Anesthesia Implications of Patient Use of Electronic Cigarettes.

Electronic cigarettes are essentially electronic nicotine delivery systems (ENDS). Use of ENDS has increased sharply in the United States in recent years, particularly among youth. We reviewed the literature on ENDS use, based on a PubMed search, with a focus on effects that could influence anesthetic and surgical outcomes. We also included a meta-analysis of articles published between 2016 and 2018 reporting injuries from exploding ENDS. These devices deliver nicotine, which is addictive and a cardiac stimulant. The nicotine in ENDS has been linked to increased risk of heart disease and myocardial infarction. Also, ENDS deliver vapors of solvents, flavorings, and other chemicals that can cause chronic and acute respiratory diseases. Furthermore, ENDS use may pose a cancer risk. However, ENDS are somewhat less dangerous than cigarettes and are used as smoking cessation devices. From the literature review, we identified 15 articles reporting injuries from ENDS fires and explosions to 93 patients. Most of these patients were young (mean age = 31.6 years) and male (91%). The most common injury sites were the thigh (62%) and hand (33%). Because the anesthetist will likely encounter increasing numbers of ENDS users in the future, it is important to identify these patients and to understand the risks of ENDS use.

Etiologia e tratamento de queimaduras provocadas por agente químico: scoping review / Etiology and treatment of chemical burns: scoping review

It is estimated that over 60,000 different chemicals might be used in industry, agriculture and the home environment. Chemical burns account for only 3% of the total, yet account for approximately 30% of burn deaths. The aim of the study was to identify the latest evidence on treatment of skin burns caused by chemical agents.A scope review was chosen, and articles published between 2013 and 2019 were selected. The research was conducted with the following descriptors: chemical burn and skin burn or skin injury or burn care or treatment burn and therap. CINAHL, MEDLINE, MedicLatina and Cochrane Database were searched. The survey was conducted in January and February 2019. Eleven articles were selected, such as case studies, retrospective and prospective studies. The circumstances in which the burns occurred were workplace accidents, home accidents and personal attacks. The chemical agents used were acid and base type. The burned body area was between 30% and 0.5%. The most severe outcome was three deaths. The first-line treatment approach to the lesion was prolonged lavage or H2O. Continuity of treatment integrates systemic, topical pharmacological measures, pain control, surgical and non-pharmacological therapies.The etiology of skin burns by chemist is multiple. The treatment integrates particularities that distinguish it from other burn types, and an appropriate approach has significant results in survival and recovery of the person with chemical burn

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Exposición a productos químicos. Descontaminación cutánea y ocular / Chemical exposute. Cutaneous and ocular decontamination

Los productos químicos, ya sea en el ámbito doméstico, agrícola o industrial, pueden tener como órgano diana de su acción tóxica la piel y las mucosas, y producir desde una irritación a una quemadura, o utilizar estas vías para la absorción y la generación de toxicidad sistémica. La descontaminación precoz de piel y mucosas es fundamental para evitar la absorción del tóxico y así reducir o evitar lesiones locales y secuelas generales que pueden ser graves o incluso mortales. Para ello es necesario disponer de un área de descontaminación química, conocer las técnicas y métodos principales de descontaminación y disponer de protocolos de actuación (AU)

Chemicals, whether domestic, agricultural or industrial, may have a toxic effect on the skin and mucous membranes, with consequences ranging from irritation to burns, or even to systemic toxicity after absorption. Early decontamination of skin and mucous membranes is essential to prevent absorption of the toxicant and reduce or avoid local injury and general sequels that can be serious or even fatal. It is therefore necessary to have a chemical decontamination area, to be aware of the main decontamination techniques and methods and to have action protocols (AU)

Treating cement burns in the emergency department.

Use of cement is widespread in the UK and warnings about burns caused by contact with the material are usually printed on bags and delivery dockets. Nevertheless, about 2 per cent of people admitted to burns units have injuries, many serious, caused by prolonged contact with wet cement. This article explores the pathophysiology of cement burns, and outlines the best forms of treatment and prevention.

A systematic review of methods of eye irrigation for adults and children with ocular chemical burns.

AIM: To present the best available research evidence on eye irrigation methods for ocular chemical burns to facilitate better-informed clinical decisions. METHODS: Randomized, quasi-randomized controlled trials and observational studies comparing the effectiveness of eye irrigation methods among adults or children as an active form of emergency treatment for ocular chemical burns were reviewed. Electronic databases in English and Chinese were searched from inception to June 2010. Two reviewers made independent decisions on whether to include each publication in the review and critically appraised the study quality independently. Given the clinical and methodological diversity among the studies, the review findings are presented in a narrative form. RESULTS AND DISCUSSION: Four studies involving 302 adults and children were identified. The results of this review indicate that patients who underwent irrigation with tap water immediately following alkali burns at the scene of injury had significantly better clinical and ocular outcomes. The evidence also suggests that in hospital settings, more patients preferred balanced saline solution (BSS) plus than other irrigation fluids. Irrigation with diphoterine was found in one study that resulted in better ocular outcomes following grade 1 and 2 ocular burns. With regard to duration of eye irrigation, patients with ocular chemical burns treated with prolonged irrigation reported shorter duration of treatment at hospital and absence from work. The results should be treated with caution, as there were significant differences between the comparison groups in some studies. IMPLICATIONS AND CONCLUSIONS: As prompt eye irrigation with tap water immediately after alkali burns had better outcomes, it would be important to commence eye irrigation immediately after burns are sustained. In this review, irrigating fluids including normal saline, lactated Ringer's, normal saline with sodium bicarbonate added, BSS Plus, and diphoterine solutions all yielded positive ocular outcomes suggesting for its use in hospital settings.

[Management of phenol burn cases combined with poisoning].

OBJECTIVE: To explore the therapeutic processing and nursing for phenol burn patients combined with poisoning. METHODS: The clinical data of 42 phenol burn cases admitted in our hospital from 1998 to 2010 were reviewed retrospectively. The general clinical manifestations, treatment and nursing methods, and the treatment results of these cases were analysed. RESULTS: Out of 42 phenol burns patients, the total burn surface area (TBSA) of 22 cases were ≤ 5%, 10 cases' TBSA were 6% ∼ 10%, and 5 cases' > 20%. 36 patients showed systemic poisoning symptoms 1 ∼ 2 hours after injury, the severity and enduring period of which correlated with TBSA. Patients whose TBSA > 10% appeared obviously dysfunction of the liver and kidney. The therapeutic methods included wound management, compensation of fluid, diuresis, alkalized urine, large dose of vitamin C and glucocorticoid, early surgery, blood purification, etc. 39 of 42 cases were successful cured, while the other 3 cases died. CONCLUSIONS: Phenol burn often complicates systemic poisoning. In the treatment of patients with this special chemical burn, it is key scheme to block phenol absorption and promote elimination of already absorbed poison as early as possible. The comprehensive management and nursing should be necessary for supporting functions of important organs.

Diphoterine for alkali chemical splashes to the skin at alumina refineries.

BACKGROUND: Diphoterine is a commercially available amphoteric, hypertonic, chelating solution used to decontaminate and irrigate chemical splashes. The aim of this study was to evaluate the implementation of Diphoterine at three alumina refineries. This is the largest case series reported to date. METHODS: One hundred eighty cases of alkali splashes to the skin were evaluated clinically. Two groups were compared; those who had applied Diphoterine first and those who had applied water first. RESULTS: There were no signs of chemical burn in 52.9% of the group who applied Diphoterine first compared with 21.4% of the group who applied water first. Only 7.9% of the group who applied Diphoterine first had blisters or more severe signs compared with 23.8% of the group who applied water first. The differences were statistically significant (P < 0.001). After implementation of Diphoterine the "first aid" injury rate for chemical burns fell 24.7% (95% CI 0.5­43.0%). CONCLUSIONS: Applying Diphoterine first was associated with significantly better outcomes following alkali skin splashes than applying water first.

Chemical eye injuries 1: presentation, clinical features, treatment and prognosis.

This is the first in a two-part unit on chemical eye injuries. It looks at chemical agents and their effects on the eye, and the clinical features and prognosis in chemical eye injuries. Extensive immediate treatment in the form of irrigation is essential even before a proper history and examination. This should be followed by aggressive early management and close long-term monitoring to promote ocular surface healing and provide the best possible opportunity for visual rehabilitation.

Ocular emergencies: a quick reference.

Sight is precious, considered by many to be the most essential of the five senses. Children's eyesight is especially important, because good vision is related to learning. Regular eye examinations are needed to maintain proper eye health, since some serious eye disorders produce no early warning symptoms. Although prevention is the best defense, eye problems or injuries still occur suddenly and unexpectedly. When they do, recognizing their signs and symptoms and knowing what to do is vital to preserving sight.

Chemical eye injuries in the workplace. Prevention and management.

1. The majority of ocular burns are related to accidents at work. Acute ocular chemical injuries require emergent recognition and management. 2. Copious irrigation of the eye, done immediately at the scene, is the most important factor in the long term prognosis of ocular chemical burns. 3. After irrigation has been completed and the eyes have been allowed to rest, visual acuity can be tested and referrals can be made to health care facilities and an ophthalmologist. 4. The nurse conducts health hazard assessments of the workplace, provides information about workplace chemicals and their risks, and ensures proper safety protective equipment and emergency supplies. Practicing emergency procedures such as irrigation is important. 5. The nurse monitors and analyzes injury exposure episodes and trends, along with coordinating referrals, treatments, and follow up care for workers with ocular chemical burns.