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Medsacpe Quiz: Are You Prepared to Confront Firework-Related Injuries?
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Quiz: Are You Prepared to Confront Firework-Related Injuries?

Richard H. Sinert, DO

June 30, 2015

According to the latest data from the National Fire Protection Association, in 2012, an estimated 8700 people were injured by fireworks in the United States. Most of the injuries (55%) were to the extremities, but 31% involved the head. In addition, more fires are reported on Independence Day than on any other day. Do you know best practices for firework-related injuries? Test your knowledge with this short quiz.

Which of the following describes a tertiary blast injury?
Injury resulting from a high-energy explosion in which people fly through the air and strike other objects
Injury caused solely by the direct effect of blast overpressure on tissue
Injury caused by flying objects that strike people
Injury resulting from inhalation of detonated material

 

847137-figure-1.jpg

 

Blast injuries are divided into the following four categories:

 

  • Primary: Caused solely by the direct effect of blast overpressure on tissue

  • Secondary: Caused by flying objects that strike people

  • Tertiary: Caused by high-energy explosions; occurs when people fly through the air and strike other objects

  • Quaternary: Encompasses all other injuries caused by explosions

 

For more on the background of blast injuries, read here.

 

Which of the following is not recommended in the treatment of burn injuries?
Administration of topical antibiotics
Use of silver sulfadiazine
Topical steroid administration
Debridement of all bullae

 

847137-figure-2.jpg

 

Burns of areas such as the face are best treated by means of an open technique. Wash the burn area, debride any open blisters, and cover the wounds with topical antibiotics. Fingers and toes should be wrapped individually, with fluffed gauze separating the digits in order to prevent maceration and adherence.

 

Cover all partial-thickness wounds with antibiotic ointment. Silver sulfadiazine is commonly used but may not be available to the emergency physician. Steroids have no role in treating burn wounds. Cleanse other areas with minor burns using a mild soap and gentle scrubbing.

 

The World Health Organization (WHO) recommends debridement of all bullae and excision of all adherent necrotic tissue.

 

For more on the emergent treatment of burn injuries, read here.

 

Which of the following is the most common error during fluid resuscitation in patients with thermal burns?
Failure to use a pulmonary artery catheter
Poor recognition of cardiac failure signs
Insufficient hydration
Overhydration

 

847137-figure-3.jpg

 

During resuscitation, the most common error is overhydration, which increases the risk for acute respiratory distress syndrome developing 3-5 days after the burn. In patients with concomitant large TBSA (total body surface area) burns and inhalation injury, the Parkland formula may result in unnecessary large fluid loads. To avoid overhydration, resuscitate patients who have inhalation injuries with amounts substantially lower than specified by the formula, accepting a urinary output in the range of 0.3-0.5 mL/kg/h.

 

For more on fluid resuscitation in patients with thermal burns, read here.

 

Which of the following treatments is a criterion for referral of a patient to a burn center?
Third-degree burns covering more than 3% of the total body surface area (TBSA)
Partial-thickness burn larger than 10% of TBSA in a patient of any age
Partial-thickness burn larger than 5% of TBSA in children younger than 10 years
Circumferential burns on the extremities or chest

 

847137-figure-4.jpg

 

The American Burn Association has established the following criteria for referring patients to a burn center:

 

  • Any partial-thickness burn larger than 20% of TBSA in a patient of any age, or larger than 10% of TBSA in children younger than 10 years or adults older than 50 years

  • Third-degree burns covering more than 5% of TBSA

  • Second-degree or third-degree burns involving critical areas (eg, hands, feet, face, perineum, genitalia, or major joints)

  • Burns with associated inhalation injury

  • Electrical or lightning burns

  • Severe burns complicated by coexisting trauma; if traumatic injuries pose a higher risk to the patient than the burn injuries, the patient may have to be sent first to a trauma center

  • Preexisting disease that could complicate management of the burn injury

  • Chemical burns with threat of cosmetic or functional compromise

  • Circumferential burns on the extremities or the chest

 

For more on referral to burn centers, read here.

 

Which of the following is considered appropriate in the observation of a patient with a blast injury?
Discharge after 4 hours when a patient who experienced an open-space explosion has normal vital signs and unremarkable lung and abdominal examinations
Discharge after 2 hours when a patient experienced a closed-space explosion
Discharge 4 hours after treatment when a patient previously displayed evidence of hypoxia
Discharge after 24 hours when a patient experienced a closed-space explosion and is asymptomatic
847137-figure-5.jpg

Limited data prevent establishing the optimal duration of observation. Consider the following guidelines:

Persons who are exposed to open-space explosions and who have no apparent significant injury and normal vital signs, as well as unremarkable lung and abdominal examinations, generally can be discharged after 4 hours of observation. Return instructions should include shortness of breath, abdominal pain, vomiting, or other symptoms.

Persons exposed to significant closed-space explosions or in-water explosions, and those who incur tympanic membrane rupture, are at higher risk for delayed complications. All such patients should have chest radiography, and selected patients should have imaging of other organs. Even if no injury is identified, these patients should receive more intensive observation over a longer period. Motivated, reliable, and completely asymptomatic patients may be sent home after 4 hours of observation.

Admit to the hospital all patients with significant burns, suspected air embolism, radiation or water pollution contamination, abnormal vital signs, abnormal lung examination findings, clinical or radiographic evidence of pulmonary contusion or pneumothorax, abdominal pain, vomiting, evidence of renal contusion/hypoxia, or penetrating injuries to the thorax, abdomen, neck, or cranial cavity.

For more about the inpatient care of patients with blast injuries, read here.

Related Resources
 

Medscape © 2015  WebMD, LLC

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this article: Richard H. Sinert. Quiz: Are You Prepared to Confront Firework-Related Injuries? Medscape. Jun 30, 2015.

 

 



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huskerbb


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Meh. Other than very minor burns, I've never seen any injuries from fireworks in my lifetime.

Not saying it can't happen, but often it is due to carelessness. Heck there's a guy in Maine this year that lit a firework ON TOP OF HIS DAMN HEAD--and it killed him. Darwinism at work.

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Yeah. Those who get hurt are the ones being stupid with them.



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Article:

http://reference.medscape.com/viewarticle/847137?src=wnl_edit_specol&uac=20010AY&impID=752577&faf=1

 



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lilyofcourse wrote:

Yeah. Those who get hurt are the ones being stupid with them.

Or, unfortunately, they hurt someone else.   



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huskerbb wrote:

Meh. Other than very minor burns, I've never seen any injuries from fireworks in my lifetime.

Not saying it can't happen, but often it is due to carelessness. Heck there's a guy in Maine this year that lit a firework ON TOP OF HIS DAMN HEAD--and it killed him. Darwinism at work.

I just got done reading an article about that guy. Stupid! 



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ed11563


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lilyofcourse wrote:

Yeah. Those who get hurt are the ones being stupid with them.

Beer + fireworks = Emergency Room visit



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huskerbb


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ed11563 wrote:
lilyofcourse wrote:

Yeah. Those who get hurt are the ones being stupid with them.

Beer + fireworks = Emergency Room visit

I've never seen that to be true. 

We always let the kids shoot off the fireworks--they were too young to drink the beer.   



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lilyofcourse


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We were messing around with fireworks as kids.

My kids got to play with them.

It's like anything, you teach responsibility.

I've heard of more accidents and injuries from grilling than fireworks.

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huskerbb wrote:

Meh. Other than very minor burns, I've never seen any injuries from fireworks in my lifetime.

Not saying it can't happen, but often it is due to carelessness. Heck there's a guy in Maine this year that lit a firework ON TOP OF HIS DAMN HEAD--and it killed him. Darwinism at work.

 I worked at one of the top 2 fireworks companies in the U.S. The only calls that came in complaining about injuries and threatening to sue us involved either alcohol or not using the item according to the directions on the package. The alcohol actually led to people not following the directions, so it's all down to that one factor.

They are actually very very safe to use - IF you follow the directions. 

 



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Police: Calais man shoots off firework from top of his head, dies

CALAIS (WGME) -- The Maine State Fire Marshal's Office said a young Calais man was killed Saturday night around 10 p.m. in a fireworks accident in Calais.

Devon Staples, 22, was killed in a bizarre incident that took place in a backyard as Staples and his friends were firing off fireworks.

Investigators said Staples had placed the fireworks mortar tube on top of his head and set it off. The explosion caused a fatal head injury and he died instantly.

Police said Staples had been drinking with friends at one of their homes on South Street. It was the first death attributed to fireworks since fireworks became legal in Maine.

Fire investigators also said there were injuries from private fireworks incidents Saturday night in Friendship, Jefferson, Lebanon, and Woodstock, involving burns and eye injuries.

http://www.wgme.com/news/features/top-stories/stories/maine-police-say-1-man-killed-calais-fireworks-accident-28113.shtml#.VZmqqkbjC60



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I can't believe that no one at the party thought to stop him. I would think you would only pull that kind of stunt to show off to people, and they really all thought it was a good idea?

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I think there was alcohol involved. But that's pretty sad that everyone was drunk enough to think it was a good idea.

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Nobody Just Nobody wrote:

Police: Calais man shoots off firework from top of his head, dies

CALAIS (WGME) -- The Maine State Fire Marshal's Office said a young Calais man was killed Saturday night around 10 p.m. in a fireworks accident in Calais.

Devon Staples, 22, was killed in a bizarre incident that took place in a backyard as Staples and his friends were firing off fireworks.

Investigators said Staples had placed the fireworks mortar tube on top of his head and set it off. The explosion caused a fatal head injury and he died instantly.

Police said Staples had been drinking with friends at one of their homes on South Street. It was the first death attributed to fireworks since fireworks became legal in Maine.

Fire investigators also said there were injuries from private fireworks incidents Saturday night in Friendship, Jefferson, Lebanon, and Woodstock, involving burns and eye injuries.

http://www.wgme.com/news/features/top-stories/stories/maine-police-say-1-man-killed-calais-fireworks-accident-28113.shtml#.VZmqqkbjC60

 Perfectly illustrated. Alcohol AND failure to follow directions. 

 



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Nobody Just Nobody wrote:

I think there was alcohol involved. But that's pretty sad that everyone was drunk enough to think it was a good idea.

 Oh I know, I just think that, even drunk, I would have know how stupid that was. 



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Mellow Momma wrote:
Nobody Just Nobody wrote:

Police: Calais man shoots off firework from top of his head, dies

CALAIS (WGME) -- The Maine State Fire Marshal's Office said a young Calais man was killed Saturday night around 10 p.m. in a fireworks accident in Calais.

Devon Staples, 22, was killed in a bizarre incident that took place in a backyard as Staples and his friends were firing off fireworks.

Investigators said Staples had placed the fireworks mortar tube on top of his head and set it off. The explosion caused a fatal head injury and he died instantly.

Police said Staples had been drinking with friends at one of their homes on South Street. It was the first death attributed to fireworks since fireworks became legal in Maine.

Fire investigators also said there were injuries from private fireworks incidents Saturday night in Friendship, Jefferson, Lebanon, and Woodstock, involving burns and eye injuries.

http://www.wgme.com/news/features/top-stories/stories/maine-police-say-1-man-killed-calais-fireworks-accident-28113.shtml#.VZmqqkbjC60

 Perfectly illustrated. Alcohol AND failure to follow directions. 

 

To be fair (sort of), guys almost NEVER read directions. 

 



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My husband read them last night. THey said, "light fuse, and get away." LOL

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Reading directions are wonderful.

But without them you know to give plenty of space, to keep water or something to put out fire and not to light one on your head.

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ed11563


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FNW wrote:

My husband read them last night. THey said, "light fuse, and get away." LOL

Clearly much too complicated for someone who is fueled by beer. 



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NAOW wrote:
Nobody Just Nobody wrote:

I think there was alcohol involved. But that's pretty sad that everyone was drunk enough to think it was a good idea.

 Oh I know, I just think that, even drunk, I would have know how stupid that was. 

 I would think if you had had THAT MUCH alcohol then you probably wouldn't be able to stand.



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huskerbb wrote:
ed11563 wrote:
lilyofcourse wrote:

Yeah. Those who get hurt are the ones being stupid with them.

Beer + fireworks = Emergency Room visit

I've never seen that to be true. 

We always let the kids shoot off the fireworks--they were too young to drink the beer.   

 Oh good god Husker, when directions are followed,, there are very few accidents.  Ed is correct about the beer factor.



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Nobody Just Nobody wrote:

I think there was alcohol involved. But that's pretty sad that everyone was drunk enough to think it was a good idea.

 Not necessarily, have you ever tried to stop a drunk from doing something ridiculous?  They will argue with you and then bring you into their stupidity.  Just walk away and bring your loved ones with you.



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I know what to do_sometimes wrote:
Nobody Just Nobody wrote:

I think there was alcohol involved. But that's pretty sad that everyone was drunk enough to think it was a good idea.

 Not necessarily, have you ever tried to stop a drunk from doing something ridiculous?  They will argue with you and then bring you into their stupidity.  Just walk away and bring your loved ones with you.

 DH says they were young and that plays into it.  They were in their early 20's.  Not sure I buy into that but whatever.  I'm sure that many think drunkenness is cute and funny but this is a prime example of why it isn't.



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I know what to do_sometimes wrote:
huskerbb wrote:
ed11563 wrote:
lilyofcourse wrote:

Yeah. Those who get hurt are the ones being stupid with them.

Beer + fireworks = Emergency Room visit

I've never seen that to be true. 

We always let the kids shoot off the fireworks--they were too young to drink the beer.   

 Oh good god Husker, when directions are followed,, there are very few accidents.  Ed is correct about the beer factor.

?????  WTF are you talking about????  I never said there were a lot of accidents.  ????  READ my posts.  I said I've NEVER seen an accident involving fireworks in my lifetime.   



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ed11563


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Nobody Just Nobody wrote:
I know what to do_sometimes wrote:
Nobody Just Nobody wrote:

I think there was alcohol involved. But that's pretty sad that everyone was drunk enough to think it was a good idea.

 Not necessarily, have you ever tried to stop a drunk from doing something ridiculous?  They will argue with you and then bring you into their stupidity.  Just walk away and bring your loved ones with you.

 DH says they were young and that plays into it.  They were in their early 20's.  Not sure I buy into that but whatever.  I'm sure that many think drunkenness is cute and funny but this is a prime example of why it isn't.

The only time I thought drunkenness was cute or pretty was when it was a drunk, pretty young woman taking off her clothes and pulling me into a bedroom. (For clarity, she fell asleep and I let her sleep it off.) 

 



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