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Zhang QF, Hao JW. [Mechanism and prevention and treatment strategy of progressive injury in high-voltage electric burns]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:718-723. [PMID: 37805781 DOI: 10.3760/cma.j.cn501225-20230331-00107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
High-voltage electric burn is one of burns that can cause severe damages to tissue and organs. Clinically, progressive injury in high-voltage electric burns is a key pathological change that affects the level of amputation and the success rate of treatment. At present, the exact definition and mechanism of progressive injury in high-voltage electric burns have not been elucidated, and the clinical treatment is mainly symptomatic treatment. Relevant research data on the mechanism and treatment of progressive injury in high-voltage electric burns are lacking. This paper analyzes and summarizes the mechanism, diagnosis, treatment, and common outcome of progressive injury in high-voltage electric burns, and provides a reference for the mechanism research, clinical diagnosis and treatment of progressive injury in high-voltage electric burns.
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Affiliation(s)
- Q F Zhang
- Burn and Wound Repair Center, the Third Hospital of Hebei Medical University, Hebei Burn Treatment Technology Innovation Center, Shijiazhuang 050051, China
| | - J W Hao
- Department of Burn Plastic (Wound Repair) Surgery, the First Hospital of Hebei Medical University, Shijiazhuang 050000, China
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Antal A, Alekseichuk I, Bikson M, Brockmöller J, Brunoni AR, Chen R, Cohen LG, Dowthwaite G, Ellrich J, Flöel A, Fregni F, George MS, Hamilton R, Haueisen J, Herrmann CS, Hummel FC, Lefaucheur JP, Liebetanz D, Loo CK, McCaig CD, Miniussi C, Miranda PC, Moliadze V, Nitsche MA, Nowak R, Padberg F, Pascual-Leone A, Poppendieck W, Priori A, Rossi S, Rossini PM, Rothwell J, Rueger MA, Ruffini G, Schellhorn K, Siebner HR, Ugawa Y, Wexler A, Ziemann U, Hallett M, Paulus W. Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines. Clin Neurophysiol 2017; 128:1774-1809. [PMID: 28709880 PMCID: PMC5985830 DOI: 10.1016/j.clinph.2017.06.001] [Citation(s) in RCA: 627] [Impact Index Per Article: 89.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/29/2017] [Accepted: 06/06/2017] [Indexed: 12/11/2022]
Abstract
Low intensity transcranial electrical stimulation (TES) in humans, encompassing transcranial direct current (tDCS), transcutaneous spinal Direct Current Stimulation (tsDCS), transcranial alternating current (tACS), and transcranial random noise (tRNS) stimulation or their combinations, appears to be safe. No serious adverse events (SAEs) have been reported so far in over 18,000 sessions administered to healthy subjects, neurological and psychiatric patients, as summarized here. Moderate adverse events (AEs), as defined by the necessity to intervene, are rare, and include skin burns with tDCS due to suboptimal electrode-skin contact. Very rarely mania or hypomania was induced in patients with depression (11 documented cases), yet a causal relationship is difficult to prove because of the low incidence rate and limited numbers of subjects in controlled trials. Mild AEs (MAEs) include headache and fatigue following stimulation as well as prickling and burning sensations occurring during tDCS at peak-to-baseline intensities of 1-2mA and during tACS at higher peak-to-peak intensities above 2mA. The prevalence of published AEs is different in studies specifically assessing AEs vs. those not assessing them, being higher in the former. AEs are frequently reported by individuals receiving placebo stimulation. The profile of AEs in terms of frequency, magnitude and type is comparable in healthy and clinical populations, and this is also the case for more vulnerable populations, such as children, elderly persons, or pregnant women. Combined interventions (e.g., co-application of drugs, electrophysiological measurements, neuroimaging) were not associated with further safety issues. Safety is established for low-intensity 'conventional' TES defined as <4mA, up to 60min duration per day. Animal studies and modeling evidence indicate that brain injury could occur at predicted current densities in the brain of 6.3-13A/m2 that are over an order of magnitude above those produced by tDCS in humans. Using AC stimulation fewer AEs were reported compared to DC. In specific paradigms with amplitudes of up to 10mA, frequencies in the kHz range appear to be safe. In this paper we provide structured interviews and recommend their use in future controlled studies, in particular when trying to extend the parameters applied. We also discuss recent regulatory issues, reporting practices and ethical issues. These recommendations achieved consensus in a meeting, which took place in Göttingen, Germany, on September 6-7, 2016 and were refined thereafter by email correspondence.
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Affiliation(s)
- A Antal
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg August University, Göttingen, Germany.
| | - I Alekseichuk
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - M Bikson
- Department of Biomedical Engineering, The City College of New York, New York, USA
| | - J Brockmöller
- Department of Clinical Pharmacology, University Medical Center Goettingen, Germany
| | - A R Brunoni
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, Laboratory of Neurosciences (LIM-27) and Interdisciplinary Center for Applied Neuromodulation University Hospital, University of São Paulo, São Paulo, Brazil
| | - R Chen
- Division of Neurology, Department of Medicine, University of Toronto and Krembil Research Institute, Toronto, Ontario, Canada
| | - L G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke NIH, Bethesda, USA
| | | | - J Ellrich
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Institute of Physiology and Pathophysiology, University of Erlangen-Nürnberg, Erlangen, Germany; EBS Technologies GmbH, Europarc Dreilinden, Germany
| | - A Flöel
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurologie, Greifswald, Germany
| | - F Fregni
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - M S George
- Brain Stimulation Division, Medical University of South Carolina, and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - R Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - J Haueisen
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, Germany
| | - C S Herrmann
- Experimental Psychology Lab, Department of Psychology, European Medical School, Carl von Ossietzky Universität, Oldenburg, Germany
| | - F C Hummel
- Defitech Chair of Clinical Neuroengineering, Centre of Neuroprosthetics (CNP) and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Swiss Federal Institute of Technology (EPFL Valais), Sion, Switzerland
| | - J P Lefaucheur
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, and EA 4391, Nerve Excitability and Therapeutic Team (ENT), Faculty of Medicine, Paris Est Créteil University, Créteil, France
| | - D Liebetanz
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - C K Loo
- School of Psychiatry & Black Dog Institute, University of New South Wales, Sydney, Australia
| | - C D McCaig
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - C Miniussi
- Center for Mind/Brain Sciences CIMeC, University of Trento, Rovereto, Italy; Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - P C Miranda
- Institute of Biophysics and Biomedical Engineering, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - V Moliadze
- Institute of Medical Psychology and Medical Sociology, University Hospital of Schleswig-Holstein (UKSH), Campus Kiel, Christian-Albrechts-University, Kiel, Germany
| | - M A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Department of Neurology, University Hospital Bergmannsheil, Bochum, Germany
| | - R Nowak
- Neuroelectrics, Barcelona, Spain
| | - F Padberg
- Department of Psychiatry and Psychotherapy, Munich Center for Brain Stimulation, Ludwig-Maximilian University Munich, Germany
| | - A Pascual-Leone
- Division of Cognitive Neurology, Harvard Medical Center and Berenson-Allen Center for Noninvasive Brain Stimulation at Beth Israel Deaconess Medical Center, Boston, USA
| | - W Poppendieck
- Department of Information Technology, Mannheim University of Applied Sciences, Mannheim, Germany
| | - A Priori
- Center for Neurotechnology and Experimental Brain Therapeutich, Department of Health Sciences, University of Milan Italy; Deparment of Clinical Neurology, University Hospital Asst Santi Paolo E Carlo, Milan, Italy
| | - S Rossi
- Department of Medicine, Surgery and Neuroscience, Human Physiology Section and Neurology and Clinical Neurophysiology Section, Brain Investigation & Neuromodulation Lab, University of Siena, Italy
| | - P M Rossini
- Area of Neuroscience, Institute of Neurology, University Clinic A. Gemelli, Catholic University, Rome, Italy
| | | | - M A Rueger
- Department of Neurology, University Hospital of Cologne, Germany
| | | | | | - H R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Y Ugawa
- Department of Neurology, Fukushima Medical University, Fukushima, Japan; Fukushima Global Medical Science Center, Advanced Clinical Research Center, Fukushima Medical University, Japan
| | - A Wexler
- Department of Science, Technology & Society, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - U Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - M Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - W Paulus
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
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Parsons AC. The Importance of Arc Flash Mitigation. Occup Health Saf 2017; 86:30-34. [PMID: 30290106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
De-energizing equipment does not absolve the facility from the responsibility of performing an arc flash analysis or providing the necessary PPE.
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Green A. How to Choose Gloves to Protect Against Arc Flash: You don't want to wear gloves that will burn, catch fire or not protect from heat. Beyond sustained injuries, ignoring the need for proper electrical PPE can result in huge fines. Occup Health Saf 2017; 86:40-41. [PMID: 30211509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Sienkiewicz Z, van Rongen E, Croft R, Ziegelberger G, Veyret B. A Closer Look at the Thresholds of Thermal Damage: Workshop Report by an ICNIRP Task Group. Health Phys 2016; 111:300-6. [PMID: 27472755 PMCID: PMC4972475 DOI: 10.1097/hp.0000000000000539] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2016] [Indexed: 05/24/2023]
Abstract
The International Commission on Non-Ionizing Radiation Protection issued guidelines in 1998 for limiting public and occupational exposure to radiofrequency electromagnetic fields (100 kHz to 300 GHz). As part of the process of updating this advice, a 2-d workshop titled "A closer look at the thresholds of thermal damage" was held from 26-28 May 2015 in Istanbul to re-examine the thermal basis of the guidelines and to provide further information on heat-related effects and thresholds of thermal damage. Overall, the workshop provided much useful information relevant to revision of the guidelines. Participants indicated that the effects of heating from radiofrequency fields are consistent with those from other sources, and that the information derived from those studies can be applied to radiofrequency-induced heating. Another conclusion was that absolute temperature of tissues was more important for thermal damage than temperature change. The discussion suggested that the 6-min averaging time used in international guidelines was valid for whole-body exposures but with a large uncertainty: 30 min may be a more appropriate averaging time for localized exposures, and less than 1 min for implanted medical devices. The duration of whole-body radiofrequency exposure is a critical parameter that often determines the effect threshold, but this will be affected by other, ongoing thermoregulation, which is dependant on many factors. The thresholds for localized radiofrequency exposure were difficult to determine because of the potential range of exposure conditions and the possibility of radiofrequency-induced local hotspots. Suggestions for future dose metrics and further research were discussed and are included in this report.
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Affiliation(s)
- Zenon Sienkiewicz
- *Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Oxfordshire, OX11 ORQ, United Kingdom; †Health Council of the Netherlands, P.O. Box 16052, 2500 BB Den Haag, the Netherlands; ‡School of Psychology, Illawarra Health & Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia; §Federal Office for Radiation Protection, Ingolstadter Landstr. 1, 85764 Neuherberg, Germany; **Laboratoire IMS CNRS/EPHE, University of Bordeaux, 351 Cours de la Libération, 33405 Talence cedex, France
| | - Eric van Rongen
- *Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Oxfordshire, OX11 ORQ, United Kingdom; †Health Council of the Netherlands, P.O. Box 16052, 2500 BB Den Haag, the Netherlands; ‡School of Psychology, Illawarra Health & Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia; §Federal Office for Radiation Protection, Ingolstadter Landstr. 1, 85764 Neuherberg, Germany; **Laboratoire IMS CNRS/EPHE, University of Bordeaux, 351 Cours de la Libération, 33405 Talence cedex, France
| | - Rodney Croft
- *Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Oxfordshire, OX11 ORQ, United Kingdom; †Health Council of the Netherlands, P.O. Box 16052, 2500 BB Den Haag, the Netherlands; ‡School of Psychology, Illawarra Health & Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia; §Federal Office for Radiation Protection, Ingolstadter Landstr. 1, 85764 Neuherberg, Germany; **Laboratoire IMS CNRS/EPHE, University of Bordeaux, 351 Cours de la Libération, 33405 Talence cedex, France
| | - Gunde Ziegelberger
- *Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Oxfordshire, OX11 ORQ, United Kingdom; †Health Council of the Netherlands, P.O. Box 16052, 2500 BB Den Haag, the Netherlands; ‡School of Psychology, Illawarra Health & Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia; §Federal Office for Radiation Protection, Ingolstadter Landstr. 1, 85764 Neuherberg, Germany; **Laboratoire IMS CNRS/EPHE, University of Bordeaux, 351 Cours de la Libération, 33405 Talence cedex, France
| | - Bernard Veyret
- *Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Oxfordshire, OX11 ORQ, United Kingdom; †Health Council of the Netherlands, P.O. Box 16052, 2500 BB Den Haag, the Netherlands; ‡School of Psychology, Illawarra Health & Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia; §Federal Office for Radiation Protection, Ingolstadter Landstr. 1, 85764 Neuherberg, Germany; **Laboratoire IMS CNRS/EPHE, University of Bordeaux, 351 Cours de la Libération, 33405 Talence cedex, France
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Witt B. Arc Flash Hearing Protection. Occup Health Saf 2015; 84:102. [PMID: 26495632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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7
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Ponder M. Magnetic Resonance Safety Practices: The New Normal. Radiol Technol 2015; 87:109-111. [PMID: 26377275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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8
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Ellenor CW, Stang PP, Etezadi-Amoli M, Pauly JM, Scott GC. Offline impedance measurements for detection and mitigation of dangerous implant interactions: an RF safety prescreen. Magn Reson Med 2015; 73:1328-39. [PMID: 24623586 PMCID: PMC4162873 DOI: 10.1002/mrm.25202] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 02/10/2014] [Accepted: 02/11/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE The concept of a "radiofrequency safety prescreen" is investigated, wherein dangerous interactions between radiofrequency fields used in MRI, and conductive implants in patients are detected through impedance changes in the radiofrequency coil. THEORY The behavior of coupled oscillators is reviewed, and the resulting, observable impedance changes are discussed. METHODS A birdcage coil is loaded with a static head phantom and a wire phantom with a wire close to its resonant length, the shape, position, and orientation of which can be changed. Interactions are probed with a current sensor and network analyzer. RESULTS Impedance spectra show dramatic, unmistakable splitting in cases of strong coupling, and strong correlation is observed between induced current and scattering parameters. CONCLUSIONS The feasibility of a new, low-power prescreening technique has been demonstrated in a simple phantom experiment, which can unambiguously detect resonant interactions between an implanted wire and an imaging coil. A new technique has also been presented which can detect parallel transmit null modes for the wire.
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Affiliation(s)
| | - Pascal P Stang
- Department of Electrical Engineering, Stanford UniversityStanford, California, USA
- Procyon Engineering, San JoseCalifornia, USA
| | - Maryam Etezadi-Amoli
- Department of Electrical Engineering, Stanford UniversityStanford, California, USA
| | - John M Pauly
- Department of Electrical Engineering, Stanford UniversityStanford, California, USA
| | - Greig C Scott
- Department of Electrical Engineering, Stanford UniversityStanford, California, USA
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Hsiao WT, Lin LH, Chiang HJ, Ou KL, Cheng HY. Biomedical electrosurgery devices containing nanostructure for minimally invasive surgery: reduction of thermal injury and acceleration of wound healing for liver cancer. J Mater Sci Mater Med 2015; 26:77. [PMID: 25631273 DOI: 10.1007/s10856-015-5416-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 11/01/2014] [Indexed: 06/04/2023]
Abstract
The aim of the present study was to investigate the thermal injury in the liver after a minimally invasive electrosurgery technique with a copper-doped diamond-like carbon (DLC-Cu) surface coating. To effectively utilize electrosurgery in a clinical caner setting, it is necessary to suppress the thermal injury to adjacent tissues. The surface morphologies of DLC-Cu thin films were characterized using scanning electron microscopy and transmission electron microscopy. Three-dimensional liver models were reconstructed using magnetic resonance imaging to simulate the electrosurgical procedure. Our results indicated that the temperature decreased significantly when minimally electrosurgery with nanostructured DLC-Cu thin films was used, and that it continued to decrease with increasing film thickness. In an animal model, thermography revealed that the surgical temperature was significantly lower in the minimally invasive electrosurgery with DLC-Cu thin film (DLC-Cu-SS) compared to untreated electrosurgery. In addition, DLC-Cu-SS created a relatively small thermal injury area and lateral thermal effect. These results indicated that the biomedical nanostructure coating reduced excessive thermal injury, and uniformly distributed temperature in the liver.
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Affiliation(s)
- Wen-Tien Hsiao
- Department of Diagnostic Radiology, Taipei Medical University Hospital, Taipei, 110, Taiwan
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Hoagland H. Gloves, arc flash, and the new ASTM test method. Occup Health Saf 2013; 82:32-34. [PMID: 24000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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11
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Kaminsky R, Ponthan R. Choosing the right FR fabrics and apparel. Occup Health Saf 2013; 82:28-30. [PMID: 24000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Pietryga JA, Fonder MA, Rogg JM, North DL, Bercovitch LG. Invisible metallic microfiber in clothing presents unrecognized MRI risk for cutaneous burn. AJNR Am J Neuroradiol 2013; 34:E47-50. [PMID: 22173750 PMCID: PMC7964672 DOI: 10.3174/ajnr.a2827] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 06/27/2011] [Indexed: 11/07/2022]
Abstract
SUMMARY We report a case of a thermal burn that occurred during MR imaging likely caused by invisible silver-embedded microfibers in the fabric of an undershirt. As the prevalence of fabric containing nondetectable metallic microfiber increases in athletic and "tech" clothing, the importance of having patients change into safe facility-provided garments before MR imaging is emphasized.
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Affiliation(s)
- J A Pietryga
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island 02903, USA
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Trivedi SJ, Lim TW, Barry MA, Byth K, Ross DL, Thiagalingam A, Kovoor P. Clinical evaluation of a new technique to monitor return electrode skin temperature during radiofrequency ablation. J Interv Card Electrophysiol 2012. [PMID: 23179920 DOI: 10.1007/s10840-012-9750-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Return electrode burns occur occasionally in cardiac radiofrequency ablation and more frequently in tumor radiofrequency ablation. A return electrode incorporating a thermochromic liquid crystal (TLC) layer, which changes color with temperature, has been shown in sheep studies to accurately indicate underlying skin temperature. We aimed to validate the accuracy of TLC-coated return electrodes in indicating skin temperature in the clinical setting of cardiac radiofrequency ablation. METHODS AND RESULTS The top layer of a standard return electrode was replaced with TLC. Fluoro-optic thermometer (FOT) probes were laid on the skin side of the return electrode, which was then placed on the left lateral mid-thigh of 18 patients (mean age = 61 ± 12 years, 12 men) undergoing cardiac radiofrequency ablation. Return electrode photographs were taken when FOT temperature exceeded 35 °C. TLC color changes, observed in 11 patients, were converted to temperature and compared with FOT temperature. TLC temperature correlated well with FOT temperature (Pearson's coefficient = 0.97 ± 0.03). Bland-Altman analysis showed good agreement (mean temperature difference = -0.04 ± 0.08 °C, upper limit of agreement = 0.11 ± 0.005 °C, lower limit of agreement = -0.19 ± 0.005 °C). The maximum FOT temperature recorded was 39.6 °C. There was no thermal injury at the return electrode site on any patients, when assessed immediately after and the day following the procedure. CONCLUSION TLC-coated return electrodes accurately indicate underlying skin temperature in cardiac radiofrequency ablation and may help prevent burns. This technology might be essential in high energy radiofrequency ablation.
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Alternate-site burns from improperly seated or damaged electrosurgical pencil active electrodes. Health Devices 2012; 41:334. [PMID: 23444680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Kendrick D, Young B, Mason-Jones AJ, Ilyas N, Achana FA, Cooper NJ, Hubbard SJ, Sutton AJ, Smith S, Wynn P, Mulvaney C, Watson MC, Coupland C. Home safety education and provision of safety equipment for injury prevention. Cochrane Database Syst Rev 2012; 2012:CD005014. [PMID: 22972081 PMCID: PMC9758703 DOI: 10.1002/14651858.cd005014.pub3] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND In industrialised countries injuries (including burns, poisoning or drowning) 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 reduce injury rates or improve a range of safety practices, 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 (hereafter referred to as home safety interventions), in reducing child injury rates or increasing home safety practices and whether the effect varied by social group. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2009, Issue 2) in The Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Social Sciences Citation Index (SSCI), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S), CINAHL (EBSCO) and DARE (2009, Issue 2) in The Cochrane Library. We also searched websites and conference proceedings and searched the bibliographies of relevant studies and previously published reviews. We contacted authors of included studies as well as relevant organisations. The most recent search for trials was May 2009. SELECTION CRITERIA Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after (CBA) studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, and which reported injury, safety practices or possession of safety equipment. 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 simultaneously combined in meta-regressions by social and demographic variables. Pooled incidence rate ratios (IRR) were calculated for injuries which occurred during the studies, and pooled odds ratios were calculated for the uptake of safety equipment or safety practices, with 95% confidence intervals. MAIN RESULTS Ninety-eight studies, involving 2,605,044 people, are included in this review. Fifty-four studies involving 812,705 people were comparable enough to be included in at least one meta-analysis. Thirty-five (65%) studies were RCTs. Nineteen (35%) of the studies included in the meta-analysis provided IPD.There was a lack of evidence that home safety interventions reduced rates of thermal injuries or poisoning. There was some evidence that interventions may reduce injury rates after adjusting CBA studies for baseline injury rates (IRR 0.89, 95% CI 0.78 to 1.01). Greater reductions in injury rates were found for interventions delivered in the home (IRR 0.75, 95% CI 0.62 to 0.91), and for those interventions not providing safety equipment (IRR 0.78, 95% CI 0.66 to 0.92).Home safety interventions were effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.41, 95% CI 1.07 to 1.86), functional smoke alarms (OR 1.81, 95% CI 1.30 to 2.52), a fire escape plan (OR 2.01, 95% CI 1.45 to 2.77), storing medicines (OR 1.53, 95% CI 1.27 to 1.84) and cleaning products (OR 1.55, 95% CI 1.22 to 1.96) out of reach, having syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) or poison control centre numbers accessible (OR 3.30, 95% CI 1.70 to 6.39), having fitted stair gates (OR 1.61, 95% CI 1.19 to 2.17), and having socket covers on unused sockets (OR 2.69, 95% CI 1.46 to 4.96).Interventions providing free, low cost or discounted safety equipment appeared to be more effective in improving some safety practices than those interventions not doing so. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury. AUTHORS' CONCLUSIONS Home safety interventions most commonly provided as one-to-one, face-to-face education, especially with the provision of safety equipment, are effective in increasing a range of safety practices. There is some evidence that such interventions may reduce injury rates, particularly where interventions are provided at home. Conflicting findings regarding interventions providing safety equipment on safety practices and injury outcomes are likely to be explained by two large studies; one clinic-based study provided equipment but did not reduce injury rates and one school-based study did not provide equipment but did demonstrate a significant reduction in injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment, was less effective in those participants at greater risk of injury. Further studies are still required to confirm these findings with respect to injury rates.
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Affiliation(s)
- Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK.
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16
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Koo JH, Shin JH, Oh YL, Ko EY, Han BK. Sonographically guided radiofrequency ablation with and without a superficial saline injection to prevent skin burns in a rabbit model. J Ultrasound Med 2012; 31:873-878. [PMID: 22644683 DOI: 10.7863/jum.2012.31.6.873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Our aim was to determine whether sonographically guided radiofrequency ablation with superficial saline injection can minimize thermal injury of the skin without an influence on therapeutic efficacy. METHODS Institutional Animal Care Committee approval was obtained. Twelve percutaneous radiofrequency ablation procedures were performed in the thighs of 6 rabbits (control, n = 6, right thigh; experimental, n = 6, left thigh). The ablation with local anesthesia was performed in the most superficial area of the thigh muscle. In the experimental group, 1 mL of saline was injected before the ablation at the tissue layer between the skin and ablated muscle. The duration and energy of the ablation were the same in the control and experimental groups. Rabbits were compared for their gross skin state and histopathologic findings after the ablation. RESULTS The degree of thermal coagulation of the muscle was similar in both groups at pathologic examination. Grossly, skin redness was mild in the experimental group but moderate in the control group. Of the 6 rabbits, 5 tended to show more frequent histopathologic changes, including an inflammatory reaction, interruption of collagen fibers, injury of the skin adnexa, and fibrosis, in the control group when compared with the experimental group. However, there was no statistically significant difference (all P> .05). One rabbit that underwent ablation at higher energy had a partially dissected epidermis in the control group only. CONCLUSIONS Sonographically guided radiofrequency ablation with a saline injection superficial to a tumor might prevent skin burns and provide equivalent therapeutic efficacy for ablating superficial lesions.
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Affiliation(s)
- Ji Hyun Koo
- Departmentof Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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17
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Smith D. No shortcuts. Occup Health Saf 2012; 81:32-36. [PMID: 22670430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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18
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Hoagland H, West D. Gloves in arc flash: a big change in NFPA 70E. Occup Health Saf 2012; 81:10-12. [PMID: 22295594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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19
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Reducing the risk of burns during electroconvulsive therapy. Health Devices 2011; 40:347-8. [PMID: 23444536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Poor contact between electroconvulsive therapy (ECT) electrodes and the skin can result in patient burns during ECT treatment. Proper site preparation and electrode application are essential to ensure adequate contact and to reduce the risk of burns.
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20
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Espada M, Munoz R, Noble BN, Magrina JF. Insulation failure in robotic and laparoscopic instrumentation: a prospective evaluation. Am J Obstet Gynecol 2011; 205:121.e1-5. [PMID: 21640966 DOI: 10.1016/j.ajog.2011.03.055] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 02/07/2011] [Accepted: 03/29/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to detect the incidence, prevalence, and location of insulation failures (IFs) in laparoscopic and robotic instruments. STUDY DESIGN In phase A, a total of 78 robotic and 298 laparoscopic instruments were tested at 20 W and 2.64 kV at Mayo Clinic in Arizona. In phase B, 60 robotic and 308 laparoscopic instruments were tested at 20 W/1 kV and 20 W/4.2 kV, respectively. RESULTS In phase A, the robotic group showed a higher prevalence (25/78; 32%) and incidence of IFs after 10 uses (35/44 instruments; 80%) when compared with laparoscopy (prevalence, 39/298 [13%]; incidence, 68/189 [36%]; P<.05). In phase B, IFs were detected in 81.7% of the robotic instruments and in 19.5% of the laparoscopic instruments (P<.005). CONCLUSION There is a high incidence and prevalence of IF in endoscopic instrumentation that is more common in the robotic group.
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Affiliation(s)
- Mercedes Espada
- Obstetrics and Gynecology Department, Hospital Quirón Madrid, Madrid, Spain.
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21
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Neumann J. Detecting and containing arc flash incidents. Power analytics software calculates potential arc flash threats in real time, recommending appropriate safety procedures and PPE needed to work in the vicinity. Occup Health Saf 2011; 80:61-62. [PMID: 21755884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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22
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Settecase F, Hetts SW, Martin AJ, Roberts TPL, Bernhardt AF, Evans L, Malba V, Saeed M, Arenson RL, Kucharzyk W, Wilson MW. RF Heating of MRI-Assisted Catheter Steering Coils for Interventional MRI. Acad Radiol 2011; 18:277-85. [PMID: 21075019 DOI: 10.1016/j.acra.2010.09.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 09/07/2010] [Accepted: 09/17/2010] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was too assess magnetic resonance imaging (MRI) radiofrequency (RF)-related heating of conductive wire coils used in magnetically steerable endovascular catheters. MATERIALS AND METHODS A three-axis microcoil was fabricated onto a 1.8Fr catheter tip. In vitro testing was performed on a 1.5-T MRI system using an agarose gel-filled vessel phantom, a transmit-receive body RF coil, a steady-state free precession pulse sequence, and a fluoroptic thermometry system. Temperature was measured without simulated blood flow at varying distances from the magnet isocenter and at varying flip angles. Additional experiments were performed with laser-lithographed single-axis microcoil-tipped microcatheters in air and in a saline bath with varied grounding of the microcoil wires. Preliminary in vivo evaluation of RF heating was performed in pigs at 1.5 T with coil-tipped catheters in various positions in the common carotid arteries with steady-state free precession pulse sequence on and off and under physiologic-flow and zero-flow conditions. RESULTS In tissue-mimicking agarose gel, RF heating resulted in a maximal temperature increase of 0.35°C after 15 minutes of imaging, 15 cm from the magnet isocenter. For a single-axis microcoil, maximal temperature increases were 0.73°C to 1.91°C in air and 0.45°C to 0.55°C in saline. In vivo, delayed contrast-enhanced MRI revealed no evidence of vascular injury, and histopathologic sections from the common carotid arteries confirmed the lack of vascular damage. CONCLUSIONS Microcatheter tip microcoils for endovascular catheter steering in MRI experience minimal RF heating under the conditions tested. These data provide the basis for further in vivo testing of this promising technology for endovascular interventional MRI.
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Affiliation(s)
- Fabio Settecase
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, L-352, San Francisco, CA 94143-0628, USA
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Abstract
‘The yron is most excellent but that it is offensive to the eye and bringeth the patient to great sorrowe and dread of the burning and the smart’”. Inscription on a 15th century cautery instrument, The Guild of Barber Surgeons, St Audoens Church, Dublin.
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Affiliation(s)
- Michael O'Riley
- Eschmann Equipment, Eschmann House, Peter Road, Lancing, West Sussex.
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24
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Magnetic resonance safety. Radiol Technol 2010; 81:615-6. [PMID: 20606056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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25
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Hardy PT, Weil KM. A review of thermal MR injuries. Radiol Technol 2010; 81:606-609. [PMID: 20606054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Paul T Hardy
- U.S. Food and Drug Administration, Center for Devices and Radiologic Health, Office of Surveillance and Biometrics, Division of Postmarket Surveillance, Silver Spring, Maryland, USA
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26
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Reducing the risk of burns and shocks during lontophoresis. Health Devices 2010; 39:98-9. [PMID: 21309271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
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.
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27
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Del Rosario E, Errando CL, García del Valle S. [Fire in the operating room: fact or fiction and what can we learn?]. Rev Esp Anestesiol Reanim 2010; 57:133-135. [PMID: 20422844 DOI: 10.1016/s0034-9356(10)70186-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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28
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Hedawoo JB, Ali A. Electric burns and disability. J Indian Med Assoc 2010; 108:84-87. [PMID: 20839563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
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.
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Affiliation(s)
- J B Hedawoo
- Department of Surgery, Government Medical College, Nagpur 440010
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29
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Hazard report. Reducing the risk of burns from surgical light sources. Health Devices 2009; 38:304-5. [PMID: 20848962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
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.
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30
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Lowry TR, Workman JR. Avoiding oral burns during electrocautery tonsillectomy. Ear Nose Throat J 2009; 88:790-792. [PMID: 19224480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
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.
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Affiliation(s)
- Thomas R Lowry
- Marshfield Clinic, 3800 Craig Road, Eau Claire, WI 54701, USA.
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31
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Xu R, Johnson MJ, Verber M, Kamara S. Development of an MR safe reach and grasp movement evaluation system to study brain activation patterns after stroke. Annu Int Conf IEEE Eng Med Biol Soc 2009; 2009:911-4. [PMID: 19964945 PMCID: PMC11075478 DOI: 10.1109/iembs.2009.5334674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
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.
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Affiliation(s)
- Rubing Xu
- Dept. of Biomedical Engineering, Marquette University, Milwaukee, WI 53233, USA.
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32
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Lee IH, Yoon YC, Cho EY, Kwon JW, Kwon ST. 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. J Ultrasound Med 2008; 27:1221-1227. [PMID: 18645081 DOI: 10.7863/jum.2008.27.8.1221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
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.
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Affiliation(s)
- In Ho Lee
- Department of Radiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, Korea
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Hoagland H, Wallace J. Arc protection around the world. Occup Health Saf 2008; 77:26-30. [PMID: 18717467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Onarheim H, Guttormsen AB, Eriksen E. [Burn treated at the Haukeland University Hospital Burn Centre--20 years of experience]. Tidsskr Nor Laegeforen 2008; 128:1168-1171. [PMID: 18480865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
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.
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MESH Headings
- Adolescent
- Adult
- Aged
- Burns/epidemiology
- Burns/prevention & control
- Burns/therapy
- Burns, Chemical/epidemiology
- Burns, Chemical/prevention & control
- Burns, Chemical/therapy
- Burns, Electric/epidemiology
- Burns, Electric/prevention & control
- Burns, Electric/therapy
- Child
- Child, Preschool
- Female
- History, 20th Century
- History, 21st Century
- Hospital Mortality
- Hospitals, University/history
- Humans
- Infant
- Intensive Care Units/history
- Male
- Middle Aged
- Norway/epidemiology
- Survival Analysis
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Affiliation(s)
- Henning Onarheim
- Kirurgisk serviceklinikk, Haukeland Universitetssykehus, 5021 Bergen.
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Netherton BL, Stecker MM, Patterson T. Mechanisms of electrode induced injury. Part 3: practical concepts and avoidance. Am J Electroneurodiagnostic Technol 2007; 47:257-263. [PMID: 18271314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
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.
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Top 10 health technology hazards: are you protecting your patients from these high-priority risks? Health Devices 2007; 36:345-51. [PMID: 18543529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
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.
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Patterson T, Stecker MM, Netherton BL. Mechanisms of electrode induced injury. Part 2: Clinical experience. Am J Electroneurodiagnostic Technol 2007; 47:93-113. [PMID: 17679578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
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.
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Affiliation(s)
- Terry Patterson
- Department of Neurosurgery, Penn State Medical Center, Hershey, Pennsylvania, USA
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40
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Warden GD. Electrical safety in iontophoresis. Rehab Manag 2007; 20:20, 22-3. [PMID: 17366933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Kendrick D, Coupland C, Mulvaney C, Simpson J, Smith SJ, Sutton A, Watson M, Woods A. Home safety education and provision of safety equipment for injury prevention. Cochrane Database Syst Rev 2007:CD005014. [PMID: 17253536 DOI: 10.1002/14651858.cd005014.pub2] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- D Kendrick
- University of Nottingham, Division of Primary Care, Floor 13, Tower Building, University Park, Nottingham, UK, NG7 2RD.
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42
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Adukauskiene D, Vizgirdaite V, Mazeikiene S. [Electrical injuries]. Medicina (Kaunas) 2007; 43:259-66. [PMID: 17413256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
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.
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Affiliation(s)
- Dalia Adukauskiene
- Clinic of Intensive Therapy, Kaunas University of Medicine, Kaunas, Lithuania
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43
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Affiliation(s)
- Susan Lange
- Center for Devices and Radiological Health, Food and Drug Administration/PHS, Rockville, MD, USA
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44
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Vaughan T, DelaBarre L, Snyder C, Tian J, Akgun C, Shrivastava D, Liu W, Olson C, Adriany G, Strupp J, Andersen P, Gopinath A, van de Moortele PF, Garwood M, Ugurbil K. 9.4T human MRI: preliminary results. Magn Reson Med 2006; 56:1274-82. [PMID: 17075852 PMCID: PMC4406343 DOI: 10.1002/mrm.21073] [Citation(s) in RCA: 250] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Accepted: 08/01/2006] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Thomas Vaughan
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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45
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Smith D. Safety considerations for live electrical measurements. Occup Health Saf 2006; 75:74, 76-7. [PMID: 17125091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
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.
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46
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Gharabaghi A, Rosahl SK, Samii A, Feigl GC, Safavi-Abbasi S, Bundschuh O, Tatagiba M, Samii M. Applicability of an Electrosurgical Device Based on Electromagnetics in Neurosurgery. Oper Neurosurg (Hagerstown) 2006; 59:ONS142-5; discussion ONS142-5. [PMID: 16888545 DOI: 10.1227/01.neu.0000220022.93378.5e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Alireza Gharabaghi
- International Neuroscience Institute, Hannover, Germany, Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany.
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Baker KB, Tkach J, Phillips MD. In vitro studies of MRI-related heating of neurostimulation systems. Magn Reson Imaging 2006; 24:677-9; author reply 679-80. [PMID: 16735193 DOI: 10.1016/j.mri.2005.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Accepted: 08/10/2005] [Indexed: 10/25/2022]
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Abstract
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.
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49
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Weigel J. Their last line of defense. Occup Health Saf 2006; 75:72, 74, 76. [PMID: 16734290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Abstract
This article will explore the role of the surgical practitioner in providing best care for the patient, by discussing electrosurgical intervention (ESI). It will exemplify the technological aspect of the role. Management of ESI equipment, and its inherent risks, will be shown to relate directly to the practitioner's role. Some safety claims for ESI equipment will be analysed, demonstrating the need for a theatre practitioner to establish the validity of sources that inform practice. The roles of circulating practitioner and scrubbed practitioner will be elucidated, with exploration of professional and ethical responsibilities to the patient, themselves and colleagues.
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