A multicenter study of preventable contact burns from glass fronted gas fireplaces.

Glass fronted gas fireplaces (GFGFs) have exterior surfaces that can reach extremely high temperatures. Burn injuries from contact with the glass front can be severe with long-term sequelae. The Consumer Product Safety Commission reported that these injuries are uncommon, whereas single-center studies indicate a much higher frequency. The purpose of this multi-institutional study was to determine the magnitude and severity of GFGF injuries in North America. Seventeen burn centers elected to participate in this retrospective chart review. Chart review identified 402 children ≤10 years of age who sustained contact burns from contact with GFGF, who were seen or admitted to the study hospitals from January 2006 to December 2010. Demographic, burn, treatment, and financial data were collected. The mean age of the study group was 16.8 ± 13.3 months. The majority suffered burns to their hands (396, 98.5%), with burns to the face being the second, much less common site (14, 3.5%). Two hundred and sixty-nine required rehabilitation therapy (66.9%). The number of GFGF injuries reported was 20 times greater than the approximately 30 injuries estimated by the Consumer Product Safety Commission's 10-year review. For the affected children, these injuries are painful, often costly and occasionally can lead to long-term sequelae. Given that less than a quarter of burn centers contributed data, the injury numbers reported herein support a need for broader safety guidelines for gas fireplaces in order to have a significant impact on future injuries.

Efficacy of intravenous tissue plasminogen activator in frostbite patients and presentation of a treatment protocol for frostbite patients.

UNLABELLED: Frostbite can be a devastating and even debilitating injury. Early identification and proper treatment of frostbite is critical in saving digits and limbs. Tissue plasminogen activator (tPA) has been shown to be effective in reducing the number of digits amputated after severe frostbite injury. Nothing has been presented in the podiatric literature regarding the use of tPA in treating frostbite patients for preserving toes and feet. Intravenous tPA and IV heparin were used to treat severe frostbite injuries that did not show improvement after rapid rewarming, had absent Doppler pulses in the distal limb or digits, showed limited or no perfusion by Tc-99 3-phase bone scan, and had no contraindications to use of tPA. All 11 patients included in this study were treated at Hennepin County Medical Center between 2008 and 2010. A total of 73 digits (upper and lower extremity) were considered at risk for amputation after evaluation with Tc-99 bone scan. Of those digits that were affected, 43 were amputated. Intravenous tPA is a safe and effective treatment to reduce the number of digital amputations after severe frostbite injury. The authors' protocol for treating severe frostbite includes the use of tPA. LEVELS OF EVIDENCE: Therapeutic, Level IV.

Slightly hypertonic saline and dextran-40 in resuscitation of methamphetamine burn patients.

The inherent danger of illegal manufacture of methamphetamine is explosion and fire with the "cookers" presenting to burn centers for treatment. Recent studies have shown that methamphetamine burn patients required resuscitation volumes two to three times that of the standard Parkland formula and experienced a higher mortality rate. The purpose of this study was to compare the fluid resuscitation requirements and other characteristics of our methamphetamine-positive burn patients with a control group of methamphetamine-negative burn patients. A retrospective study of burn patients with methamphetamine-positive urine toxicology screens was conducted from August 1996 to April 2005. The data collected were age, sex, %total body surface area (%TBSA) burn, urine toxicology screen result, length of stay (LOS), ventilator days, weight, urine output, and fluid requirement during the first 24 hours along with fluid type, survival, and hospital charges. Methamphetamine-positive patients were matched to controls for %TBSA, age, and sex. Eleven methamphetamine-positive burn patients were well matched with 11 methamphetamine-negative controls. There was no difference in intubation rate, ventilator days, LOS, and there were no deaths in either group. There was no statistical difference between the two groups for the ratio of the 24-hour fluid resuscitation requirement divided by the estimate from the Parkland formula. Hospital charges were similar for the two groups. The largest volume of fluid infused was lactated Ringers (LR) and the slightly hypertonic fluid combination of LR + 50 mEq sodium bicarbonate + 3.4 mmol potassium phosphate. Both groups also received a dextran-40 (Rheomacrodex) infusion. In contrast to previous studies, our experience with methamphetamine-positive burn patients shows that they did not have an increased initial fluid requirement, a longer LOS, more days on the ventilator, higher hospitalization charges nor an increased mortality rate. The only apparent difference between our study and others is in the method of resuscitation. The slightly hypertonic fluid combination of LR + 50 mEq sodium bicarbonate +3.4 mM potassium phosphate was used for resuscitation along with Rheomacrodex. Prospective trials should be conducted on this fluid resuscitation strategy to determine wider applicability for all large burn patients.

An open-label study to evaluate the safety and efficacy of tissue plasminogen activator in treatment of severe frostbite.

BACKGROUND: Severe frostbite can have devastating consequences with loss of limbs and digits. One of the mechanisms of cold injury to human tissue is vascular thrombosis. The effect of tissue plasminogen activator (tPA) and heparin in limb and digit preservation in severe frostbite patients has not been previously studied. METHODS: Intra-arterial (6 patients) or intravenous (i.v., 13 patients) tPA and IV heparin were used in patients with severe frostbite. All patients between January 1, 1989 and February 1, 2003 with severe frostbite not improved by rapid rewarming, with absent Doppler pulses in distal limb or digits, without perfusion by Technetium (Tc) 99m three-phase bone scan, and no contraindication to tPA use were eligible. Efficacy was assessed on the basis of predicted digit amputation before therapy, given the clinical and Tc-99m scan results, versus partial or complete digits removed. RESULTS: There were no complications with i.v. tPA. Two patients with intra-arterial TPA had bleeding complications. We know from historical Tc-99m scan data which digits were at risk for amputation. In this study, there were 174 digits at risk in 18 patients and only 33 were amputated. CONCLUSION: Intravenous tPA and heparin after rapid rewarming is safe and reduced predicted digit amputations considerably. Patients with no response to thrombolytic therapy were those with more than 24 hours of cold exposure, warm ischemia times greater than 6 hours, or evidence of multiple freeze-thaw cycles. Our algorithm for treatment of severe frostbite now includes use of i.v. tPA for patients without contraindications.