was then examined for the presence of facial trauma using the CT 3D face. Data was analyzed using the SPSS program. Result: Out of 115 patients, 85 (74%) were males and 30 (26%) were females. A total of 59 (51%) patients were between 15 – 30 years of age; 26 (23%) were aged between 31 – 50; and 30 (26%) were above 51 years of age. 76% patients had facial trauma where head injuries were evident. 63% female and 80% male had facial trauma where head injuries were found in patients. Out of these 115 patients majority were involved in road traffic accidents and are from the age group 15 – 30 and predominantly male. Conclusion: Based on the study conducted; it is safe to conclude that patients who have facial trauma associate with head injuries are young males and is mainly caused by road traffic accident. The result might vary by governmental, culture or social differences. Key words: Facial Trauma; Head Injuries; emergency department _____________________________________________________________________________________________ INTRODUCTION Trauma is a type of injury where external force is being applied suddenly and violently at the body which causes a serious injury [1]. A head injury in human body is any trauma that can cause injury of scalps, brain or skull. The injury could be a minor bruise or serious injury on the head and brain injury [2]. Some injuries can result in prolonged or unrecoverable brain damage. The injury can cause bleeding inside the brain or forces that damages the brain directly. The most common cause of head injuries are road traffic accidents, fall, physical assault or others. These accidents can occur at home, work, outdoors, sports or many other places. Head injuries are commonly associated with facial trauma; often result from high energy blunt force injury to facial skeleton. Typical mechanisms of trauma include motor vehicle accidents, altercation and fall [3]. - PG Emergency Medicine, Department of Emergency Medicine, Ziauddin University Hospital, North Campus, Karachi * Correspondence Email: [emailprotected] The face is vital to human appearance and function. Facial injuries can impair a patients ability to eat, speak, interact with others, and perform other important functions. Facial injuries may be caused by a direct blow, penetrating injury, or fall. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury [11]. METHODOLOGY This study was carried out at the department of emergency medicine, Ziauddin University Hospital, Karachi, Pakistan. Patients of either gender with more than 15 years of age presenting to Ziauddin Hospital Karachi who were diagnosed of having head injuries were selected. Patients who gave the history of previous head trauma were not included in this study, this aimed at avoiding some ambiguity during examination as to whether the encountered trauma was the result of the recent head injury or previous underlying trauma. Each patient was then examined for the presence of facial trauma, using 3D CT scan. A 3D CT scan, or a three-dimensional computerized tomography scan, is a type of x-ray that allows high quality images of organs, blood vessels, and bones to be recorded in a very short amount of time. The individual CT images are then layered together to form a virtual model of the body. It is able to reveal the functionality of many of the anatomical structures in the body, in addition to structural defects, tumors, and lesions [12]. The obtained data was checked for completeness and clarity then entered into the computer and analysis was performed using Statistical package for social sciences program (SPSS). Chi –square test (X2) will be carried out and significant level p RESULT A Total of 115 patients with head trauma were included in the study. The gender distribution of the study population is as shown in Table 1 below. Table 1:- There were 85 (74%) males and 30 (26%) females. The age distribution of the study population is as shown in Table 2 below. Table 2:- There were 59 (51%) cases between ages 15 – 30, 26 (23%) cases with ages from 31 – 50 years males and 30 (26%) with age over 51 years old. The presence of facial trauma according to gender is shows in table 3. Out of 115 patients monitored, 19 female have facial trauma out of 30 which consist of 63% female, while 68 male patients have facial trauma with head injuries out of 85 which make 80% of male population. The total of 76% patients has facial injuries where head injuries were evident. Table 3:- Presence of facial trauma according to gender The presence of facial trauma according to age is shows in table 4 along with graphical representation. Out of 115 patients monitored, 59 patients were between ages 15 – 30. From these 59 patients 51 have facial trauma where head injuries were evident, this make 86% of the population. The patients between 31 – 50 years of ages were 26, where only 14 were found to have facial trauma which makes 54% of the population. The patients over 51 years of age were 30 where 22 were found to have facial trauma which makes 73% of the population. Table 4:- Presence of facial trauma according to age Table 5 shows prevalence of facial trauma by gender according to the causes of injuries. Out of 87 patients where facial trauma was also observed 11% female had it because of road traffic accident comparing to 39% male. Fall in female was 9% comparing to 17% male; no assault in female was observed while 14% male had facial trauma during assault. Table 6 below shows the details of prevalence of facial trauma by age according to cause of injury. The detail shows higher number of road traffic accident, followed by fall, assault and other causes of injuries. DISCUSSION Head injuries causes hospitalization of 200 – 300 patients per 100,000 population per year worldwide. A head injury associated with facial trauma comprises a number of complications, such as sequestrum formation, sinusitis, nasolacrimal duct injuries, facial deformity and injury to or entrapment of the globe. Trauma is very well known to be the main cause of death in first forty years of life. Facial trauma can be very dangerous as this could impact the essential parts of the body like speech, respiration, vision or smell so special attentions and importance should be given to facial trauma patients [13]. An international study was done in France to determine the types of facial injuries; 25.4% of the injuries were aged between 21 – 30 years. Sex ratio was 2.7M/1F. The most frequent cause was sports injuries (25.8%); followed in decreased order by traffic injuries (23.1%); home injuries (17.6%); fight injuries (3.4%); work injuries (3.4%) and dog bite (3.2%) [4]. Multiple studies conducted that amongst facial trauma the most common sites are nose (50%) [6] and maxillofacial trauma (5%) [5]. In this study 115 patients with head trauma were included with sex ration of 2.8M / 1F which seems to be consistent with previous studies done in different part of the globe [8, 10, 7]. The findings in this study also revealed the most common involving age group was 15 – 30 years of age; which constituted 51% as compared to other age groups. This finding is the same as that done in Nigeria and others in 2010 [42]. The reason for high prevalence of head and facial trauma to this age group (15 – 30 years) as compared to other age group could be related to activities of this age group in economic and social activities which lead to increase in accidents and violence. In this study it was also found that male are slightly more involved as compared to females where by 74% were male patients and 26% were female patients. The most common cause of facial trauma is to be road traffic accidents which involve motor cycle; car and pedestrian while the second most is fall from height. This was similar to previous findings in other studies which shows most common etiologies of injuries were car crash (39%); followed by assaults (28%) with majority are male with age group 15 – 30 years [9]. Observations from multiple studies of different part of the world shows that leading cause of facial trauma associated with head injuries is road traffic accident followed by fall and assault. Based on the study design and area; each study has its precise section of dominance. CONCLUSION This study concludes the prevalence of facial trauma associated with head injuries was 76% and higher age group is 15 – 30 years with 51% than other age group and prevalence of male 59% than female 16% had facial trauma where head injuries were eminent. The common cause is road traffic accident 50% followed by fall 26%, assault 13.7% and others were 9%. CONSENT FOR THE STUDY All patients or relatives were given a necessary explanation about the study before they asked to participate. For those patients who were unconscious, consents were obtained from their relatives. For patients under ages 18 years, informed consents were obtained from their parents/ guardians. ACKNOWLEDGEMENT We would like to acknowledge faculty of Ziauddin Hospital, North Campus for helping us during the study, staff for helping in data collection and all others who have given their input. The study was self funded. REFERENCE Anderson T ,Heitger M, and Macleod AD (2006). Concussion and Mild Head Injury. Practical Neurology : 342–357. Heegaard WG, Biros MH. Head. In: Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. St. Louis, Mo: Mosby; 2009:chap. 38 Aksoy E, Unlu E, Sensoz O. A retrospective study on epidemiology and treatment of maxillofacial fractures. J Craniofac Surg. 2002:772-5 Lebeau J, Kanku V, Duroure F, Morand B, Sadek H, Raphaà «l B. Facial injuries treated in the Grenoble University Hospital. 2006;107:23-9 Goodisson, D, MacFarlane, M, Snape, L. Darwish, B, Head injury and associated maxillofacial injuries New Zealand Med J 2004,vol.117 Khan, A. R.,Arif, S., ,J Ayub Med Coll Abbottabad 2005 Vol.17 Hashim H, Iqbal S. Motorcycle accident is the main cause of maxillofacial injuries in the Penang Mainland, Malaysia. 2011;27:19-22. Madubueze CC, Chukwu CO, Omoke NI, Oyakhilome OP. Head and neck injuries as seen in a Nigerian teaching hospital. Ozo CInt Orthop. 2010. Bouguila J, Zairi I, Khonsari RH, Jablaoui Y, Hellali M, Adouani A.Epidemiology of maxillofacial traumatology in Tunis. Rev Stomatol Chir Maxillofac. 2008 Khan AA. A retrospective study of injuries to the maxillofacial skeleton in Harare, Zimbabwe. Br J Oral Maxillofac Surg 1988; 26:435-439. Rankin M, Borah GL. Perceived functional impact of abnormal facial appearance. Plast Reconstr Surg 2003; 111:2140. Saigal K, Winokur RS, Finden S, et al. Use of three-dimensional computerized tomography reconstruction in complex facial trauma. Facial Plast Surg 2005; 21:214. Motamedi MH: An assessment of maxillofacial fractures: a 5-year study of 237 patients. J Oral Maxillofac Surg 2003, 61(1):61–64

Commemorative Speech Essay

In Harry Potter and the Prisoner of Azkaban we were introduced to Sirius Black, a character who would change the Harry Potter world, as all readers would know it. I would like to commemorate his memory; not only because he did pass in Harry Potter and the Order of the Pheonix, but also because he introduced us to the greater plot and foreshadowing that JK Rowling had in store for us, I am qualified to speak on this topic because I have read the Harry Potter series 14 times and listened to the audio books 8 times. Sirius is a fighter. Sirius spent 13 years in Azkaban, being held for a crime he didn’t commit, and never lost hope. Even though the whole wizarding world was against him and thought that he killed muggles, and Peter Petigrew, he fought to get out and protect his god son. Sirius is also a person who brought Harry information about his parents. Sirius was Lily and James’ best friend since the first day at Hogwarts, and grew up with them. Sirius exposed the truth that Wormtail betrayed his parents, and made the bold statement that â€Å"he would rather have died than betray his friends†. Sirius Black also turned into that person that Harry needed. Sirius was a father/older brother role model that Harry lacked and so desperately needed. Sirius was always there for Harry when he needed him. In the Goblet of Fire he gave him life saving advice when Harry had to face the 3 tasks. In the Order of the Pheonix Sirius calmed Harry about the uncertainties he had about his father, and came to his resuce at the Ministry of Magic. Everything about Sirius Black was crucial during the Harry Potter books. Sirius was one of the most influential and important character in the Harry Potter books, and that is why I chose to commemorate him.

Middle Managers

Managers are the most important human resource in any organisation because they are charged with the responsibility of ensuring that the organisational goals are achieved within the specific time through spending less financial resources. Both organisations and people need each other to further their different goals or objectives. Therefore if mutuality is missing, it makes no sense in trying to assemble a group and develop a cooperation because there is no common base on which to build. Therefore, for attainment of organisational effectiveness, human resource and especially the middle level managers is the most important asset that must be paid attention by the management.Management practices are employed by middle managers in order to enhance the effectiveness of any organization including learning institutions, and these management activities are planning, organizing, leading, and controlling. The middle managers through the planning function is responsible in coming with a schedu le of business activities that will result to attainment of the set goals. The middle managers outline what to be done and the expected output from the employees.The organizing function of any organization has to deal with the issue of allocating the tasks to the employees respectively according to their competence. Resistance by the workers may be experienced if the allocating process used is viewed to be inappropriate and oppressing which always leads to poor organization performance. So middle managers have to convince the employees that everything will be okay and there interests will be taken care of.The leading/directing function of any organization is faced with the tasks of demonstrating to employees how to do various activities and also involves the employment of charismatic leaders in form of middle managers who can influence the employees towards positive attitude of performing their work and also capture the attention of the top management. The Controlling management pra ctice by the middle managers is responsible for monitoring the results of any undertakings and thus can make any corrections or adjustments if need to do so arise. (Maund, 2001)There are three levels of management in any organisation. The first level is the top level managers who include the senior managers and the executive officers and they are responsible for formation of organisational goals and objectives and they play an important role in decision making process. The second level is that of middle level managers who are responsible for ensuring that all the functional strategies from various departments are workable and can be achieved with certainty.This level of management is the most critical one in that both the lower and top management attracts attention regarding to various activities within the firm.   For example, the top management may exert pressure on them to achieve better results while the lower management may want them to reduce their level of supervision withi n the workplace. The third level is that of operational management or lower level managers who ensures that organisational activities are undertaken to achieve the set objectives or goals. . (Dale, 2001)How Middle Managers can meet their demandsAccording to the latest research, reports suggests that middle level managers have a discrete and decisive function in all organisations   particularly in the learning institutions and they do not only act as a medium between the top managers and the subordinates. Middle managers in many learning institutions in an effort to be effective and efficient in the workplace have the responsibility of balancing the ever competing demands of their roles brought about by conflicts from both the top management and the subordinates or the low level management. In order to attain the above objective this middle level managers have embarked on various critical roles in order to avoid any misunderstandings in the workplace and thus achieve the desired ou tput. Such roles include the following: (Fiddler, and Atton, 1999)Middle managers in learning institutions act as change agents within these organisations. Globalization has taken the centre stage almost in all sectors of the economy including learning institutions. There is increased interaction of people from different cultures, societies, and various backgrounds in undertaking various business activities with the aim of achieving their goals for example opening learning branches in other countries. Because of invention of advanced technology the world has increasingly become a village and as a result global business is the modern form of business in this 21st centuryBecause of globalization in relation to learning institutions there have been great disregard to national borders, governments have lower hand in controlling the flow of their economies and large companies including learning institutions are now not restricted to only one particular country as it was before. Middle le vel managers in learning institution have to cope with changes brought about by this aspect of globalization and they should brief the top management on decision making process. They also have the task of ensuring that the teachers in this institution are equipped with skills, expertise, and knowledge that can tap new knowledge from other people from different countries without hindering the learning process.Middle managers have the duty of being a strategist in order to cope with the increasing demands from both the top management and the low level management. This implies that they have the tasks of ensuring that the strategies formulated by the organisation are implemented and executed in a good way that will lead to achievement of goals. They should therefore have the ability to interpret direction from the top managers in to functional departmental strategies and policies that will avoid any conflicts in the organisation and those plans must be viable and supportive for the mis sion of the organisation. (Baker, 1999)In order to enhance this responsibility the middle level mangers must pay much attention  Ã‚   to formulation of workable strategies. A strategy may be defined as the calculated means by which the enterprise deploys its resources to accomplish its purpose and basic objectives under the most advantageous circumstances. Therefore the middle level mangers have the task of ensuring that the organisation   for example learning institution must be overall low cost effective system which will ensure good returns for example high performance through use of competent teachers and using of advanced technologies. So the work of middle managers is to ensure sourcing of competent teachers and application of approved high quality technologies e.g. the use of white boards.Middle level managers must also act at ethicists in any organisation in order to balance the competing demands brought about by the interactions with both top and low level managers. Thi s role implies that the middle managers especially those from learning institutions should develop a system that will help them sustain pressure from both top managers and subordinates in the process of promoting moral conduct within the organisation   that will foster good results. For example teachers will be motivated to lecture/teach and students too will be motivated to work hard and achieve their results.   The other role middle managers have to embark on is the responsibility of being a team player in the organisation or in the workplace. (Klagge, 1998)This implies that the middle managers must show commitment and support cooperation among the top management, low level management or the subordinates and themselves. For these middle managers to maximize the concept of teamwork in the organisation then they should emphasize on formation of groups within the workplace.A group can be defined as social unit which people interacts face to face when working. If an organisation e mphasises group work then it is more likely that good results will be achieved. Sometimes some kind of work require teamwork participation in order to achieve goals, so managers should encourage group decisions too because they bound to succeed unlike individual decisions. With the concept of teamwork for example the subordinates will be motivated when they work together with the subordinates e.g. head teachers working together with teachers in trying to achieve good learning process.The other role that will help balance the competing demands in an organisation is that of being the mentor of employees especially the subordinates.   Leading by example for example engaging in groups with the subordinates and demonstrating what the subordinates are supposed to do. Also to get admiration from both the employees and the top management they should act as top manager’s advocate to subordinates as well as being subordinate supporter to top level managers.Another useful role that wi ll balance the competing demands is that of middle managers embracing the concept of being tacticians. This means that middle managers have to understand the organisational environment e.g. internal and external factors that may cause conflicts within the organisation. The main aspect of being tactician is that of middle managers encouraging collective decision making thus parties involved in carrying out duties will be motivated to work because they were part of the decisions arrived. (Fiddler, and Atton, 1999)Advice to Middle ManagersFor these level of managers to be effective and efficient in the organisation   and more so to be able to balance the competing demands they need to be committed in their roles and especially being change agents in the learning institutions. Proper communication is essential to any organisation or group effectiveness and learning institutions are not exceptional. Research indicates that poor communication is probably the most frequently cited source of interpersonal conflicts. It is only through transmitting meaning from one person to another that ideas and messages can be conveyed.Communication can play the following functions; controlling employee’s behaviour, motivating the workforce, provides a release for emotional expression of feelings and performs the role of facilitating decision making in organisation. Proper channels of communication should be put in place in learning institution and this will help the organisation to attain their set goals for example teachers reporting to their head teachers then the head teachers to senior managers then to the executive arm respectively if there have been a problem to be solved. (Edmondson, Bohmer and Pisano, 2001)Leadership is another concept that middle level managers should emphasize on. Without proper leadership, organisation’s effectiveness and efficiency cannot be achieved and bad leadership in an organisation may cause poor results and thus lack of attainment of objectives.   It should also be noted that not all managers are leaders and not all leaders are managers. Leaders can emerge from within a group as well as by formal appointments to lead a group. A good leadership style should be adopted in an organisation and especially in the learning institutions.This implies the way in which the functions of middle managers with particular regard to the concept of leadership are carried out. Styles like autocratic style of leadership should be discouraged as this does not give the opportunity subordinates in decision making and only top managers are responsible to do so. Learning institutions should prefer the use of democratic style of leadership whereby the focus of power is more with the group as a whole and not in the top managers and there is greater interaction in the group. The middle managers of learning institutions should practice laissez faire style of leadership in that the employees especially the subordinates are left to choo se groups for themselves and make their own decisions that will help them achieve the organisational goals. (Azzar, 2001)The middle managers’ impact on control mechanisms in any organization is great and immeasurable.   It is therefore important that managers look for convenient, cost-conscious and appreciated ways of control mechanisms in order to build a dynamic, committed and, a motivated workforce that will result in better productivity and profitability of the organization thus enhancing effectiveness and efficiency of the organizationConclusion:For middle level managers to meet the demands of top management as well as that of subordinates they should fully define their roles to avoid conflicts that may arise in the course of work. They should also use proper leadership and good communication skills in order to achieve the organisational effectiveness. Middle level managers has a greater need to understand organisational   behaviour in order to achieve the organisati onal   effectiveness and particularly in learning institutions and much attention should be directed to people, structure, technology and the environment.Organisational   effectiveness can only be achieved if the middle management is be able to incorporate good leadership, motivation, a well defined organisational   structure, forming group dynamics and setting up good structures for communicating in the workplace. The organisations should also be flexible in the sense that they should be ready to cope with change without affecting their productivity.References:Ardts, J. (2002): Developing people in line with corporate needs. Human Resource Management International.Azzar.J. (2001): The Heart of School Leadership-Educational LeadershipBaker, D. (1999): Strategic Human Resource Management-Performance, alignment, and management. Librarian Career Development.Bhindi, N. (2003): Practicing creative leadership- Pipedream or possibility? The Practicing AdministratorDale, M. (2001): Th e Art of HRD: Developing Management Skills  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   , Vol. 3, New DelhiCrest Publishing HouseEdmondson, A. Bohmer, R. and Pisano, G. (2001): Speeding up team learning. Harvard Business Review.Farson, R. and Keyes, R. (2002): The Failure-tolerant leader. The Innovative EnterpriseFiddler, B. and Atton, T. (1999): Dealing with poor performance and range of solutions in poor performing staff in schools and how to manage them. London and New York, RoutledgeKlagge, J. (1998): The Empowerment Squeeze-Views from the Middle Management Position. Journal of management development, 17(8)Maund, L. (2001): An Introduction to Human to Human Resource Management: Theoryand Practice: Macmillan, Palgrave

Essay about Arguement definition - 774 Words

Arguement definition Right Intentions Wrong Choice In an earlier story that was reported, one Samuel Mohammed burnt down a house in his West Palm Beach community. However, the question is not if Mohammed burnt the house down or not, because he admit to doing so. The question is did Mr. Mohammed commit a crime or not. Okay let me explain. The house was as abandoned building in his neighborhood and its use as a drug house was well known to the police and community. After making sure that, there was no one in the house, Mr. Mohammed torched it one night, stood about to watch the progress of the fire, and called the police and the fire department, which he admit to the police that he did in fact sets the house on fire. Mr.†¦show more content†¦His intentions were to burn down the drug house, and not to harm anyone. Then we have to see if Mr. Mohammed had justified reasons to burn the house. Mr. Mohammed burnt the house because he feels the house was a drain on the community; furthermore, he feels that it made the neighb orhood unsafe. Next, you need to know the definition of civil disobedience before we can discuss it. Civil disobedience means refusal to obey civil laws regarded as them unjust, by employing methods of passive resistance. Therefore, now you must prove the criminal charges of arson are unjust for this to be civil disobedience. While Mr. Mohammed did commit arson because he burnt down property that does not belong to him, he felted that his reasons were justified. The defendant felt this was the only way to rid his neighborhood of this problem. As stated in the beginning, the police knew of this house and did nothing about it. Although Mr. Mohammed knew he would be committing arson, he was left with no other choice. Furthermore, Mr. Mohammed admitted to setting the house on fire and calls the police and fire department, which lead one to believe that his intentions were not malicious. Finally, now that you know what arson and civil disobedience means and how Mr. Mohammed story stack up against both of them. You can finally answer the question, which is did Mr. Mohammed perform arson or was it civil disobedience. Well you now know to commit arson maliciousShow MoreRelatedManagers Can Be Developed, but Leaders Are Born, Not Made.1683 Words   |  7 PagesManagers can be developed, but leaders are born, not made. 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