Electronic Cigarette-Related Injuries Presenting to Five Large Burn Centers, 2015-2019

2021 ◽  
Author(s):  
Carmen E Flores ◽  
Paul J Chestovich ◽  
Syed Saquib ◽  
Joseph Carroll ◽  
Mariam Al-Hamad ◽  
...  
Keyword(s):  
Thermal Injury ◽  
Burn Injury ◽  
Electronic Cigarettes ◽  
Total Body Surface Area ◽  
Public Health Problem ◽  
Electronic Cigarette ◽  
Body Region ◽  
Outpatient Basis ◽  
Burn Centers ◽  
Thermal Injuries

Abstract Electronic cigarettes are advertised as safer alternatives to traditional cigarettes yet cause serious injury. US burn centers have witnessed a rise in both inpatient and outpatient visits to treat thermal injuries related to their use. A multicenter retrospective chart review of American Burn Association burn registry data from 5 large burn centers was performed from January 2015 to July 2019 to identify patients with electronic cigarette-related injuries. A total of 127 patients were identified. Most sustained less than 10% total body surface area burns (mean 3.8%). Sixty-six percent sustained 2nd degree burns. Most patients (78%) were injured while using their device. Eighteen percent of patients reported spontaneous device combustion. Two patients were injured while changing their device battery, and two were injured modifying their device. Three percent were injured by second-hand mechanism. Burn injury was the most common injury pattern (100%), followed by blast injury (3.93%). Flame burns were the most common (70%) type of thermal injury; however, most patients sustained a combination-type injury secondary to multiple burn mechanisms. The most injured body region was the extremities. Silver sulfadiazine was the most common agent used in initial management of thermal injuries. Sixty-three percent of patients did not require surgery. Of the 36% requiring surgery, 43.4% required skin grafting. Multiple surgeries were uncommon. Our data recognizes electronic cigarette use as a public health problem with potential to cause thermal injury and secondary trauma. Most patients are treated on an inpatient basis although most patients treated on outpatient basis have good outcomes.

79 Electronic Cigarette-Related Injuries Presenting to Five Large Burn Centers, 2015–2019

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S54-S55
Author(s):  
Carmen E Flores ◽  
Paul J Chestovich ◽  
Syed F Saquib ◽  
Joseph T Carroll ◽  
Mariam Al-Hamad Daubs ◽  
...  
Keyword(s):  
Thermal Injury ◽  
Spontaneous Combustion ◽  
Electronic Cigarettes ◽  
Total Body Surface Area ◽  
Public Health Problem ◽  
Electronic Cigarette ◽  
Outpatient Basis ◽  
Burn Centers ◽  
Split Thickness Skin Grafting ◽  
Inpatient Basis

Abstract Introduction Electronic cigarettes are advertised as safer alternatives to smoking cigarettes yet can cause serious injury. As consumer use of electronic cigarettes has increased, burn centers have witnessed a rise in both inpatient and outpatient visits to treat thermal and blast injuries related to their use. Methods A multicenter retrospective chart review of ABA burn registry data from 5 large burn centers was performed from January 2015 to July 2019 to identify patients who sustained Electronic Nicotine Delivery Systems (ENDS)-related injuries. Results A total of 127 patients with electronic cigarette-related injuries were identified, of which 113 were male (89%) and 14 were female (11%). Mean age was 34.0 years (SD 13.5%, range 1–75 years). The majority of patients (n=92, 72%) were treated on an inpatient basis, and average length of stay was 6.7 days. Most patients sustained less than 10% total body surface area burns (mean 3.8%, SD 2.6%, range 0.1% to 16.5%). 66% (n=85) sustained 2nd degree burns, and 36% (n=46) sustained 3rd degree burns. Most patients were injured while using the ENDS (n=100, 78%), while 18% (n=24) of patients reported spontaneous combustion. 2 patients (1.5%) were injured while changing their device battery, and 2 patients (1.5%) were injured while modifying the device. 3% (n=4) were injured by second-hand mechanism. Burn injury was the most common injury pattern (100%), followed by blast injury (n=81, 63%). Flame burns were the most common (n=89, 70%) type of thermal injury, followed by contact burns (n= 70, 55%), flash burns (n=47, 37%), chemical burns (n=2, 1.5%), and electrical burns (n=1, 0.7%). The most commonly injured body region was the extremities. There were no ENDS-related deaths. Silvadene was the most common topical agent used in the initial management of thermal injuries, followed by Bacitracin and Xeroform. 63% (n=80) of patients did not require surgery, while 36% (n=46) required surgical excision, and 15% (n=20) required split-thickness skin grafting. Multiple surgeries were uncommon. 22% of patients required one operation, 12% required two operations, and 2% required 3 operations. Conclusions Our data recognizes use of ENDS as a growing public health problem with potential to cause thermal injury and secondary trauma. Most injuries occur during use, however many result from spontaneous combustion while the device is not being used. Treatment of ENDS-related injuries is institution-dependent. Most patients are treated on an inpatient basis however the majority of patients treated on outpatient basis have good outcomes.

102 Wildfire Burns: Implications for Burn Care

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S67-S67
Author(s):  
Tina L Palmieri ◽  
Kathleen S Romanowski ◽  
Soman Sen ◽  
David G Greenhalgh
Keyword(s):  
Length Of Stay ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Ventilatory Support ◽  
Mass Casualty ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
Injury Incidence ◽  
Burn Centers ◽  
Burn Care

Abstract Introduction Climate change, the encroachment of populations into wilderness, and carelessness have combined to increase the incidence of wildfire injuries. With the increased incidence has come an increase in the number of burn injuries. Prolonged extrication, delays in resuscitation, and the extreme fire and toxic air environment in a wildfire has the potential to cause more severe burn injury. The purpose of this study is to examine the demographics and outcomes of wildfire injuries and compare those outcomes to non-wildfire injuries. Methods Charts of patients admitted to a regional burn center during a massive wildfire in 2018 were reviewed for demographic, treatment, and outcome. We then obtained age, gender, and burn size matched controls from within 2 years of the incident, analyzed the same measures, and compared treatment and outcomes between the two groups. Results A total of 20 patients, 10 wildfire (WF) burns and 10 non-wildfire (NWF) burns, were included in the study. Age (59.6±7.8 WF vs. 59.4±7.4 years), total body surface area burn (TBSA) (14.9±4.7 WF vs. 17.2±0.9 NWF) and inhalation injury incidence (2 WF and 2 NWF) were similar between groups. Days on mechanical ventilation (24.3±19.4 WF vs. 9.4±9.8 NWF), length of stay (49.9±21.8 WF vs. 28.2±11.7 days) and ICU length of stay (43.0±25.6 WF vs 24.4±11.2 NWF) were higher in the WF group. WF patients required twice the number of operations. Mortality was similar in both groups (1 death/group). Conclusions Wildfire burn injuries, when compared to age, inhalation injury, and burn size matched controls, require more ventilatory support and have more operations. As a result, they have longer lengths of stay and have a prolonged ICU course. Burn centers should be prepared for the increased resource utilization that accompanies wildfire injuries. Applicability of Research to Practice All burn centers must be prepared for the possibility of wildfires and the increased resource utilzation that accompanies mass casualty events.

Effect of Preemptive Nerve Block on Inflammation and Hyperalgesia after Human Thermal Injury

1996 ◽  
Vol 84 (5) ◽  
pp. 1020-1026 ◽  
Author(s):  
Juri L. Pedersen ◽  
Michael E. Crawford ◽  
Jorgen B. Dahl ◽  
Jannick Brennum ◽  
Henrik Kehlet
Keyword(s):  
Nerve Block ◽  
Thermal Injury ◽  
Burn Injury ◽  
Surgical Trauma ◽  
Blister Formation ◽  
Nociceptive Pathways ◽  
Initial Block ◽  
Skin Erythema ◽  
Thermal Injuries ◽  
Nociceptive Input

Background Postoperative pain relief may be improved by reducing sensitization of nociceptive pathways caused by surgical trauma. Such a reduction may depend on the timing and efficacy of analgesia and the duration of the nociceptive block versus the duration of the nociceptive input. We examined whether a prolonged nerve block administered before a superficial burn injury could reduce local inflammation and late hyperalgesia after recovery from the block. Methods The effects of a preemptive saphenous nerve block on primary and secondary hyperalgesia, skin erythema, and blister formation, were compared to the opposite unblocked leg for 12 h after bilateral thermal injuries (15 x 25 mm, 49 degrees C for 5 min) in 20 healthy volunteers. Recovery from the block was identified by return of sensation to cold. Results Six subjects were excluded because of insufficient initial block (2 subjects) or because the block lasted beyond the study period (4 subjects). The remaining 14 subjects experienced significantly reduced primary (P = 0.005) and secondary hyperplasia (P = 0.01) in the blocked leg after return of cold sensation compared to the unblocked leg. Erythema intensity and blister formation were not significantly affected by the blockade (P = 0.94 and P = 0.07, respectively). Conclusions These data suggest that a prolonged, preemptive nerve block reduced late hyperalgesia after thermal injury, whereas the erythema and blister formation were not significantly affected.

6 Complete Blood Count and Derived Indices: Evolution Pattern and Prognostic Value in Adult Burned Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S7-S7
Author(s):  
Ignacio Aramendi ◽  
Laura Moreno ◽  
Julio R Cabrera ◽  
Martin Angulo ◽  
Gimena dos Santos ◽  
...  
Keyword(s):  
Blood Count ◽  
Thermal Injury ◽  
Complete Blood Count ◽  
Total Body Surface Area ◽  
Distribution Width ◽  
Major Health Problem ◽  
Lymphocyte Ratio ◽  
Inflammatory Status ◽  
Evolution Pattern ◽  
Thermal Injuries

Abstract Introduction Thermal injuries represent a major health problem. Biomarkers capable of predicting burned patients outcomes are missing. Certain parameters of complete blood count (CBC) such as red cell distribution width (RDW) and mean platelet volume (MPV), as well as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and RDW-to-platelet ratio (RPR) have been associated with inflammatory status and outcome in diverse medical conditions. The aim of this study was to describe the evolution pattern of these parameters in adult burned patients. Methods Adult burned patients admitted to the National Burn Center of a University Hospital between May 2017 and March 2018 were included. Patients characteristics and outcomes were recorded, as well as CBC parameters on days 1, 3, 5 and 7 after thermal injury. Results Eighty-eight patients were included. Total body surface area burned was 14 [7–23] %, and mortality was 15%. Non-survivors presented higher RDW (days 3, 5 and 7; P < 0.01) and MPV (days 3 and 7; P < 0.01). NLR decreased after admission in all patients (P < 0.01), but was higher in non-survivors compared to survivors on days 1 and 7 (P < 0.01). On day 3, PLR was higher in survivors than in non-survivors (P < 0.05). In deceased patients, RPR was significantly higher on days 3, 5 and 7 (P < 0.01). There was a significant correlation between NLR on admission and burn extension and severity. Kaplan-Meier analysis revealed that NLR, PLR and RPR could identify patients with increased mortality. Conclusions Basic CBC parameters and derived indices could be useful as biomarkers to determine prognosis in adults with thermal injuries. Applicability of Research to Practice The study allowed us to identify basic CBC parameters and indices that behave differently in survivors and non-survivors. Interestingly, the CBC profile that differentiates survivors and non-survivors varies at each time point. A particular combination of CBC parameters might be used as a prognostic indicator depending on evolution time since thermal injury.

Thermal injury impairs cardiac protein synthesis and is associated with alterations in translation initiation

2004 ◽  
Vol 286 (4) ◽  
pp. R740-R750 ◽  
Author(s):  
Charles H. Lang ◽  
Robert A. Frost ◽  
Thomas C. Vary
Keyword(s):  
Protein Synthesis ◽  
Translation Initiation ◽  
Thermal Injury ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Mrna Translation ◽  
Translation Efficiency ◽  
High Mobility Group Protein ◽  
Translational Repressor ◽  
Significant Difference

The purpose of the present study was to determine whether burn injury decreases myocardial protein synthesis and potential contributing mechanisms for this impairment. To address this aim, thermal injury was produced by a 40% total body surface area full-thickness scald burn in anesthetized rats, and the animals were studied 24 h later. Burn decreased the in vivo-determined rate of myocardial protein synthesis and translation efficiency by 25% but did not alter the protein synthetic rate in skeletal muscle. To identify potential mechanisms responsible for regulating mRNA translation in cardiac muscle, we examined several eukaryotic initiation factors (eIFs) and elongation factors (eEFs). Burn failed to alter eIF2B activity or the total amount or phosphorylation status of either eIF2α or eIF2Bϵ in heart. In contrast, hearts from burned rats demonstrated 1) an increased binding of the translational repressor 4E-BP1 with eIF4E, 2) a decreased amount of eIF4E associated with eIF4G, and 3) a decreased amount of the hyperphosphorylated γ-form of 4E-BP1. These changes in eIF4E availability were not seen in gastrocnemius muscle where burn injury did not decrease protein synthesis. Furthermore, constitutive phosphorylation of mTOR, S6K1, the ribosomal protein S6, and eIF4G were also decreased in hearts from burned rats. Burn did not appear to adversely affect elongation because there was no significant difference in the myocardial content of eEF1α or eEF2 or the phosphorylation state of eEF2. The above-mentioned burn-induced changes in mRNA translation were associated with an impairment of in vitro myocardial performance. Finally, 24 h postburn, the cardiac mRNA content of IL-1β, IL-6, and high-mobility group protein B1 (but not TNF-α) was increased. In summary, these data suggest that thermal injury specifically decreases cardiac protein synthesis in part by decreasing mRNA translation efficiency resulting from an impairment in translation initiation associated with alterations in eIF4E availability and S6K1 activity.

scholarly journals Burn-induced increase in atrogin-1 and MuRF-1 in skeletal muscle is glucocorticoid independent but downregulated by IGF-I

2007 ◽  
Vol 292 (1) ◽  
pp. R328-R336 ◽  
Author(s):  
Charles H. Lang ◽  
Danuta Huber ◽  
Robert A. Frost
Keyword(s):  
Thermal Injury ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Ring Finger ◽  
E3 Ligase ◽  
E3 Ligases ◽  
Igf I ◽  
Mrna Content ◽  
Total Body

The present study determined whether thermal injury increases the expression of the ubiquitin (Ub) E3 ligases referred to as muscle ring finger (MuRF)-1 and muscle atrophy F-box (MAFbx; aka atrogin-1), which are muscle specific and responsible for the increased protein breakdown observed in other catabolic conditions. After 48 h of burn injury (40% total body surface area full-thickness scald burn) gastrocnemius weight was reduced, and this change was associated with an increased mRNA abundance for atrogin-1 and MuRF-1 (3.1- to 8-fold, respectively). Similarly, burn increased polyUb mRNA content in the gastrocnemius twofold. In contrast, there was no burn-induced atrophy of the soleus and no significant change in atrogin-1, MuRF-1, or polyUb mRNA. Burns also did not alter E3 ligase expression in heart. Four hours after administration of the anabolic agent insulin-like growth factor (IGF)-I to burned rats, the mRNA content of atrogin-1 and polyUb in gastrocnemius had returned to control values and the elevation in MuRF-1 was reduced 50%. In contrast, leucine did not alter E3 ligase expression. In a separate study, in vivo administration of the proteasome inhibitor Velcade prevented burn-induced loss of muscle mass determined at 48 h. Finally, administration of the glucocorticoid receptor antagonist RU-486 did not prevent burn-induced atrophy of the gastrocnemius or the associated elevation in atrogin-1, MuRF-1, or polyUb. In summary, the acute muscle wasting accompanying thermal injury is associated with a glucocorticoid-independent increase in the expression of several Ub E3 ligases that can be downregulated by IGF-I.

scholarly journals Early abnormal fibrinolysis and mortality in patients with thermal injury: a prospective cohort study

BJS Open ◽  
2021 ◽  
Vol 5 (2) ◽  
Author(s):  
A E Pusateri ◽  
T D Le ◽  
J W Keyloun ◽  
L T Moffatt ◽  
T Orfeo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Odds Ratio ◽  
Thermal Injury ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Clot Strength ◽  
Increased Risk

Abstract Introduction Abnormal fibrinolysis early after injury has been associated with increased mortality in trauma patients, but no studies have addressed patients with burn injury. This prospective cohort study aimed to characterize fibrinolytic phenotypes in burn patients and to see if they were associated with mortality. Methods Patients presenting to a regional burn centre within 4 h of thermal injury were included. Blood was collected for sequential viscoelastic measurements using thromboelastography (RapidTEG™) over 12 h. The percentage decrease in clot strength 30 min after the time of maximal clot strength (LY30) was used to categorize patients into hypofibrinolytic/fibrinolytic shutdown (SD), physiological (PHYS) and hyperfibrinolytic (HF) phenotypes. Injury characteristics, demographics and outcomes were compared. Results Of 115 included patients, just over two thirds were male. Overall median age was 40 (i.q.r. 28–57) years and median total body surface area (TBSA) burn was 13 (i.q.r. 6–30) per cent. Some 42 (36.5 per cent) patients had severe burns affecting over 20 per cent TBSA. Overall mortality was 18.3 per cent. At admission 60.0 per cent were PHYS, 30.4 per cent were SD and 9.6 per cent HF. HF was associated with increased risk of mortality on admission (odds ratio 12.61 (95 per cent c.i. 1.12 to 142.57); P = 0.041) but not later during the admission when its incidence also decreased. Admission SD was not associated with mortality, but incidence increased and by 4 h and beyond, SD was associated with increased mortality, compared with PHYS (odds ratio 8.27 (95 per cent c.i. 1.16 to 58.95); P = 0.034). Discussion Early abnormal fibrinolytic function is associated with mortality in burn patients.

scholarly journals Exploding power: a statewide review of lithium battery related burns

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Jason Diab ◽  
Justine O’Hara ◽  
Andrea-Issler Fisher ◽  
Erik La Hei ◽  
Robert Gates ◽  
...  
Keyword(s):  
Lithium Battery ◽  
Injury Severity ◽  
Burn Injury ◽  
Electronic Cigarettes ◽  
Total Body Surface Area ◽  
Ethics Committees ◽  
Home Setting ◽  
Royal North Shore Hospital ◽  
South Wales ◽  
Severity Of Injury

Introduction: With the increase of lithium battery devices, including electronic cigarettes and battery power banks, there has been a steady rise in burn injuries secondary to device malfunction. These devices may cause chemical or flame burns. Our aim was to identify and classify epidemiological trends of explosions from lithium battery devices across the state of New South Wales (NSW), Australia. Methods: A review of the NSW Burn Injury Service (SBIS) database from January 2005–December2019, together with medical records from the burns units at the Children’s Hospital at Westmead (CHW), the Concord Repatriation General Hospital (CRGH) and the Royal North Shore Hospital (RNSH) was conducted. All patients who suffered a burn secondary from a lithium battery device were included and data was extracted on mechanism of injury, severity of injury and management. This study was approved by the ethics committees of CHW, RNSH and CRGH [2020/PID00179]. Results: Of the 24 patients identified, six were paediatric and 18 were adults. The majority were male (7:1) with a mean age of 29.0 (+/- 16.6 years). The mean total body surface area burnt was 2.5% (+/- 0.9) [range 0.1–21.0%]. The majority occurred after 2014 and involved spontaneous explosions. Their injuries ranged from partial to full thickness burns with flame being the most common type (n=15). Three quarters of the cases (n=18) occurred in a home setting. Conclusions: Lithium battery device explosions can result in a mix of burn depth injuries from flame, contact and electrical, or chemical burns. Consumers need to be made more aware of the potential risks associated with use of lithium battery powered devices.

T cells from burn-injured mice demonstrate a loss of sensitivity to glucocorticoids

2010 ◽  
Vol 299 (2) ◽  
pp. E299-E307 ◽  
Author(s):  
Michele D'Elia ◽  
Julie Patenaude ◽  
Charles Dupras ◽  
Jacques Bernier
Keyword(s):  
T Cells ◽  
T Cell ◽  
P38 Mapk ◽  
Thermal Injury ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
T Cell Response ◽  
Mitogen Activated Protein Kinase ◽  
Activated T Cells ◽  
Cell Functions

Glucocorticoids (GC) are steroid hormones that modulate T cell functions and restrain their hyperresponsiveness following stimulation. Naive T lymphocytes are sensitive to GC but become more resistant when they are activated. A balance between activation and inhibition signals is important for a targeted and effective T cell response. Thermal injury is characterized by an immune dysfunction and hyperactive T cells visible at day 10 postburn. In this study, our objective was to evaluate T cell sensitivity to GC following thermal injury and to identify mechanisms that could modulate their sensitivity. One mechanism that we hypothesized was increased p38 mitogen-activated protein kinase (MAPK) activity that could lead to GC resistance. Male C57BL/6 mice underwent a full-thickness 20% total body surface area. At 10 days postinjury, splenic T cells were isolated. Glucocorticoid receptor (GR) expression was higher in T cells from burn-injured mice. Interestingly, these cells were also less sensitive to GC-induced apoptosis prior to and poststimulation. Furthermore, anti-CD3-activated T cells from burn-injured mice showed increased proliferation and CD25 expression, which resisted corticosterone's (CORT) suppressive effect. Anti-CD3-activated CD4+CD44+ memory cells from burn-injured mice expressed the highest level of CD25 and were resistant to CORT. Increased phosphorylation of p38 MAPK was also noted in activated T cells from burn-injured mice. Pharmacological inhibition of p38 MAPK decreased cell proliferation and normalized interferon-γ (IFNγ) production. In conclusion, we demonstrate that a unique event like burn injury induces a loss of sensitivity to GC in splenic T cells and have identified p38 MAPK as a key modulator for this resistance.

scholarly journals From Tobacco Cigarettes to Electronic Cigarettes: The Two Sides of a Nicotine Coin

2021 ◽  
Vol 2 ◽  
Author(s):  
Ahmad Besaratinia
Keyword(s):  
Electronic Cigarettes ◽  
Public Health Problem ◽  
The United States ◽  
Multiple Organ ◽  
Electronic Cigarette ◽  
Global Challenge ◽  
Current State ◽  
Quit Smoking ◽  
Tobacco Epidemic ◽  
Lower Health

Tobacco smoking-related diseases, including cardiovascular disease, pulmonary disease, stroke, and cancer in multiple organ sites, are the leading causes of preventable death, worldwide. Youth electronic cigarette use (vaping) is an evolving public health problem in the United States and around the world. Many of the same toxicants and carcinogens present in tobacco smoke are also found in electronic cigarette vapor, although mostly at substantially lower levels. The reduced concentrations of these chemicals in electronic cigarette vapor may imply lower health risk; however, they cannot equate to no risk. To date, the long-term health consequences of vaping are largely unknown. This “Perspective” provides a concise chronology of events leading up to an unprecedented global challenge, namely the convergence of global tobacco epidemic and youth vaping epidemic. Current state of knowledge, outstanding questions in the field, present challenges, and future directions in research are highlighted. The existing data show a continued and dynamic evolution of the converged epidemics. The goal should be to prevent youth vaping while improving smoking cessation strategies. In smokers who are unable or unwilling to quit smoking, the objective should be to provide “provably” safe or less-harmful alternatives, which should “completely” or “substantially” substitute tobacco cigarettes.

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