Harvey N. Himel

A SERIOUS SKIN SULFUR MUSTARD BURN FROM AN ARTILLERY SHELL

Despite the Geneva Protocol of 1925 and the Paris Conference on Prohibition of Chemical Weapons in 1989, sulfur mustard and other chemical weapons continue to pose a hazard to both civilians and soldiers. The presence of artillery shells containing sulfur mustard, both in waters where these shells were dumped and in old battlefields, presents a problem in times of peace, especially for those who collect wartime memorabilia. Past literature has reported several hundred incidents involving fishermen who inadvertently pulled leaking shells aboard their fishing vessels, thereby exposing themselves to the vesicant chemical. Other literature reports exposure to children who found the chemical shells in old battlefields. The purpose of this article is to report the first case of a serious sulfur mustard burn that occurred after removing the detonator from an old artillery shell in a historic battle field near Verdun, France. The circumstances surrounding the injury, the diagnosis and management of injuries secondary to sulfur mustard, and the long-term consequences to the patient are presented and discussed. Although skin grafting has been used in the management of other chemical burn injuries, this report is the first to describe the need for split-thickness skin grafts in the management of a patient with sulfur mustard burns.

Psychometric assessment of psychologic factors influencing adult burn rehabilitation.

This article describes psychometric assessment instruments that are available for the screening of psychosocial problems that can interfere with patient rehabilitation. Structured assessment of patient depression, anxiety, substance abuse, social support, and willingness to take control and responsibility for health care is important throughout all stages of the patients treatment. There are psychometrically sound, relatively brief, and nonintrusive measures with which to assess these variables. The hope is that the early and accurate identification of those patients who are in need of psychosocial services can lead to the implementation of services that will ameliorate psychosocial problems and facilitate total patient rehabilitation. Although many excellent measures exist, the most important assessment tool for the screening of psychosocial problems in patients with burns, which has emerged from this review, is the Psychological Adjustment to Illness Scale (PAIS). The PAIS integrates many of the relevant characteristics of psychologic screening and provides normative values that are specific to patients with burns. Ideally, this scale should be supplemented by an assessment of post-traumatic stress disorder, substance abuse, and personality and coping styles, because these critical factors are not adequately covered by the PAIS. Finally, the Burn Specific Health Scale shows promise for the assessment of health status and quality of life in patients with burns. Future clinical research will hopefully compare and contrast the efficacy and relevance of these measures. Furthermore, future clinical evaluation and research will need to relate the influence of psychosocial factors on the patients total health functioning. Structured psychometric evaluation of the psychosocial and health characteristics will ensure that patients who have been burned will attain the most fulfilling quality of life that is available to them.

Health risks to fire fighters

Fire fighters work in varied and dangerous environments and face unique health hazards that increase their risk for line-of-duty injury and death. While working with sophisticated equipment within such environments, the fire fighter is exposed to high noise levels, changing thermal conditions, and hazardous breathing atmospheres. In addition, his or her protective equipment can impose limitations on efficiency and performance. These conditions have been related to specific physical performance requirements that will reduce line-of-duty injury, disability, and even death. Physical fitness and health maintenance programs that reduce the risk for cardiovascular disease and musculoskeletal injuries have been prescribed for fire fighters. These programs are essential components of any modern fire service.

Frostbite of the face after recreational misuse of nitrous oxide

Exposure of the skin to nitrous oxide, a liquified gas stored under pressure in a cylinder, can occur in anaesthesiologists and in those involved in recreational misuse of the gas. A case is reported of a man who presented to the emergency department after sniffing nitrous oxide and sustaining frostbite injury to his left cheek. Conservative management of this injury allowed spontaneous separation of the necrotic tissue and healing of the granulating wound by contraction.

Electric heating pad burns

Patients with sensory deficits are especially prone to heating pad burns. Two cases are reported of patients with anesthetic skin who received partial and full-thickness burns of their feet from an electric heating pad. These burn injuries could have been prevented if the patients understood the potential hazard of heating pads.

Electrical burn injuries of workers using portable aluminium ladders near overhead power lines.

The use of aluminium ladders around high voltage power lines has resulted in a significant number of electrical injuries and electrocutions. Workers often misjudge wire distances or lose control of fully extended ladders, thereby exposing themselves to electrocution hazard. High-voltage electrical burns of two workers using an aluminium ladder that contacted a high voltage power line are reported. The circumstances surrounding the injury, the clinical management of the case, and the methods of prevention are presented and discussed.

Major burn injuries among restaurant workers in New York City: an underappreciated public health hazard

Major burns among food service workers appears to be an underappreciated source of morbidity and public expense in New York City. A retrospective study was conducted to identify workers requiring hospital admission over the past 3 years. Seventy-six restaurant workers (3.8% of all adult admissions) were identified. They averaged 33 years of age, and sustained burns with a mean %TBSA of 12.5, resulting in a mean length of stay of 12.8 days. Scalds predominated, with water/coffee burns most common (n = 29), followed by oil (n = 27), and soup/sauce burns (n = 12). Burns to the extremities occurred in 97% of patients. Surgery was required in 32 of 76 patients (42.1%). Oil burns were more likely to require surgery than aqueous scalds (59 vs 34%; P < 0.01). Hospitalization expenses averaged

Bilateral amputations following hydrotherapy tank burns in a paraplegic patient

1.13 million dollars per year. There were no mortalities. Restaurant-related major burns are a frequent occurrence, particularly scald injuries. Hospital care and further disability result in enormous publicly funded expenses. The morbidity and lost wages are a severe detriment to workers and their families. Greater public health awareness measures are warranted.

The use of recombinant human erythropoietin and cultured epithelial autografts in a Jehovah's witness with a major thermal injury

Hydrotherapy is an important part of wound care and physical therapy. The benefits of hydrotherapy are derived from waters cleansing ability, buoyancy, drag, inertia and temperature. If the temperature of the water is not adequately controlled, an immersion scald burn can occur. A paraplegic patient who was receiving hydrotherapy for treatment of his malleolar ulcers sustained immersion scald burns that ultimately necessitated below-the-knee amputations.

Steam vaporizer burn injuries

Haemostatic debridement, recombinant-human erythropoietin and cultured epithelial autografts have been used successfully in a Jehovahs Witness with a major burn injury. Tourniquet ischaemia complemented by a topical haemostatic agent minimized excisional blood loss, while recombinant-human erythropoietin accelerated erythropoiesis, thereby correcting postburn anaemia. Cultured epithelial autografts provided coverage of the granulating wounds without creating donor sites.