Reducing the risk of burns and shocks during lontophoresis

Although uncommon, burns and shocks can occur during iontophoresis treatments. A thorough understanding of the proper operation of iontophoresis equipment, along with proper preparation of the treatment site, can significantly reduce the likelihood of injuries.

Electric burns and disability

Forty-nine cases of electric burns with various factors responsible for accidents were studied. The stress was given on the study of disability after electric burns. Different complications of electric burns including morbidity and mortality were noted. Proper training of personnel in handling the electrical goods will reduce the incidence of electrical burns significantly. Better warning signals may also help to reduce the incidence of electric burns. Electric burns constitute one of the crippling accidents as the deep tissue destruction results from such injury. This leads to high incidence of upper extremity amputations, necessitating long unemployment and extensive new job training and rehabilitation. A retrospective and prospective study was undertaken among 49 patients of electric burns. In this series about 40% patients have become permanently disabled and 21% severely disabled. The mortality rate was 70.2%. The major disability was due to amputations required to the patient. The incidence of amputation was 34.6%. The mortality rate was 10.2%. Seventeen patients required 28 amputations. Hence, the major problem in electrical burns is due to permanent disability because of amputations, ultimately giving rise to the problem of rehabilitation mostly in young working people. Upper limb was burnt in 96% of patients. Hence, it further aggravates the severity in electrical burn injury because it is a working limb.

Hazard report. Reducing the risk of burns from surgical light sources

Surgical light sources can heat instruments enough to burn patients and can even start small fires in the operating room. Hospitals can reduce this risk by educating clinicians on the proper use of these devices and by purchasing models that incorporate certain safety features.

Avoiding oral burns during electrocautery tonsillectomy

Electrocautery tonsillectomy is a common method of tonsil removal, and electrocautery devices are widely available. Although these devices are relatively safe, inadvertent patient injury may occur with their use, such as oral cavity burns. We describe a simple surgical technique that reduces the risk of oral burns during electrocautery tonsillectomy and review additional safety considerations.

Development of an MR safe reach and grasp movement evaluation system to study brain activation patterns after stroke

An MR safe apparatus is important for the for monitoring of tasks in the magnetic resonance (MR) environment. This paper describes the development of an MR safe movement evaluation system to measure the hand grasp and elbow flexion/extension movements. The system will be used to monitor motor performance in the fMRI environment and assess functional and motor impairment level pre and post robot-assisted therapy.

Perineural air injection as a means of prevention of thermal injury of the sciatic nerve during radio frequency ablation: a preliminary experimental study in rabbits

OBJECTIVE

The purpose of this study was to determine whether perineural air injection before radio frequency (RF) ablation of thigh muscles can minimize thermal injury to the sciatic nerve.

METHODS

Eighteen percutaneous RF ablation procedures were performed in the thighs of 9 rabbits (control, n = 9, right thigh; experimental, n = 9, left thigh) with an internally cooled electrode (1-cm active tip). In the control group, the tip of the electrode was located in posterior muscles 5 mm away from the sciatic nerve before ablation. In the experimental group, sonographically guided air injection into the perineural space was performed just before ablation. Animals were killed 7 days after ablation, and the presence or absence of pathologic changes of the sciatic nerves (axonal necrosis, myelin digestion, endoneurial fibrosis, perineurial fibrosis, and dystrophic calcification) in both groups were compared under an optical microscope.

RESULTS

Perineural air injection was achieved successfully with a single puncture in all rabbits in the experimental group. All of the pathologic findings were observed much more frequently in the control group, and the differences in the frequencies of axonal necrosis and myelin digestion of the sciatic nerve between the groups were clinically significant (P < .05).

CONCLUSIONS

Perineural air injection may be useful for reducing the frequency of thermal injury during RF ablation of lesions adjacent to nerves.

[Burn treated at the Haukeland University Hospital Burn Centre--20 years of experience]

BACKGROUND

The Burn Centre at Haukeland University Hospital has had a national burn function since 1984.

PATIENTS AND METHODS

The following data were reviewed: area injured, age, sex, length of stay, mortality and county of residence for all admissions in the period 1984-2004.

RESULTS

1294 acute admissions for burns, chemical injuries or high-voltage injuries were identified. 71% of the patients were male. The mean age was 29.6 years; 24% were below 3 years of age. The mean (SD) area of injury was 19.5 +/- 18.3 % of the body surface area. 458 patients (35%) had burns involving less than 10% of the body surface area. The mean length of hospitalisation was 19.5 +/- 19.8 days. 140 patients (10.8%) died before discharge; these had a significantly higher age and injured area than the 1154 survivors. Every year there were 2-3 patients who had such extensive burns or substantial comorbidity that they only received palliative treatment. The probability of survival after a burn affecting 60% of the body surface, was around 50 % for all ages combined. On average 1.17 patients per 100.000 inhabitants were transferred annually from other parts of Norway for specialized treatment at this burn centre.

INTERPRETATION

Despite societal focus on burn prevention measures there has been no reduction in the number of patients transferred to the burn centre during the 20-year period.

Mechanisms of electrode induced injury. Part 3: practical concepts and avoidance

This three part series of articles has discussed mechanisms of electrode related injuries from a theoretical viewpoint in Part 1 (Stecker et al. 2006) and from a clinical experience viewpoint in Part 2 (Patterson et al. 2007). The third and final part of the series discusses practical concepts for the end user to use to both understand the basic principles at work in the creation of electrode related injuries as well as to avoid electrode related injuries. To help accomplish this, an online presentation with animations and voiceover is used to supplement written explanations of these basic principles. Areas of interest include mechanical pressure points, adhesives in contact with skin, electrosurgical unit (ESU) radiofrequency concepts, magnetic resonance imaging (MRI) radiofrequency concepts, electrochemical concepts, and basic electrical safety concepts. The goal of this article series has been to heighten awareness of electrode related lesions in general and to help clinicians become better at injury avoidance. A list of electrode related injury avoidance fundamentals is presented. Finally, practical scenarios are presented to illustrate the applications of the concepts.

Top 10 health technology hazards: are you protecting your patients from these high-priority risks?

This list of 10 high-impact hazards was compiled by ECRI Institute to help healthcare facilities prioritize their efforts to protect patients and staff from injuries that can occur during the use of medical devices and systems.

Mechanisms of electrode induced injury. Part 2: Clinical experience

In the previous paper in this series, basic mechanisms of electrode related injuries were discussed. In this paper, the discussion begins with some of the clinical aspects of burns. This is followed by a summary of the clinical literature on injuries produced by surface and subdermal electrodes. This clinical literature demonstrates that most electrode burns are related to the presence of high frequency electric fields (RF) created either by an electrosurgical unit or a magnetic resonance imaging (MRI) scanner. A smaller number of lesions are produced by low current, long duration direct current (DC) stimulation and during high current stimulation such as defibrillation. A discussion of the clinical complications from indwelling intracranial electrodes centers on electrodes placed for deep brain stimulation (DBS) that are currently used therapeutically in a wide array of neurologic disorders. The probability of considering a post-implant MRI scan is high and the safety of such scans is the focus of discussion. A very small number of adverse incidents have indicated a downward revision in the specific absorption rate recommendations for MRI examination with those patients who present with indwelling DBS leads and internal pulse generators. Continued vigilance when any type of electrode is used is important.

Home safety education and provision of safety equipment for injury prevention

BACKGROUND

In industrialised countries injuries are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home, but there is little meta-analytic evidence that child home safety interventions improve a range of safety practices or reduce injury rates and little evidence on their effect by social group.

OBJECTIVES

We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment in increasing home safety practices or reducing child injury rates and whether the effect varied by social group.

SEARCH STRATEGY

We searched The Cochrane Library, MEDLINE, EMBASE, CINAHL, DARE, ASSIA, Psychinfo and Web of Science, plus a range of relevant web sites, conference proceedings and bibliographies. We contacted authors of included studies and surveyed a range of organisations.

SELECTION CRITERIA

Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, which reported safety practices, possession of safety equipment or injury.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed study quality and extracted data. We attempted to obtain individual participant level data (IPD) for all included studies and summary data and IPD were simultaneoulsy combined in meta-regressions by social and demographic variables.

MAIN RESULTS

Eighty studies were included; 37 of which were included in at least one meta-analysis. Twenty-three (62%) were RCTs and 12 (32%) included in the meta-analysis provided IPD. Home safety education was effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.35, 95% CI 1.01 to 180), functional smoke alarms (OR 1.85, 95% CI 1.24 to 2.75), storing medicines (OR 1.58, 95% CI 1.18 to 2.13) and cleaning products (OR 1.63, 95% CI 1.22 to 2.17) out of reach, syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) and poison control centre numbers accessible (OR 3.66, 95% CI 1.84 to 7.27), fitted stair gates (1.26, 95% CI 1.05 to 1.51), socket covers on unused sockets (OR 3.73, 95% CI 1.48 to 9.39) and storing sharp objects out of reach (OR 1.52, 95% CI 1.01 to 2.29). There was a lack of evidence that interventions reduced rates of thermal injuries, poisoning or a range of injuries. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury.

AUTHORS' CONCLUSIONS

Home safety education provided most commonly as one-to-one, face-to-face education, in a clinical setting or at home, especially with the provision of safety equipment is effective in increasing a range of safety practices. There is a lack of evidence regarding its impact on child injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment was less effective in those at greater risk of injury.

[Electrical injuries]

Electrical trauma can be caused by low-voltage current (from 60 to 1000 V, usually 220 or 360 V), high-voltage (more than 1000 V) current, lightning, and voltaic arc. Often victims are little children, teenagers, and working-age adults. Electrical injuries and clinical manifestations can vary a lot and range from mild complaints not demanding serious medical help to life-threatening conditions. Lightning causes serious injuries in 1000-1500 individuals every year worldwide. The case fatality rate is about 20-30%, with as many as 74% of survivors experiencing permanent injury and sequela. The primary cause of death in victims of lightning strike or other electrical trauma is cardiac or respiratory arrest. That is why appropriate urgent help is essential. Subsequently electrical burns, deep-tissue and organ damage caused by electricity, secondary systemic disorders often demand intensive care and prompt, usually later multistage surgical treatment; therefore, prevention of electrical trauma, which would help to reduce electrical injuries in children and working-age population, is very actual. The most important is to understand the possible danger of electricity and to avoid it.

9.4T human MRI: preliminary results

This work reports the preliminary results of the first human images at the new high-field benchmark of 9.4T. A 65-cm-diameter bore magnet was used together with an asymmetric 40-cm-diameter head gradient and shim set. A multichannel transmission line (transverse electromagnetic (TEM)) head coil was driven by a programmable parallel transceiver to control the relative phase and magnitude of each channel independently. These new RF field control methods facilitated compensation for RF artifacts attributed to destructive interference patterns, in order to achieve homogeneous 9.4T head images or localize anatomic targets. Prior to FDA investigational device exemptions (IDEs) and internal review board (IRB)-approved human studies, preliminary RF safety studies were performed on porcine models. These data are reported together with exit interview results from the first 44 human volunteers. Although several points for improvement are discussed, the preliminary results demonstrate the feasibility of safe and successful human imaging at 9.4T.

Safety considerations for live electrical measurements

Test instruments available today, when combined with safe work practices, offer troubleshooters many enhancements that make the measurement environment and the measurements themselves much easier and safer than ever before.

Applicability of an Electrosurgical Device Based on Electromagnetics in Neurosurgery

Because of electrical and thermal spread to healthy nervous tissue, the application of electrosurgical tools in neurosurgery has specific limitations. This is true for both bipolar and monopolar devices. These limitations are not inherent to an instrument in which action is based on electromagnetic interaction with human tissue. We evaluated the indications and the clinical applicability of a new radiofrequency electrosurgical unit that works on this biophysical principle. The system was found to be a useful addition for the resection of morphologically tougher tissue with keyhole approaches in which the ultrasound aspirator cannot easily be applied.

Electrosurgical burns in pediatric patients undergoing liver resection with saline-enhanced radiofrequency technology

Use of saline-enhanced radiofrequency (RF) technology reduces blood loss in infants undergoing liver resection. Radiofrequency systems continuously deliver much higher currents for longer periods of time than conventional coagulation instruments and thus increase the risk of complications. Thress infants undergoing liver resection with the newer RF technology at one facility experienced electrosurgical unit (ESU) dispersive pad burns. As a result, an experiment was performed on animal subjects to determine best ESU dispersive pad placement on infants and to gather data on device impedance. Recommendations to prevent burns include central placement of the ESU dispersive pad and activating warming devices only after resection is complete.