High-Pressure Injection Injury Caused by Electronic Cigarette Explosion: A Case Report

Blast injury of the finger caused by mobile battery explosion: A case report

Lithium-ion batteries can cause several types of injuries upon explosion due to misfire. We report a case in which a mobile battery explosion resulted in high-pressure injection of metal debris into a small entry point on the skin creating puncture wounds on a patient's index finger, necessitating surgical intervention for massive debridement. A healthy 45-year-old, right-hand-dominant woman presented to the emergency department 4 h after a mobile battery had exploded in her left hand, causing burns to the left index finger. The battery had exploded due to misfire because the patient had accidentally hit it with a hammer. Radiographs of the index finger demonstrated foreign material extending from the fingertip to the ulnar proximal phalanx along the flexor tendon sheath, which was consistent with a high-pressure injection injury. She underwent semiurgent incision, irrigation, and debridement of the left index finger the day after the injury. The wound healed uneventfully within a month. At the 6-month follow-up, the palm-to-tip distance was 1 cm, and sensation at the tip was recovered. Compositional analysis of the debris revealed that the two major elements were aluminum and nickel (both less than 10%); lithium constituted less than 1% of the debris, a level deemed safe in humans. The protocol of semiurgent incision, irrigation, and debridement was safe and effective in the treatment of the injection injury caused by the mobile battery explosion.

Injuries associated with electronic nicotine delivery systems: A systematic review

BACKGROUND

Since its introduction on the market in 2007, the number of reports on injuries caused by the overheating, ignition, or explosion of electronic nicotine delivery systems (ENDSs) has increased significantly. These injuries appear to have different causes, the most important one being lithium-ion battery overheating to the point of ignition or explosion.

METHODS

A literature search for all relevant studies concerning ENDS-related traumatic injuries of all kinds was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses protocol. The search started with the first introduction of ENDSs in 2007 and ended February 2020. Articles included were reports on patients who sustained flame, chemical, or traumatic injuries of the skin, soft tissue, and/or bone, related to the use of ENDSs.

RESULTS

This systematic review includes 180 patients from 41 case series and reports, published between 2016 and 2020. The mean age was 30.8 years (range, 17-59 years) with an overall male predominance (168 of 180 patients, 93%). In most injuries, multiple anatomical sites were affected, with the thigh/lower limb being the most commonly injured area (77%) followed by the upper limb/hand (43%). Eighty-two patients (51%) required a surgical treatment, 70 patients (43%) were managed conservatively with dressings or ointments, and 9 patients (6%) underwent enzymatic debridement. Thirty-five percent of all patients underwent skin grafting.

CONCLUSION

Injuries from overheating, ignition, or explosion of ENDSs are an emerging, underreported, and underresearched issue. There is a need for increased regulation of ENDSs and improved surveillance of related injuries. Both health care providers and consumers should be made aware of the risks and be advised about how to safely handle these devices. In contrast to other articles, this systematic review includes all types of injuries related to ENDS overheating, ignition, and explosion. To our knowledge, this is the most extensive systematic review performed to date.

LEVEL OF EVIDENCE

Review article, level III.

Health Hazards and Complications Associated with Electronic Cigarettes: A Review

Electronic cigarettes (ECs) are devices that vaporize and release a sweetened liquid containing nicotine as a substitute for burning tobacco. EC manufacturers have suggested that "vaping" is a safer alternative to conventional smoking because of the potential reduction of exposure to toxic substances. In 2019, National Youth Tobacco Survey reported that 10.5% and 27.5% of middle and high school students used ECs in the previous 30 days (0.6% and 1.5% in 2011, 3.3% and 11.7% in 2017, and 4.9% and 20.8 in 2018), respectively. Increased EC use among younger individuals is mainly because of the widespread perception that ECs are relatively less harmful than conventional cigarettes as they do not involve smoking tobacco and contain little or no nicotine. This review suggests that ECs may not be completely harmless. There are increasing number of case reports on various complications arising from using ECs, which are especially popular among young individuals and could negatively affect their health. Reported complications include lipoid pneumonia, acute eosinophilic pneumonia, hypersensitivity pneumonia, organizing pneumonia, diffuse alveolar hemorrhage, multiple reactive pulmonary nodules, subacute bronchiolitis, mouth and tongue injuries, dental injuries, complex facial fractures, thermal injuries, nickel contact allergy, C1 and C2 fractures, and fatal intoxication after ingesting liquids. Complications that develop directly from the substances in the devices and those resulting from device explosion and burning are being reported with increasing frequency. There is an urgent need for legislation and restriction regarding the sale of these devices considering their increasing frequency of use by younger individuals.

A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist

Following the recent electronic cigarette (e-cigarette) illness outbreak, the current review aimed to collect all related clinical cases for study and analysis and provide a critical synopsis of the proposed injury mechanism. Adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines, e-cigarette-related clinical cases were identified via Google Scholar and PubMed databases. Additionally, references of published case reports and previous review papers were manually searched, revealing 159 publications presenting e-cigarette-related case reports and 19 reports by the Centers for Disease Control and Prevention. 238 individual cases were identified; 53% traumatic injuries due to e-cigarette explosion or self-combustion, 24% respiratory cases, and 12% poisonings. Additional cases pertained to oral, cardiovascular, immunologic, hematologic, allergic reactions, infant complications, and altered medication levels. Case reports were mainly published between 2016-2019 (78%). The oldest case, a lipoid pneumonia, was published in 2012. The current review showed that e-cigarette-related health effects extend beyond the acute lung injury syndrome, including traumatic, thermal injuries and acute intoxications. Physicians should be aware of the distinct clinical presentations and be trained to respond and treat effectively. Regulators and public health authorities should address the regulatory gap regarding electronic nicotine delivery systems (ENDS) and novel tobacco products.

High-pressure injection injury: a case report and systematic review

High-pressure delivery devices for paint and other substances can lead to severe injuries of the hand without immediate surgical debridement. We present a case of a high-pressure paint gun injury treated surgically with full resolution of function. A systematic review of the literature details outcomes of similar injuries.

Risk Management and Avoiding Legal Pitfalls in the Emergency Treatment of High-Risk Orthopedic Injuries

Many orthopedic injuries can have hidden risks that result in increased liability for the emergency medicine practitioner. It is imperative that emergency medicine practitioners consider the diagnoses of compartment syndrome, high-pressure injury, spinal epidural abscess, and tendon lacerations in the right patient. Consideration of the diagnosis and prompt referrals can help to minimize the complications these patients often develop.