Uncontacted tire explosion causing trauma to bilateral lower extremities: A case report

It is uncommon for tire explosion related injuries on the lower extremity. The bilateral lower extremities were injured by tire explosion when the patient was seated in a bus. She sustained an open fracture with partial bone loss in the right calcaneus (a comminuted fracture in the right ankle joint) and a closed comminuted fracture in the left tibia and fibula. This damage was caused by uncontacted tire explosion, thanks to a thick floor between the exploded tire and the patient''s feet. This type of injury on lower extremity caused by uncontacted tire explosion was uncommon.     

重组人生长激素在瓦斯爆炸烧伤患者的应用与研究

目的:了解重组人生长激素(rhGH)对瓦斯烧伤患者血清胰岛素样生长因子(IGF-1)、白蛋白、血糖以及肿瘤坏死因子-α1(TNF-α1)、白细胞介素-1α(IL-1α)、C-反应蛋白(CRP)等炎性介质的影响,探讨rhGH对烧伤愈合的机制。方法:13例同一批瓦斯烧伤患者随机分为治疗组(7例)、对照组(6例)。治疗组于伤后7天每日早7时接受rhGH皮下注射(0.2u.kg-1.d-1),疗程14天,对照组同时同部位注射等量生理盐水。结果:治疗组用药第7、14天和停药后7天的血清IGF-1、白蛋白含量高于对照组(P<0.01),治疗组用药第7、14天的血清TNF-α、IGF-1、CRP低于同期对照组(P<0.05),治疗组停药后7天的血糖水平低于用药第14天(P<0.01)。结论:rhGH可以提高瓦斯烧伤患者血清IGF-1、白蛋白的水平,降低血TNF-α、IL-1α、CRP的水平,血糖升高的不良反应可随停药而逆转。     

The Halifax explosion and the birth of a surgical specialty—myth or reality

The work of Dr William E. Ladd after a devastating explosion in Halifax in 1917 has been credited with his decision to devote his subsequent career to the betterment of surgical care for children. He has been recognized as the “father of pediatric surgery” in North America. The authors present a written refutation of this causal association by Dr Ladd.     

Triage in a Bomb Disaster with 166 Casualties

Abstract Background: We describe the surgical response of the Helsinki University Hospitals to a bomb disaster with 166 casualties. According to the Helsinki Area Disaster Plan, severely injured patients were transported to several hospitals with emergency facilities to avoid overtriage. Methods: The patient data were gathered from hospitals, health centers and other doctor visit/ appointments records. Injury Severity Scores (ISS), critical mortality rate and death/wounded ratio were calculated. Results: Of the 166 injured patients, 5 died immediately at the bombing site. Sixty-six patients were transported to the six affiliated hospitals. The mean ISS score for survivors was 12. Seventeen percent of the acute survivors were critically injured (ISS>15). The critical mortality rate was 8%. There were no later deaths; the dead/wounded ratio was 4.4. Operative treatment was performed for 38% of the patients treated in surgical emergency departments. Conclusion: The bombing attack in Myyrmanni shopping center led to 166 casualties, of whom 66 patients were received at six affiliated hospitals in Helsinki and Uusimaa Area. The critical mortality rate was low. A local disaster plan was implemented. The surgical response was rapid and well coordinated. In a mass casualty disaster not all disaster victims need to go to a trauma center.     

Non‐operative management of multiple penetrating fragments of the torso secondary to an explosion

Explosive devices owe their devastating effect to a combination of a complex pressure wave generated by the explosion, and the shrapnel flying at high speed. Exploratory laparotomy has been the rule for abdominal injuries associated with explosions. In the present report, we describe the clinical course of a patient who was subjected to an explosion with multiple small shrapnel penetrating the abdominal wall. A non‐operative approach was successfully followed.     

经尿道前列腺电切术中发生膀胱内爆炸5例分析

目的提高对经尿道电切术中发生膀胱内爆炸的认识,以期减少该并发症的发生率。方法回顾本院1994～2010年开展经尿道电切术发生术中膀胱内爆炸的5例病例,分析总结经验教训,提出预防策略。结果其中4例是在连续电切并使用Ellick冲洗球冲洗膀胱后,再次电切或电凝时发生膀胱内爆炸。5例病例中4例发生明显的膀胱破裂,给予相应处理。结论经尿道电切术中发生膀胱内爆炸是极为罕见的并发症,考虑主要原因是在冲洗膀胱时进入了一定量的空气,在与膀胱内可燃气体充分混合达一定比例后,因电火花引发爆炸,易导致膀胱破裂。术中注意缩短手术时间,并及时有效排除各种原因产生的气体应可减少其发生机会。     

Biophysics of the photoablation process

Besides the coagulation, where the body digests the necrotic tissue and direct evaporation of tissue, the photoablation effect turns out to be very important in tissue removal.In the case of high tissue absorption the process channels in photoablation can either be photochemical (bond breaking) or fast thermal. In the case of transparent media, a plasma formation due to high irradiances and an optical breakdown is necessary for ablation or photodisruption.All the process channels lead to a fast microscale explosion and to Shockwaves. For soft tissue the main process channel is the fast thermal explosion.Assuming that tissue will be disintegrated, if the energy deposited within a single laser pulse is larger than a material specific threshold, the thresholds for the radiant exposure and ablation rates respectively can be calculated.There is a large difference, whether the laser radiation is applied to the tissue surface in noncontact or through a fibre in contact. In contact the fast thermal explosion happens in a closed chamber and hence the photohydraulic effect will support the photoablation.The thermally damaged zone in the surrounding tissue depends on the optical penetration depth mainly in cases that the pulse duration is shorter than a critical time given by the heat conductivity. Pulsed lasers can be used non-thermally only if the average power is less than a tenth of a watt. With a higher amount of average power a pulsed laser will act comparable to a cw laser.     

Aerial fireworks can turn deadly underwater: Magnified blast causes severe pulmonary contusion

Firework injuries have been reported in the literature but usually with regards to mangled extremities, superficial burns and disfiguring soft tissue injuries. Unbeknownst to most lay handlers of recreational fireworks, the blast effect of even a small explosive charge is magnified significantly when detonated underwater, turning a modestly charged firework into a potentially deadly weapon. While the literature is abundant in injuries sustained from underwater detonations of military grade explosives, we found only a single case report of traumatic brain injury resulting from an illegal M80 explosive [4]. We describe a young man who sustained severe life-threatening haemorrhagic pulmonary contusion resulting from incomplete launching of an aerial firework that detonated in the water where he was partially submerged. This report reviews the mechanism of underwater blast injuries and the factors contributing to severe internal organ damage from relatively small-charge and commercially available explosive devices.     

Fires and explosions

Fires and explosions require three elements in order to occur (the ‘fire triangle’): oxygen, fuel and heat. In the operating theatres, different team members have control over each limb of the fire triangle hence good teamwork is paramount to prevent and restrain a fire. Managing a fire involves recognizing early signs and separating the three elements of the fire triangle, extinguishing the fire immediately, evacuating when appropriate and delivering post-fire care. Airway fires are a particular challenge and establishing a patent airway and ensuring ventilation in these cases can be very difficult and require surgical input. This article reviews the physics and aetiology of surgical fires and explosions. It summarizes international guidelines for the prevention and treatment of fires.     

Optimizing mass casualty burns intensive care organization and treatment using evidence-based outcome predictors

Background

Majority of current research focuses on pre-hospital care in mass casualty incidents (MCI) whereas this study is the first to examine multifactorial aspects of intensive care unit (ICU) resource management during a surge in massive burn injury (MBI) patients whilst identifying key outcome predictors that resulted in successful disaster managements.

Intra-Articular Fractures of the Distal Tibia

In a study of 23 intra-articular fractures of the distal tibia of which 18 were re-examined after an average follow-up period of 5.4 years, two major fracture patterns were identified: type A, a rotational pattern, caused by low energy trauma and type B, a compressive fracture pattern caused by high energy trauma. Type B fractures could be divided into three subgroups: 1) An isolated fracture of the anterior or posterior margin of the distal tibia, 2) an extra-articular comminuted fracture with extension into the ankle joint and 3) a comminuted intra-articular fracture.

When the initial displacement and comminution were severe or the reduction was not complete, the final results of the comminuted intra-articular fractures were not acceptable. The incidence of osteoarthritis was highest in the group of comminuted intra-articular fractures. The extra-articular comminuted fractures seemed to have a better prognosis as indicated by the final clinical results, including the occurrence of osteoarthritis.

It is clear from this study that comminuted intra-articular fractures should not be treated by primary operation. All fractures treated non-operatively had acceptable final clinical results.     

Evaluation of leap motion control for hand rehabilitation in burn patients: An experience in the dust explosion disaster in Formosa Fun Coast

Hand burns cause functional impairment. Leap motion control (LMC), a kind of virtual reality games, employs a novel system that provides biofeedback and training of fine motor function and functional skills. In this study, we hypothesized that LMC would improve burned hand function.Sixteen participants were allocated to either the LMC group or the control group. The LMC group played 20 min identical leap motion video games after 40 min traditional occupational therapy (OT). The control group received traditional OT for 60 min. Both groups received interventions 2 days a week for 4 months.A series of questionnaires were administered, including BSHS-B, QuickDASH, iADL, and Barthel index. Data on baseline characteristics including joint range of motion (ROM), grip and pinch strength, and scar thickness were obtained. Furthermore, we used the Mann–Whitney U test and Wilcoxon signed-rank test for comparison, as appropriate.We found improvements in BSHS-B, QuickDASH, and iADL in the LMC group (all p < 0.05) compared to those in the control group. In the LMC-trained hand, the ROM of the thumb IP joint and pinch strength increased, whereas the scar thickness over the first dorsal interossei muscle decreased (p < 0.05). In conclusion, leap motion training could help patients with hand burns to increase finger ROM, decrease scar thickness, and improve hand function.