The domestic iron. A danger to young children

OBJECTIVES: To study the epidemiology of thermal injury caused by the domestic iron in children 5 years old or less. METHODS: Retrospective review of case notes held in the accident and emergency (A&E) department of a large teaching hospital over a 36 month period. Data regarding demographics, site and extent of injury, mechanism of injury and outcome were retrieved. RESULTS: 62 thermal injuries were identified in 59 patients. Of these, 60 were contact burns and two were scalds. The male to female ratio was 2:1. The mean age was 24 months. Fifty five per cent were aged between 1 and 2 years old. The hand was the commonest site of injury (63%) and, of these, two thirds were on the palm. Interestingly 10% occurred on the face. Iron contact burns accounted for 23.5% of all contact burns in this age group over this period. The majority of contact burns were partial thickness and most were less than 1% body surface area. Inadequate supervision is a recurring theme in many of these cases. A suspicion of non-accidental injury was raised in 10 cases and confirmed in nine of these. CONCLUSIONs: Iron burns are common in young children, particularly boys aged between 1 and 2 years old. Most can be treated in the A&E clinic. The potential for serious injury does exist. Non-accidental injury always needs to be considered. Efforts at prevention and increasing public awareness are needed.     

Hepatitis C: a danger to healthcare workers

There is no vaccine to prevent hepatitis C. The disease has infected more than 4 million people in the United States. Up to 10,000 people in the United States will die annually from the disease and that number will triple by the year 2010 (more than AIDS) (National Institutes of Health, 1997). The primary transmission route is through blood. The risk to healthcare workers of becoming infected after exposure from a needle stick is between 1.2% to 10%, whereas for HIV it is 0.3%. Healthcare workers must shift their self-protection focus from HIV to hepatitis C. Annual education on Universal Precautions must emphasize the risk of hepatitis C. Further, all healthcare workers should be baseline-tested immediately following exposure.     

The domestic iron. A danger to young children

Objectives—To study the epidemiology of thermal injury caused by the domestic iron in children 5 years old or less.

Methods—Retrospective review of case notes held in the accident and emergency (A&E) department of a large teaching hospital over a 36 month period. Data regarding demographics, site and extent of injury, mechanism of injury and outcome were retrieved.

Results—62 thermal injuries were identified in 59 patients. Of these, 60 were contact burns and two were scalds. The male to female ratio was 2:1. The mean age was 24 months. Fifty five per cent were aged between 1 and 2 years old. The hand was the commonest site of injury (63%) and, of these, two thirds were on the palm. Interestingly 10% occurred on the face. Iron contact burns accounted for 23.5% of all contact burns in this age group over this period. The majority of contact burns were partial thickness and most were less than 1% body surface area. Inadequate supervision is a recurring theme in many of these cases. A suspicion of non-accidental injury was raised in 10 cases and confirmed in nine of these.

Conclusions—Iron burns are common in young children, particularly boys aged between 1 and 2 years old. Most can be treated in the A&E clinic. The potential for serious injury does exist. Non-accidental injury always needs to be considered. Efforts at prevention and increasing public awareness are needed.

     

An overview of atopic eczema in children: a significant disease

Atopic eczema is a significant disease, being the most common skin disorder in children, affecting 12-15% of all school-age children (Emerson et al, 1998). It is an inflammatory skin condition, which is genetic in origin but is triggered by many factors, such as detergents, emotional distress or dust mites (Buxton, 1998) and often starts in the first year of life. It is characterised by dry and itchy skin. This often breaks down and becomes infected, partly as a result of the close relationship of atopic eczema and the organism Staphylococcus aureus, which is found on the skin of most children with atopic eczema (Goodyear, 1993).     

Hemolysis: a hidden danger.

Hemolysis is something that occurs to a small degree with every dialysis treatment. As we monitor our patients and the equipment we use, we hope that we have looked at everything and that our patients will be safe. We were extremely fortunate that we did not have a mortality related to this event. All of the hospitalized patients recovered and HP went on to receive her kidney transplant and is doing well. CG came back to dialyze in our unit after his physician was satisfied that our problem had been solved. In retrospect, we did not realize that we had an instrument in use that picked up the hemolysis long before we did. Our blood volume monitors showed us the increase in blood volume as the cells were lysed and vascular volume increased as the intracellular fluids were released. The concurrent rise in BP with these patients was also indicative of increased vascular volume. The blood volume monitor also showed the drop in hematocrit as red cells were lysed. We are now more experienced in interpreting these parameters and we are grateful to have this monitor on all of our patients and to have a new parameter to watch for to help forestall any further problems. Our patients' symptoms were baffling at the time because there were no overt signs of hemolysis. There was no "cherry pop" or brown colored blood in the lines or dialyzers which are what we have been taught to look for. Patients #1 and #3 essentially had no symptoms till the next day. Patient #2 exhibited nausea and some mild abdominal pain, which was also not new for him with his diabetic gastroparesis. Our nursing staff was very "gun shy" following this episode and some staff members seriously considered a change in profession. Fortunately they did not and opted to stay. It was brought home to all that dialysis, though it may seem to be a routine procedure, is inherently risky. Diligence and careful monitoring of all of our patients during their runs needs to be our utmost priority. Hemolysis to this degree is fortunately rare and we are grateful to have had an education with a positive outcome for all concerned.     

Presenteeism in nursing: a clear and present danger to productivity

Over the last decade, economists have identified that presenteeism, the first cousin of absenteeism, occurs when employees show up for work but, because of mental or medical illness, do not function productively or perform at 100%. Research has begun to identify nursing as an occupational group with high presenteeism. The author discusses the etiology and potential solutions for managing this new component in the productivity equation and in addressing depression, the major contributor to presenteeism.     

Recognizing imminent danger: characteristics of a suicide bomber

By all reports, the public is at increasing risk of attack by terrorist organizations. Citizens have been asked to increase their vigilance and report suspicious individuals to reduce the chance of a suicide or homicide bombing. Terrorist groups often target their actions to inflict the most casualties and may choose mass gatherings to detonate an explosive device. Since EMS providers are frequently assigned to work special details where large numbers of people may gather, EMTs and paramedics can assist law enforcement in identifying individuals who may pose a threat to the people gathered at the event. The characteristics of suicide bombers discussed here are meant to increase your awareness level to recognize a potential problem. The astute EMS provider can then notify appropriate law enforcement personnel for further investigation and action.     

Cortical response to subjectively unconscious danger

Cortical involvement in the evolution-favored automatic reaction to danger was studied. Electrical neural activity was recorded from 31 subjects, reporting fear of spiders, at 60 scalp locations. Visual stimuli containing spiders (negative elements) or, alternatively, nonnegative elements were presented to subjects, though they were unaware of their presence: a concurrent visual detection task using consciously perceived targets was administered. Spatial and temporal principal component analyses were employed to define and quantify, in a reliable manner, the main components of the neuroelectrical response to unconscious stimuli, and a source localization algorithm provided information on their neural origin. Results indicated that around 150 ms after stimulus onset, ventromedial prefrontal areas previously reported as responding rapidly to danger-related (conscious) stimuli were activated by unconsciously perceived spiders more markedly than by nonnegative unconscious stimuli. Subsequently, around 500 ms after stimulus onset, activation of the posterior cingulate and visual association cortices increased in this same direction. These data support previous results indicating that the ventromedial prefrontal cortex is involved in the top-down regulation of attention (through its capability to modulate the activity of posterior cortices in charge of visual processing) and that it automatically facilitates danger processing.