Dissociative responses in the immediate aftermath of the Oakland/Berkeley firestorm

This study examined relationships between dissociative symptoms experienced in the immediate aftermath of the Oakland/Berkeley firestorm and contact with the fire, life events, demographic variables, and actions taken after learning about the fire. One hundred eighty-seven participants completed self-report measures about their experiences during and immediately following the fire. Dissociative symptoms were significantly related to contact with the fire, sex, and stressful life events. Also, dissociative symptoms were significantly related to engaging in certain activities, such as trying to get closer to the fire and going into blocked-off areas and crossing police barricades. These results suggest that dissociative symptoms may merit special attention in intervention focusing on the immediate aftermath of disaster.     

Value of endotracheal tube safety in laryngeal laser surgery

BACKGROUND AND OBJECTIVES: Due to the increased popularity of laryngeal laser therapy, surgeons and anesthesiologists are inevitably confronted with questions concerning the choice of the most efficient endotracheal tube (ETT) for laryngeal laser surgery, especially with regard to possible endolaryngeal tube fires, or combustions. The purpose of this study was to determine the current practice in endolaryngeal laser surgery in Germany. STUDY DESIGN/MATERIALS AND METHODS: A questionnaire was sent to 152 ENT Departments in Germany, care was taken that the responders could send back the questionnaire anonymously. Among other questions the participants were asked for the number of lasersurgical treatments of the larynx performed in the past, the usual type of ETTs in use, whether other safety precautions were taken during CO2 laser surgery of the larynx and for intraoperative complications like tube ignition, fires or combustions. RESULTS: Eighty six of the 152 addressed ENT departments replied. In laryngeal laser surgery, 59/86 departments regularly use special laser tubes in daily routine (74.5%). In about 20,000 lasersurgical procedures, 15 incidents of ETT fire have been reported. In six of the reported 15 cases a tube fire occurred despite the fact that special laser tubes had been utilized. CONCLUSIONS: The present study could demonstrate that the use of special laser tubes does not necessarily protect against ETT fire. Thus, even when using special laser tubes other safety measures should be taken. In view of the maximum safety for the patient it has to be stated, that the safety during surgery correlates definitely with the experience of the surgeon. The weakest point of ETTs is usually situated in the cuff region.     

Report on a study of fires with smoke gas development

Background

This is a report on an international non-interventional study of patients exposed to fires with smoke development in closed rooms. The objective of the study was to document clinical symptoms, relevant laboratory values and blood cyanide concentrations from fire victims in order to confirm or rule out presumptive correlations between the individual parameters.

Materials and methods

The study was conducted in five European countries with patients being included if they presented with the characteristic clinical signs, such as soot deposits and altered neurological status. Venous blood samples were taken from victims prior to administration of an antidote in all cases and determination of cyanide concentration was performed in a central laboratory using high performance liquid chromatography.

Results

Data from 102 patients (62?% male, average age 49 years) were included in the evaluation with no blood samples being available for analysis from 2 patients. In 25 patients the blood cyanide concentration was below the limit of detection of 1.2 μmol/l. Cyanide levels between 1.2 and 10 μmol/l were measured in 54 patients, 7 patients had values between 10 and 20 μmol/l, 4 patients between 20 and 40 μmol/l while levels above 40 μmol/l were determined in 10 patients. The results of the study could not demonstrate that the cyanide level was influenced either by the interval between smoke exposure and blood sampling or the duration presence at the fire scene. The following clinical signs or laboratory values were recorded as relevant for increased and possibly toxic cyanide levels: respiratory arrest, dyspnea, resuscitation requirement, tracheal intubation, respiratory support measures, low Glasgow coma scale (GCS) score and respiratory frequency. A correlation between cyanide concentration and the total amount of soot deposits on the face and neck, in the oral cavity and in expectoration was confirmed. A correlation between cyanide and carboxyhemoglobin (COHb) levels in the blood of fire victims was also confirmed.

Conclusions

As long as it is not possible to immediately determine the blood cyanide concentration in patients exposed to fire with smoke development, a decreased GCS score, soot deposits particularly in expectoration, dyspnea and convulsions are to be regarded as risk markers for intoxication. In their presence immediate administration of hydroxocobalamin as an antidote is recommended.     

The long-term results of electric fire hand burns in children

An 11-year retrospective series of 95 deep, electric fire hand burns in children was studied and the epidemiology, treatment and operative management analysed. From this series a group of 14 patients was recruited to assess the long-term results of this injury. At long-term follow-up (mean 14.4 years) the recorded parameters included range of movement, hand sensation, power and size. Photographs were taken and any subjective problems noted. Analysis of these data showed a marked variation in range of movement, sensation, size and appearance of the injured hands. Despite this, complaints about cosmetic results or any restriction of activities were rare. In conclusion, these injuries are particularly destructive but with appropriate surgical management, albeit protracted, and despite imperfect cosmetic results, excellent function can be obtained in the growing hand.     

火针联合艾拉光动力治疗难治性痤疮

目的:评价火针联合艾拉光动力治疗难治性痤疮的临床疗效。方法:选择2017年5月-2019年1月笔者医院就诊的难治性痤疮患者,共300例,采用随机数字法分为三组,即对照组、火针组和联合组,每组100例。对照组:采用口服抗生素和异维A酸治疗;火针组:采用火针治疗,1周1次;联合组:采用火针联合艾拉光动力治疗。疗程均为4周。采用中医证候积分定量评估病情严重程度、治疗前后积分变化以及临床疗效和并发症,疗程结束后继续随访4周,比较复发率。结果:三组治疗后中医症候积分均较前降低,且联合组积分绝对值显著低于火针组,对照组最高,而降低百分比显著高于火针组,对照组最低(P<0.05)。疗程结束后,联合组总有效率显著高于火针组,对照组最低(P<0.05)。联合组和火针组均未出现严重不良反应,均能坚持完成规定疗程。随访发现,联合组复发率显著低于火针组,对照组最高(P<0.05)。结论:针对难治性痤疮患者可选择火针联合艾拉光动力治疗,能够显著改善临床症状,提高临床疗效,降低复发率,同时不增加不良反应,有较好的安全性。     

Fire hazard during ophthalmic surgery

A plastic surgical drape was ignited by a disposable cautery during cataract surgery performed under local anesthesia. The flame was quickly extinguished, and the procedure was completed without complications. The patient did well postoperatively and attained a corrected visual acuity of 20/25. Precautions should be taken to minimize the possibility of fire occurring during ophthalmic surgery.     

Surgical field fire during a repair of bronchoesophageal fistula

Most surgical fires involve the airway but they can also occur in the surgical field. Herein, we report an intraoperative fire in the surgical field during repair of a bronchoesophageal fistula. During the portion of the surgery after the fistula was divided and the bronchus was open to atmosphere, continuous positive airway pressure was applied to the nondependent lung, and in conjunction with the use of electrocautery and dry sponges in the field, resulted in a fire. Anesthesia for thoracic surgery carries unique risks of fire because these patients frequently require large oxygen concentrations, special interventions for improving oxygenation, and have variable degrees of airway disruption. This report highlights unique safety concerns during anesthesia for thoracic surgery, and addresses more general safety issues relating to fire risk in all surgical patients.     

Fire safety and emergency evacuation guidelines for intensive care units and operating theatres: for use in the event of fire,flood, power cut,oxygen supply failure,noxious gas,structural collapse or other critical incidents

The need to evacuate an ICU or operating theatre complex during a fire or other emergency is a rare event but one potentially fraught with difficulty: Not only is there a risk that patients may come to harm but also that staff may be injured and unable to work. Designing newly-built or refurbished ICUs and operating theatre suites is an opportunity to incorporate mandatory fire safety features and improve the management and outcomes of such emergencies: These include well-marked manual fire call points and oxygen shut off valves (area valve service units); the ability to isolate individual zones; multiple clear exit routes; small bays or side rooms; preference for ground floor ICU location and interconnecting routes with operating theatres; separate clinical and non-clinical areas. ICUs and operating theatre suites should have a bespoke emergency evacuation plan and route map that is readily available. Staff should receive practical fire and evacuation training in their clinical area of work on induction and annually as part of mandatory training, including ‘walk-through practice’ or simulation training and location of manual fire call points and fire extinguishers, evacuation routes and location and operation of area valve service units. The staff member in charge of each shift should be able to select and operate fire extinguishers and lead an evacuation. Following an emergency evacuation, a network-wide response should be activated, including retrieval and transport of patients to other ICUs if needed. A full investigation should take place and ongoing support and follow-up of staff provided.     

Bandage burns: the fire risk of cottonwool: two case reports

A potential fire hazard of conventional dressings is reported. The danger is illustrated by the two following case reports of patients who sustained burns when the cottonwool component of their dressings caught fire.     

TRIAGE AND INITIAL TREATMENT OF BURNS IN THE GOTHENBURG FIRE DISASTER 1998. ON-CALL PLASTIC SURGEONS' EXPERIENCES AND LESSONS LEARNED

Just before midnight on the 29 October 1998 the on-call plastic surgeons were alarmed because of a fire accident thought to involve a few burned patients. Quite soon the information suggested an in-door fire disaster in which many of the 400 young people visiting a disco were caught by a rapidly spreading fire. A cross-sectional survey of the resulting overload, triage and initial treatment of burns was analysed. Two-hundred and thirteen patients were transported to the four hospitals in Gothenburg area and a total of 150 were admitted as inpatients, 73 to Sahlgrenska University Hospital. The initial organisation at the scene of the fire was seriously inadequate because of incorrect information about the number of casualties. As there was no triage officer the principle of "scoop and run" was practised, placing the major burden on the receiving hospitals. The emergency disaster plan in our hospital was not launched, because of misinformation and lack of communication. Early documentation in emergency case books was incomplete as the whole organisation was overloaded. Intubation or tracheostomy and escharotomy at the intensive care unit were not delayed. Triage for transportation to burns units was adequate.     

Triage and initial treatment of burns in the Gothenburg fire disaster 1998. On-call plastic surgeons' experiences and lessons learned.

Just before midnight on the 29 October 1998 the on-call plastic surgeons were alarmed because of a fire accident thought to involve a few burned patients. Quite soon the information suggested an in-door fire disaster in which many of the 400 young people visiting a disco were caught by a rapidly spreading fire. A cross-sectional survey of the resulting overload, triage and initial treatment of burns was analysed. Two-hundred and thirteen patients were transported to the four hospitals in Gothenburg area and a total of 150 were admitted as inpatients, 73 to Sahlgrenska University Hospital. The initial organisation at the scene of the fire was seriously inadequate because of incorrect information about the number of casualties. As there was no triage officer the principle of "scoop and run" was practised, placing the major burden on the receiving hospitals. The emergency disaster plan in our hospital was not launched, because of misinformation and lack of communication. Early documentation in emergency case books was incomplete as the whole organisation was overloaded. Intubation or tracheostomy and escharotomy at the intensive care unit were not delayed. Triage for transportation to burns units was adequate.     

Fire tests and hazards: an Australian approach

The use of fire tests in assessing fire hazards is described against a general discussion of the uses of fire tests, the concepts of fire hazard and fire risk and the methods of test classification. Four approaches to fire hazard assessment are explored: analysis of fire risk data, simulation experiments, ‘direct data’^† tests and fire hazard specifications using direct data or ‘supportive data’ tests. It is concluded that users of these tests need to be aware of their significance and the manner in which they should be used.     

Assault by burning--a reappraisal.

Assault by burning is a serious form of trauma that often results in higher incidence of inhalation injury, longer intensive care unit (ICU) and hospital stay, and higher mortality rate than is observed in the general burn population. We evaluated the epidemiology and outcome of assault burn victims treated in a tertiary burn center over a 6-year period. Among the 1063 acute burn patients who had been admitted to the Burns Unit between March 1993 and February 1999, 28 (2.6%) had assault burn injuries either by scald, chemical or fire. The mean extent of burn was 21.9%+/-20.8% (range 2-90%) total body surface area and the mean length of hospital stay was 65.2+/-107.3 days (range 1-565). Nineteen out of 25 patients (67.9%) underwent 76 operations. Nine patients had inhalation injuries requiring intubation and ICU admission. Three patients died in the series, which yielded a mortality rate of 10.7%. Compared to the general burn population, the assault burn group had significantly larger burn size (P<0.001), higher incidence of inhalation injury (P<0.001), longer ICU and hospital stay (P<0.001), and higher mortality rate (P<0.005). When these 28 victims were grouped according to the type of assault burn injury into a fire group, chemical group and scald group, all the 9 ICU admission and the 3 mortalities belonged to the fire group. Assault by fire resulted in larger burn size (P=0.03), more inhalation injury (P<0.001) and longer ICU stay (P=0.02). Although the fire group had a longer hospital stay and higher mortality rate, this was statistically insignificant.     

异维A酸联合火针治疗结节囊肿型痤疮的临床疗效与皮肤超声评估

探讨异维A酸联合火针治疗结节囊肿性痤疮的疗效,分析火针治疗前后的皮肤激光共聚焦 扫描显微镜及皮肤超声的成像特征。方法 选取我院2023年1月-6月收治的87例结节囊肿型痤患者为研究对 象,采用随机数字表法分为对照组（47例）和观察组（40例）。对照组予以口服异维A酸治疗,观察组予 以异维A酸联合火针治疗,比较两组临床疗效,并采用皮肤激光共聚焦扫描显微镜及皮肤超声观察治疗前 后镜下变化。结果 两组治疗后2、4周治疗总有效率比较,差异无统计学意义（P ＞0.05）,观察组治疗后 6、8周治疗总有效率高于对照组,差异有统计学意义（P＜0.05）;皮肤激光共聚焦扫描显微镜下粉刺表现 为毛囊失去原有的结构,真皮浅层有圆形低折光性的栓塞,皮肤超声可见结节囊肿性皮损表现为皮下的混 合回声等影像学特征,火针治疗后,共聚焦激光扫描显微镜下可见真表皮曾恢复正常结构,部分可见真皮 乳头边缘有较多高着光物质;皮肤超声下结节囊肿可见明显的消退不留痕迹。结论 异维A酸联合火针治 疗痤疮的起效更快,疗效确切。皮肤激光共聚焦扫描显微镜及皮肤超声可用于判断火针治疗痤疮的疗效。     

Fires and burns during plastic surgery

Many plastic surgery procedures are performed under local anethesia. When the procedure involves the head and neck, oxygen is perilously close to the surgical field. A thorough understanding of the fire triangle will allow the plastic surgeon to develop a routine that will avoid any risk of fire. The fire triangle consists of a heat source, a fuel, and an oxidizer. By removing one component of the fire triangle, the risk of fire is averted. An in-depth look at each component is needed because fire hazards involve some surprising sources.     

Alcohol based surgical prep solution and the risk of fire in the operating room: a case report

A few cases of fire in the operating room are reported in the literature. The factors that may initiate these fires are many and include alcohol based surgical prep solutions, electrosurgical equipment, flammable drapes etc. We are reporting a case of fire in the operating room while operating on a patient with burst fracture C6 vertebra with quadriplegia. The cause of the fire was due to incomplete drying of the covering drapes with an alcohol based surgical prep solution. This paper discusses potential preventive measures to minimize the incidence of fire in the operating room.     

针对性护理干预结合雷火灸对妇科肿瘤手术患者切口愈合美观性影响

目的 分析针对性护理干预结合雷火灸对妇科肿瘤手术患者切口愈合美观性的影响。方法 选取 2023年1月-12月于我院接受妇科肿瘤手术的100例患者作为研究对象,采用随机数字表法分为对照组与观察 组,各50例。对照组予以常规护理,观察组予以针对性护理干预结合雷火灸,比较两组切口愈合美观性、术 后胃肠功能情况。结果 观察组切口愈合美观率高于对照组,差异有统计学意义（P＜0.05）;观察组术后腹 胀发生率低于对照组,肛门排气时间、首次排便时间短于对照组,差异有统计学意义（P＜0.05）。结论 针 对性护理干预结合雷火灸在妇科肿瘤手术患者中的应用可促进术后切口愈合美观性提高,改善患者胃肠道 功能。     

Recordings of abnormal activity in patients with deafferentation and central pain

We have performed a single-unit analysis of the spontaneous activity of cells in 9 patients with central and deafferentation pain and 4 patients without pain. These studies have concentrated on the analysis of cells firing in bursts, which are particularly prevalent in pain patients. These cells were found to fire typically at interspike intervals of 1-2 ms and interburst intervals of 50 ms. Such cells occurred throughout nucleus ventralis caudalis, nucleus ventrocaudalis parvocellularis and possibly nucleus ventralis intermedius and are different in terms of firing characteristics and locations from bursting cells found in non-pain patients.     

Airway fire during tracheostomy: prevention strategies for surgeons and anaesthetists.

Airway fires are an uncommon but real and devastating complication of tracheostomy. One such fire in a 31-year-old man is described. Surgical fires are discussed, and 15 reported cases of tracheostomy fire are reviewed. A tracheostomy protocol, adopted by our department and designed to avoid this life-threatening complication, is described. Surgeons and anaesthetists involved in tracheostomy must understand the fire hazard and how to avoid it.