Treatment of hot bitumen-contact-burn injuries

[Where there´s smoke - there´s no fire? - Burns from E-Cigarette explosions]

INTRODUCTION

The popularity of E-Cigarettes is increasing. Besides addiction and pulmonary health damage, reports of burn injuries from e-cigarette explosions are also increasing. Mostly, explosions of e-cigarettes are attributed to its lithium-ion battery. Due to increasing cases and missing guidelines we want to present three cases of our hospital and publish recommendations for the management of burn injuries caused by e-cigarette explosions.

PATIENTS/MATERIAL AND METHODS

Three cases of e-cigarette explosions which occurred between 2016 and 2019, are presented.

RESULTS

All three e-cigarette explosions occurred in the trouser pockets. Two patients were male one patient was female. The age ranged from 24 to 64 years, the burned total body surface area (TBSA) from 3 % to 12.5 %. All three patients required skin grafting and the length of stay in hospital ranged from five to eleven days.

CONCLUSION

In the synopsis of recent literature, we recommend the following management of burns due to e-cigarette explosions. The guidelines of the Advanced Trauma Life Support should be followed, signs of an inhalation trauma should be checked and litmus test should be performed prior to irrigation with aqueous solutions to prevent exothermic reactions with remaining metals. If litmus test shows alkali pH wounds should be irrigated by mineral oil.

Edible oil methods to remove asphalt on burns

Asphalt, also known as bitumen, is a viscous liquid or a semi-solid form of petroleum. In cases of hot liquid asphalt splash, asphalt broadly adheres to the skin surface and is hard to remove from skin. Because accidental burns from hot liquid asphalt splash rarely occur, there is no consensus about initial approaches to remove adherent asphalt from skin. We reviewed articles relating to asphalt burns and summarized methods to remove adherent asphalt from skin, including our present case in which we successfully removed adherent asphalt by edible butter and vegetable oil. We summarized information of 127 cases and classified agents used to remove asphalt in four categories: (i) medicines; (ii) health-care products; (iii) foods; and (iv) solvents. Before the 1990s, antimicrobial topical medicines were mainly reported to treat asphalt burns but it took half a day or more to remove asphalt. Mineral oils and edible oils such as butter and vegetable oil are easily available in grocery stores and could emulsify to remove asphalt in a few hours. From the review of articles and our experience, edible oils are useful agents for the first approach to remove asphalt from the point of view of efficacy, safety, availability and expense.

Hot asphalt burns: a review of injuries and management options

Hot asphalt burns to human tissue can increase the likelihood of infection and potential conversion of partial thickness to full-thickness injuries. Successful intervention for hot asphalt burns requires immediate and effective cooling of the asphalt on the tissue followed by subsequent gradual removal of the cooled asphalt. A review of the literature reveals that multiple substances have been used to remove asphalt, including topical antibiotics, petroleum jelly, a commercial product known as De-Solv-It (ORANGE-SOL, Chandler, AZ), sunflower oil, baby oil, liquid paraffin, butter, mayonnaise, and moist-exposed burn ointment (MEBO). Although many of these products may be effective in the removal of asphalt, they may not be readily available in an emergency department setting. Topical antibiotics are readily available, are more commonly described in the medical literature, and would be expected to be effective in the removal of asphalt. We developed guidelines for on scene (first-aid) management and the initial care of such patients upon presentation to a health care facility. These guidelines emphasize the principles of early cooling, gradual removal of adherent asphalt using topical antibiotics, and avoidance of the use of topical agents, which are likely to result in tissue toxicity.