Mass chemical casualties: Treatment of 41 patients with burns by anhydrous ammonia

Zhang, Fang; Zheng, Xianyou; Ma, Bing; Fan, Xiaoming; Wang, Guangyi; Xia, Zhaofan

doi:10.1016/j.burns.2015.02.016

Cited by 18 publications

(7 citation statements)

References 21 publications

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“…As a result, chemical inhalation is more severe than mere thermal damage. We previously reported an event wherein 41 patients had liquid ammonia burns combined with inhalation injury[6]. In the present case, measures were taken to stop the damage caused by the chemicals, such as emergency tracheotomy, bronchoscopy airway lavage, continuous airway rinsing, and so forth, which perhaps partially accounted for the patient’s good prognosis.…”

Section: Discussionmentioning

confidence: 78%

Potentially fatal electrolyte imbalance caused by severe hydrofluoric acid burns combined with inhalation injury: A case report

Wang¹,

Wang²,

He³

et al. 2019

WJCC

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BACKGROUNDHydrofluoric acid (HF) is one of the most common causes of chemical burns. HF burns can cause wounds that deepen and progress aggressively. As a result, HF burns are often severe even if they involve a small area of the skin. Published cases of HF burns have mostly reported small HF burn areas. Few cases of HF inhalation injury have been reported to date.CASE SUMMARYA 24-year-old man suffered from extensive hydrofluoric acid burns covering 60% of the total body surface area (TBSA), including deep second degree burns on 47% and third degree burns on 13% of the TBSA, after he fell into a pickling pool containing 15% HF. Comprehensive treatments were carried out after the patient was admitted. Ventricular fibrillation occurred 9 times within the first 2 h, and the lowest serum Ca2+ concentration was 0.192 mmol/L. A dose of calcium gluconate (37 g) was intravenously supplied during the first 24 h, and the total amount of calcium gluconate supplementation was 343 g. Extracorporeal membrane oxygenation (ECMO) was applied for 8 d to handle the acute respiratory distress syndrome (ARDS) induced by the HF inhalation injury. The patient was discharged after 99 d of comprehensive treatment, including skin grafting.CONCLUSIONExtensive HF burns combined with an inhalation injury led to a potentially fatal electrolyte imbalance and ARDS. Adequate and timely calcium supplementation and ECMO application were the keys to successful treatment of the patient.

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Section: Discussionmentioning

confidence: 78%

Potentially fatal electrolyte imbalance caused by severe hydrofluoric acid burns combined with inhalation injury: A case report

Wang¹,

Wang²,

He³

et al. 2019

WJCC

Self Cite

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“…The available literature included cutaneous radiation injuries (Parrish and Seda 2019 ; DiCarlo et al 2020 ), armed conflicts (Haverkamp et al 2019 ), parties/concerts/discos (Chen et al 2019 ; Lin et al 2019 ; Tseng et al 2019 ; Yang et al 2019 ), communication accidents (Ewbank et al 2018 ), terrorist attacks (Konwinski et al 2016 ; Ozoilo et al 2010 ; Sheridan et al 2017 , Hunt et al 2020), mass chemical casualties (Zhang et al 2015 ), petroleum and LPG explosions (Kumar 2013 ; Carlsonet al 2015 ), earthquakes (Kearns and Holmes 2014 ), indoor fires (Koning et al 2015 ), forest fires (Seifman et al 2011 ), and mine explosions (Allister and Hamilton et al 1983 ).…”

Section: Resultsmentioning

confidence: 99%

“…The six most serious patients with inhalation injuries were admitted to the burn intensive care unit. One of that patients died because of respiratory failure and ongoing pulmonary infection (Zhang et al 2015 ).…”

Section: Resultsmentioning

confidence: 99%

The urgent need to achieve an optimal strategic stock of human allogeneic skin graft materials in case of a mass disaster in Poland

et al. 2022

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A burn is a sudden injury which immediate or long-term consequences may be life-threatening for the patient. A mass disaster event may involve large numbers of severely burned patients. Patients of this type typically have a limited area of healthy, unburned skin from which an autologous split thickness skin graft could be collected. In a clinical situation of this type, it is necessary to use a particular skin substitute. Non-viable allogeneic human skin graft materials might be considered as the most suitable skin substitutes in the treatment of such patients. At present, Poland does not have a sufficient supply of human allogeneic skin graft materials to meet the needs arising from a sudden and unforeseen mass disaster. This study involved an analysis of selected mass disasters. From this an estimate was made from a verified casualty profile of the necessary minimum stock of human allogeneic skin graft materials. An insufficient amount of skin results from an inadequate number of skin donors, which in turn results from the current tissue donation system. Therefore, a proposal has been made for the organizational, legal and systemic changes required to improve the situation in Polish transplantology, with particular emphasis on skin donation. In order to achieve a strategic stock of human skin grafts, a tissue collecting transplantation team should be organized. The rights and obligations of the non-physician transplant team member should be extended. Proposals have been made for awareness campaigns (adverts, posters etc.) and educational schemes (educational video, lectures during transplant coordinator training, etc.). Finally, a proposal has been made for possible methods to deal with the logistic management of the allogeneic skin stock. The required, essential stock of human allogeneic skin in the event of a mass disaster has been estimated at 600,000 cm 2 . Supplementary Information The online version contains supplementary material available at 10.1007/s10561-022-10001-z.

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“…14 Chemical inhalation injury may progress to serious acute lung injury later. 15 Blast lung or intestinal injury due to an explosion also may deteriorate, even if the patients are initially asymptomatic. 16 Accordingly, the present patients who were categorized as "green" should have been categorized as "yellow.…”

Section: Triagementioning

confidence: 99%

Multiple Patients With Burn Injury Induced by a Chemical Explosion Managed by Physician-Staffed Helicopters

Kondo

Jitsuiki

Osaka

et al. 2019

Disaster med. public health prep.

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On December 1, 2017, the Fuji factory of Arakawa Chemical Industries exploded. Dust that formed as a byproduct from the crushing and packing process of the resin for ink exploded at the facility. The Fuji City Fire Department requested the dispatch of 2 physician-staffed helicopters (known as a doctor helicopter [DH] in Japan). The first party of emergency services established a headquarters and first-aid station. However, this area was feared to be at risk of a second explosion. Physicians performed re-triage for all 11 burned patients. Three severely injured patients were transported to emergency medical service centers either by ground ambulance or the DH without undergoing any decontamination. The physician who escorted the patient by ground ambulance complained of a headache. One of the severely injured patients was treated at a local hospital and then transported to an emergency medical service center after undergoing decontamination and intubation. Fortunately, all patients who were transported to medical facilities obtained a survival outcome. Chemical, biological, radiological, nuclear, and explosive incidents are rare but can be fatal for responders to these types of disaster. Therefore, all who work in these settings should be prepared and trained adequately to ensure that they have the knowledge and skill to both manage patients and protect themselves from harm. (Disaster Med Public Health Preparedness. 2019;13:799–805)

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Mass chemical casualties: Treatment of 41 patients with burns by anhydrous ammonia

Cited by 18 publications

References 21 publications

Potentially fatal electrolyte imbalance caused by severe hydrofluoric acid burns combined with inhalation injury: A case report

Potentially fatal electrolyte imbalance caused by severe hydrofluoric acid burns combined with inhalation injury: A case report

The urgent need to achieve an optimal strategic stock of human allogeneic skin graft materials in case of a mass disaster in Poland

Multiple Patients With Burn Injury Induced by a Chemical Explosion Managed by Physician-Staffed Helicopters

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