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PubMed1985

The clinical consequences of an industrial aerosol plant explosion.

The factors relating to the clinical outcome of an industrial aerosol plant explosion are reviewed. Eighteen of 24 workers inside the plant required hospitalization and five died. Proximity to the blast was associated with extensive injuries unless workers were shielded by physical barriers or partitions. Burn severity and mortality were increased in those wearing synthetic garments compared to their counterparts wearing fiber clothing. Facial burns occurred in all unprotected workers. Forearm and hand burns in 11 patients required decompressive escharotomies. Topical treatment with silver sulfadiazine was associated with more significant leukopenia and neutropenia than treatment with silver nitrate. We conclude that industrial design should include safeguards which isolate workers from flammable materials, including isolation of explosive materials from working areas, alarm systems to detect leakage of flammable agents, protective barriers and shields, and the regulation and institution of flame and flash-resistant clothing.

Accidents, Occupational↗
PubMed1999

Blast injury from explosive munitions.

OBJECTIVE: To evaluate the effect of blast in common war injuries. METHODS: One thousand three hundred and three patients injured by explosive munitions and demonstrating extremity wounds without other penetrating injuries were admitted to the Military Medical Academy in Belgrade between 1991 and 1994. Of these, 665 patients (51%) had symptoms and physical signs that were compatible with the clinical diagnosis of primary blast injury, whereas the remaining 658 patients did not. RESULTS: Random sampling of 65 patients in the blast group during the early posttraumatic period showed statistically significant elevations in blood thromboxane A2 (TxA2), prostacyclin (PGI2), and sulfidopeptide leukotrienes compared with the random sample of 62 patients in the nonblast group. This difference could not be accounted for by differing injury severity between the groups, because the severity of wounds as measured by both the Injury Severity Score and the Red Cross Wound Classification was similar in both groups. Amongst blast patients, 200 patients (30%) had long-term (1 year) symptoms and signs reflecting central nervous system disorders. These symptoms and signs were only sporadically found in 4% of the nonblast patients. These findings indicate that primary blast injury is more common in war injuries than previously thought and that of those affected by blast, a surprisingly high proportion retain long-term neurologic disability. The elevation in eicosanoids could be used to confirm and monitor blast injury. CONCLUSION: In relation to the immediate management of patients injured by explosive weapons, it follows that particular attention should be paid to the presence and/or development of blast injury. Our findings indicate that blast is more common in war injuries than previously thought. Eicosanoid changes after blast injury suggest that blast injury causes a major physiologic stress. A variety of effects on the central nervous system suggest that blast injury could be responsible for some aspects of what is now considered to be the posttraumatic stress disorder.

Adult↗
PubMed1992

Use of PCB blood levels to assess potential exposure following an electrical transformer explosion.

Following the explosion of a transformer, passersby, building occupants, and cleanup personnel had potential exposure to the transformer dielectric fluid containing polychlorinated biphenyls (PCBs). As part of a medical evaluation, blood serum was analyzed for PCBs, and the concentrations found were similar to that of a regional comparison group (median 4.0 ng/mL or parts per billion, range 1-10, n = 60). Some workers employed by the utility company that owned the transformer had potential exposure to PCBs in the past. This positive comparison group had significantly higher serum PCB concentrations, related to known direct contact (median 5.0, mean 14 ng/mL, 1-187, n = 25) or not (median 4.0, mean 11 ng/mL, 2-72, n = 17). Therefore, in this investigation, elevation of serum PCB levels could be related to past contact during work with transformers, but not to potential short-term exposure at the time of a transfer explosion.

Aroclors↗
PubMedDate not supplied

Managing a combined burn trauma disaster in the post-9/11 world: lessons learned from the 2003 West Pharmaceutical plant explosion.

At 1:37 pm on January 29, 2003, an explosion occurred at the West Pharmaceutical chemical plant in Kinston, North Carolina. The explosion killed three people at the scene and resulted in more than 30 admissions to area hospitals. The disaster resulted in 10 critically ill burn patients, who were all intubated with inhalation injuries, many with combined burn and trauma injuries. All 10 critically injured patients were admitted to a tertiary care facility 100 miles away with both a Level I trauma center and a verified burn center. Ultimately, 7 of 10 patients survived (a mortality rate of 30%), and none were transferred to another trauma or burn center. This article analyzes the unique challenges that combined burn and trauma patients present during a disaster, critically examines the response to this disaster, describes lessons learned, and presents recommendations that may improve the response to such disasters in the future.

Burn Units↗
PubMed1987

Explosive anaesthetic agents. A regional survey on the use of ether and cyclopropane.

A total of 156 consultant anaesthetists in the North East Thames Regional Health Authority were circulated with a questionnaire on their personal use of ether and cyclopropane and their attitudes towards restriction or withdrawal of these agents: 144 completed questionnaires were received (92% response). Four anaesthetists (3%) claimed to use ether regularly at least once a month and 27 anaesthetists (19%) felt that their anaesthetic practice would suffer if ether were withdrawn. Cyclopropane had 62 regular users (43%) and 65 anaesthetists (45%) felt that their practice would suffer if it were withdrawn. Ninety-two anaesthetists (64%) were prepared to confine their use of explosive agents to either the anaesthetic room or the operating room; of these, three-quarters favoured the anaesthetic room. There were few notable differences in the pattern of use of explosive agents between anaesthetists with more than 21 years in the specialty and those with less than 21 years.

Anesthesia, Inhalation↗
PubMed1962

Rupture of bacteria by explosive decompression.

Foster, John W. (University of Georgia, Athens), Robert M. Cowan, and Ted A. Maag. Rupture of bacteria by explosive decompression. J. Bacteriol. 83:330-334. 1962.-A device is described for instantaneously rupturing bacteria and other cells in a closed system under controlled conditions by explosive decompression. With this device, 31 to 59% of Serratia marcescens, ranging up to 20 mg (dry wt) of cells per ml, were ruptured after nitrogen saturation at 1740 psi. Under similar conditions, 10 to 25% of Brucella abortus and Staphylococcus aureus were ruptured. Rupture of these organisms produced readily separable cell walls. Centrifugation in linear glycerol gradients was applied to further separate cell walls from debris. Mycoplasma gallinarum, Leptospira pomona, and Eimeria tenella (avian coccidia) oöcysts were also broken up by the decompression chamber. Pressure and duration of saturation of cells with gas affected rupture efficiency. Within the limits of this study, concentration of organisms and volume of suspensions did not have a definite effect.

Bacteria↗
PubMed1975

Report on injuries sustained by patients treated at the Birmingham General Hospital following the recent bomb explosions.

As a result of recent bomb explosions a total of 82 patients were treated at the Birmingham General Hospital, 61 with minor injuries. Bomb injuries may be divided into three main groups due to the blast effect (such as blast lung and ruptured tympanic membranes), the flash (such as burns to the exposed part of the body), and shrapnel (which may cause a wide variety of injuries). The amount of warning of such explosions is usually minimal, and so the prepared accident schemes of most hospitals are inappropriate. If the disaster occurs outside normal working hours much responsibility initially falls on the resident staff. This report gives some idea of the type of injuries they are likely to see.

Adolescent↗
PubMed1983

Cardowan coal mine explosion: experience of a mass burns incident.

A coal mine explosion 1700 feet (516 m) underground and two miles (3.2 km) from the pit head resulted in 40 casualties. Two hours elapsed between the explosion and the arrival of patients at hospital. Six patients suffered mechanical injuries, only one of which was life threatening. Thirty six suffered burns; in 18 over 15% of the total body surface area was affected. Nineteen patients had a mild respiratory upset requiring oxygen treatment. The average length of inpatient stay in those admitted was 24 days. Early assessment and treatment in the accident and emergency department was relatively simple because of the large proportion of burn injuries. Lack of communication between site and hospital made administration of the disaster difficult.

Adult↗
PubMed1990

The Peterborough lorry explosion, 22 March 1989: an analysis of the hospital response.

As a result of the lorry explosion on the Fengate Industrial Estate, Peterborough on 22nd March 1989, 82 casualties arrived at Peterborough District Hospital. Despite the fact that casualties arrived at the A&E Department in large numbers before the Major Accident Plan could be implemented, all of the casualties had been assessed and either admitted or sent home within 3 h of the explosion. In the process several valuable lessons were learned, and their implications are discussed in this paper.

Disaster Planning↗
PubMed1984

Bowel preparation and the risk of explosion during colonoscopic polypectomy.

Concentration of oxygen, methane, and hydrogen were measured in intracolonic gas samples aspirated through the colonoscope at the time of colonoscopy from 46 patients. Of the above patients 20 prepared either with mannitol (n = 10) or with castor oil (n = 10) had the instrument passed to the caecum without air insufflation or suction. After mannitol, mean intracolonic hydrogen concentration (4.07%) was significantly higher (p less than 0.001) than after castor oil (0.51%). Mean oxygen and methane concentrations were approximately similar. Potentially explosive concentrations of hydrogen (greater than 4.1%) and or methane (greater than 5%) were present in 6/10 patients given mannitol and 2/10 patients given castor oil. Nevertheless only one patient from each group had coexisting oxygen concentrations of more than 5% producing thus a combustile mixture. Routine colonoscopy (using air insufflation and suction) was performed in 26 patients prepared with mannitol. Mean intracolonic hydrogen and methane was 0.63% and 0.88% respectively. The highest recorded concentration of hydrogen was 2.6%, and of methane 2.1%, while all patients had oxygen concentrations of more than 5%. It is suggested, therefore, that routine insufflation and suction before colonoscopic electrosurgical polypectomy should result in safe levels of these gases. The remote possibility of pockets of undiluted gas in explosive concentration, however, indicates the use of an inert gas such as carbon dioxide if mannitol preparation is used before electrosurgery.

Adult↗
PubMed1999

Blast lung injury from an explosion on a civilian bus.

OBJECTIVE: To assess clinical signs and management of primary blast lung injury (BLI) from explosions in an enclosed space and to propose a BLI severity scoring system. DESIGN: Retrospective analysis. PATIENTS: Fifteen patients with primary BLI resulting from explosions on two civilian buses in 1996. RESULTS: Ten patients were extremely hypoxemic on admission (PaO2 < 65 mm Hg with oxygen supplementation). Four patients remained severely hypoxemic (PaO2/fraction of inspired oxygen (FIO2) ratio of < 60 mm Hg) after mechanical ventilation was established and pneumothoraces were drained. Initial chest radiographs revealed bilateral lung opacities of various sizes in 12 patients (80%). Seven patients (47%) had bilateral pneumothoraces and two patients had a unilateral pneumothorax. Five (33%) had clinically significant bronchopleural fistulae. After clinical and laboratory data were collected, a BLI severity score was defined based on hypoxemia (PaO2/FIO2 ratio), chest radiographic abnormalities, and barotrauma. Severe BLI was defined as a PaO2/FIO2 ratio of < 60 mm Hg, bilateral lung infiltrates, and bronchopleural fistula; moderate BLI as a PaO2/FIO2 ratio of 60 to 200 mm Hg and diffuse (bilateral/unilateral) lung infiltrates with or without pneumothorax; and mild BLI as a PaO2/FIO2 ratio of > 200, localized lung infiltrates, and no pneumothorax. Five patients developed ARDS with Murray scores > 2.5. Respiratory management included positive pressure ventilation in the majority of the patients and unconventional methods (ie, high-frequency jet ventilation, independent lung ventilation, nitric oxide, and extracorporeal membrane oxygenation) in patients with severe BLI. Of the four patients who had severe BLI, three died. All six patients with moderate BLI survived, and four of five with mild BLI survived (one with head injury died). CONCLUSIONS: BLI can cause severe hypoxemia, which can be improved significantly with aggressive treatment. The lung damage may be accurately estimated in the early hours after injury. The BLI severity score may be helpful in determining patient management and prediction of final outcome.

Adolescent↗
PubMedDate not supplied

Dehiscence of radial keratotomy wounds without globe rupture following explosion injury.

PURPOSE: To report a case of explosive trauma to a patient with a history of radial keratotomy (RK), which resulted in multiple wound dehiscences but not globe rupture. METHODS: A 29-year-old male underwent radial keratotomy 1 year before he sustained facial trauma from a gasoline tank explosion. Corneal abrasions were treated with copious irrigation, topical antibiotics, corticosteroids, and scopolamine. He did not have a ruptured globe in either eye. RESULTS: The incision sites from radial keratotomy had evidence of anterior dehiscence in both eyes. One month following the injury, the patient had corrected visual acuity of 20/20-1 in the right eye and 20/25+1 in the left eye. At that time, the RK wounds were well healed with minimal irregularity over the incision sites. CONCLUSION: This case demonstrates the excellent recovery of visual acuity in a patient with a partial thickness traumatic wound rupture 12 months following radial keratotomy.

Adult↗
PubMed1997

The St Marys fragmentation grenade explosion.

The accidental explosion of a fragmentation grenade in a munitions factory at St Marys injured four workers, two critically. The prompt response by ambulances and physician-staffed helicopter emergency medical service prevented deaths, but the incident suggests lessons for the future handling of urban explosions.

Adult↗
PubMed2001

Minimal fixation in the treatment of open hand and foot bone fractures caused by explosive devices: case series.

AIM: To evaluate minimal fixation method with Kirschner's wires in the treatment of open fractures of the hand and foot short bones, caused by explosive devices. METHOD: There were 270 wounded persons with open fractures of hand and foot short bones, who were surgically treated at the Department of Surgery at the Osijek University Hospital. The stabilization of an unstable open fracture was performed with intramedullary positioned Kirschner's wires. In a few cases, satisfactory stabilization was achieved with Kirschner's wires positioned percutaneously alongside the wound and perpendicularly through the fracture. In the rest of the wounded, plaster immobilization was sufficient after surgical treatment and fracture reposition. RESULTS: Among 270 persons with 412 open hand and foot bone fractures, 49% had fracture only in the feet, 27% only in the hands, and 24% in both hands and feet. Unstable short bone fractures were found in 56 patients (21%). Such fractures were stabilized with Kirschner's wires (n=71). In 58 patients (21%) partial hand and foot amputations had to be performed. Reconstructive operations to improve pseudarthrosis after minimal osteosynthesis were performed on 5 short bones (7%). Osteitis was found on four short bones (6%) after minimal osteosynthesis. CONCLUSION: Minimal osteosynthesis with Kirschner's wires is a reliable and adequate method of the treatment of open unstable short bone fractures caused by explosive devices.

Blast Injuries↗
PubMed2001

Treatment evaluation of hindfoot injuries caused by pressure activated explosive devices in the war and peace time.

Injuries caused by pressure activated explosive devices are very complex medical and social problem in Bosnia and Herzegovina. Hindfoot injuries are also a big challenge for orthopedic surgeons concerning all forthcoming physical assessment of the patients and the fact that the forefoot and midfoot remain preserved. The study included 60 patients with amputation that followed such an injury, and 60 patients treated with reconstructive procedures. The gait of the patients was assessed in the period of 4 years. In 20 patients, destroyed tissues were sent referred for pathohistologic examination, which revealed typical signs of a damage caused by high kinetic energy devices. The gait was analyzed objectively by the examiner and subjectively by the patients, which was the main indicator of successful treatment. Infection analysis and plantogram were also taken into account. The study showed that in a number of cases primary reconstruction of the hindfoot injuries caused by pressure activated explosive devices was possible with satisfactory results, thus foot amputation having strict indication. Indications for amputation have been limited and foot preservation has become more real in the majority of patients.

Adolescent↗
PubMed2004

Dr. Walter C. McCrone's contribution to the characterization and identification of explosives.

Dr. McCrone was an amazing individual, possessing many talents and having many interests. He especially loved applying polarized light microscopy (PLM) to answering the question-at-hand and solving problems. He applied PLM to many different fields including the identification of air pollution particles, asbestos identification, art conservation, pharmaceuticals, industry problems and forensic sciences. A field that I believe he enjoyed the most was the characterization and identification of explosives. Throughout his life he worked on, gave presentations and published articles on the characterization and identification of explosives. Also, he encouraged other scientists to give presentations and publish on the subject by providing "behind the scene" advice and/or be a co-author on a paper. He unselfishly taught others how to apply PLM and incorporate this invaluable tool into their analytical scheme.

Explosions↗
PubMed1992

[Diathermy-induced gas explosion in the intestinal tract].

Surgical diathermy is widely used in modern operating rooms, although explosion in the gastrointestinal tract is a known serious complication. We report a case of colonic explosion following use of diathermy. Based on our experience and the available data, it is recommended that in cases of gastrointestinal tract obstruction, poor bowel preparation or following use of oral mannitol for bowel preparation, diathermy should be avoided in opening the gastrointestinal lumen.

Aged↗