- Email: [email protected]
Burn injuries during paint thinner sniffing
Burns 24 (1998) 757±759
Burn injuries during paint thinner sning W.S. Ho, E.W.H. To, E.S.Y. Chan, W.W.K. King * Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Accepted 23 June 1998
Abstract Thinner sning is popular among school children in Asian countries because it is readily available at low cost. Besides its toxicity to major organs, thinner inhalation is associated with various burn accidents. Four teenagers were admitted to the Burns Unit of the Prince of Wales Hospital over the period of 1996±1997. They sustained 3±25% TBSA ¯ame burn and two of them had inhalation injuries as a result of the ignition of a cigarette during thinner sning. None of them had evidence of thinner intoxication as shown by blood tests. In the management of their acute burn injuries, their hidden social and family problems were explored. With the cooperation of dierent disciplines, early psychosocial intervention was given and their behavioral and psychological disturbances were successfully managed. # 1998 Elsevier Science Ltd for ISBI. All rights reserved.
1. Introduction Sning of volatile organic solvents containing toluene is common in Asian countries among teenagers for mood alteration. They are popular because of the low cost, readily available and have a rapid onset of mood elevation eects. Paint thinner is commercially available and therefore it is much more easy to obtain than narcotics and other neuroleptics and is frequently being abused by school children in Hong Kong. In a large-scale survey among Japanese high school students, 3% had purposely inhaled thinner and 1% had abused it [1]. Paint thinner is very toxic and aects major organs including CNS, lung, liver, kidney and adrenal gland [2]. Thinner sning is potentially fatal. There are reports on acute thinner intoxication causing ventricular ®brillation [3] and cardiac arrest, rhabdomyolysis, polyneuropathy, chemical pneumonia and coma [4]. Chronic intoxication can result in a signi®cant loss of mylinated nerve ®bers, diuse cerebral and cerebellar cortex atrophy and giant axonopathy causing neurological and behavioral disturbances [5, 6]. Owing to the alteration in mental status, thinner sniing is associated with numbers of accidents. Smoking during and immediately after sning this in¯ammable * Corresponding author. Tel.: +852-2632-2639; Fax: 852-26377974.
agents can cause burn disaster with inhalation injury. Unfortunately, thinner abusers are commonly smokers. Four patients who suered from burn injuries during thinner sning were admitted to the Burns Unit of the Prince of Wales Hospital over the period 1996±1997. Besides the burn insults, their hidden family, social and psychological problems were also explored and managed.
2. Patients All these four patients were male, 13±17 years old, secondary school students. They came from lower social class, one from a single-parent family and three from disputed families. They all had a history of school delinquency with 2±13 months experience of thinner sning. The cause of their burn injuries was due to the ignition of a cigarette during thinner inhalation and they sustained 3±25% TBSA ¯ame burn. None of them had evidence of thinner intoxication as judged by blood screening. One of the cases had accidentally spilt the thinner onto his head and neck region, anterior chest wall and upper limbs and sustained 25% TBSA deep burn and inhalation injury which required 48 h intubation for airway support (Fig. 1). Subsequent skin grafting was needed for wound coverage.
0305-4179/98/$19.00 # 1998 Elsevier Science Ltd for ISBI. All rights reserved. PII: S 0 3 0 5 - 4 1 7 9 ( 9 8 ) 0 0 1 0 3 - X
758
W. Ho et al. / Burns 24 (1998) 757±759
Fig. 1. 17 year-old boy who sustained 25% TBSA deep burn during thinner sning. He required immediate intubation for his airway injury.
Another boy sustained 15% TBSA deep burn involving the same areas of the head and neck region, anterior chest wall and both upper limbs (Fig. 2). He also had inhalation injury and was admitted to the ICU for intensive airway monitoring for 24 h. Again, skin grafting was required. The remaining two patients had 3±5% TBSA super®cial to intermediate burn to head and neck region without signi®cant airway injury. They were managed conservatively. Because of the region of injuries, all of them were screened for eye injury and their eyes were observed to be intact.
3. Psychosocial management This group of patients were socially deprived and being neglected. They had diculties in their schooling, problems in getting along with their peer groups and had family disputes. Perhaps, they had cried for help but being ignored had later used thinner sning to escape from unhappy events without realizing the price to pay. The burn incidences oered a golden opportunity to explore and solve these problems. Our psychiatrist was involved in managing their acute psychological stress from their admission. With considerable eort, we were able to establish a good rap-
port with the patients during their burn treatment. Finally, we gained their trust and their social and family problems were disclosed. After having managed the acute phase of their burns, multiple interviews were conducted. Parents, school teachers and social workers were invited to join the burns team that consisted of plastic surgeons, psychiatrist, nursing specialists, physiotherapists and occupational therapists. Patients were involved in small group sessions in discussing and solving their problems in thinner sning, burn scar management, family, school and peer group relationship. Regular follow-ups and visits were arranged to make sure that they have continuous care and attention. With vigorous intervention, their vicious cycles of self destruction were broken and they are now able to enjoy normal social and family lives.
4. Discussion There is no dierence in treating burn injuries during thinner inhalation from other ¯ame burns. However, special attention should be paid to possible airway injury and thinner intoxication. We should also bear in mind that this group of patients are likely to have hidden social and family problems with severe physical and psychological disturbances. It has been
W. Ho et al. / Burns 24 (1998) 757±759
759
Fig. 2. Similar burn pattern (2 weeks postburn) in another 16 year-old boy who also sustained 15% TBSA burn with inhalation injury.
shown by McGarvey et al. that family problems, including a history of running away from home, breaking rules and ®ghting with parents, and delinquent behaviors, including earlier personal use of drugs, selling illegal drugs, buying drugs from dealers, committing crimes while under the in¯uence, committing crimes to get money to buy drugs and threatening to hurt people were higher among those youth with a history of inhalant use [7]. A cross-sectional study was conducted by Tapia-Conyer et al. to examine the relationship between known risk factors and inhalant abuse among a group of Mexican juvenile oenders. Of the 626 subjects studied, gender, low socio-economic level and labor status were the principal risk factors associated with inhalant abuse [8]. Our patients had similar social background and they were at risk of committing crimes. Early recognition of their psychosocial problems and prompt intervention is the only way to bring them back to normal lives and prevent further tragedy.
References [1] Matsushita S, Suzuki K, Higuchi S, Takeda S, Hayashida M. Alcohol and substance use among Japanese high school students. Alcohol Clin. Exp. Res. 1996;20(2):379±83. [2] Carabez A, Sandoval F, Palma L. Ultrastructural changes of tissues produced by inhalation of thinner in rats. Microsc. Res. Tech. 1998;40(1):56±62. [3] Nee PA, Llewellyn T, Pritty PE. Successful out-of-hospital de®brillation for ventricular ®brillation complicating solvent abuse. Arch. Emerg. Med. 1990;7:220±3. [4] Akisu M, Mir S, Genc B, Cura A. Severe acute thinner intoxication. Turk. J. Pediatr. 1996;38(2):223±5. [5] Means ED, Prockop LD, Hooper GS. Pathology of lacquer thinner induced neuropathy. Ann. Clin. Lab. Sci. 1976;6(3):240± 50. [6] Escobar A, Aruo C. Chronic thinner intoxication: clinicopathologic report of a human case. J. Neurol. Neurosurg. Psychiatr. 1980;43(11):986±94. [7] McGarvey EL, Canterbury RJ, Waite D. Delinquency and family problems in incarcerated adolescents with and without a history of inhalant use. Addict. Behav. 1996;21(4):537±42. [8] Tapia-Conyer R, Cravioto P, De La Rosa R, Velez C. Risk factors for inhalant abuse in juvenile oenders: the case of Mexico. Addiction 1995;90(1):43±9.
Burn injuries during paint thinner sning W.S. Ho, E.W.H. To, E.S.Y. Chan, W.W.K. King * Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Accepted 23 June 1998
Abstract Thinner sning is popular among school children in Asian countries because it is readily available at low cost. Besides its toxicity to major organs, thinner inhalation is associated with various burn accidents. Four teenagers were admitted to the Burns Unit of the Prince of Wales Hospital over the period of 1996±1997. They sustained 3±25% TBSA ¯ame burn and two of them had inhalation injuries as a result of the ignition of a cigarette during thinner sning. None of them had evidence of thinner intoxication as shown by blood tests. In the management of their acute burn injuries, their hidden social and family problems were explored. With the cooperation of dierent disciplines, early psychosocial intervention was given and their behavioral and psychological disturbances were successfully managed. # 1998 Elsevier Science Ltd for ISBI. All rights reserved.
1. Introduction Sning of volatile organic solvents containing toluene is common in Asian countries among teenagers for mood alteration. They are popular because of the low cost, readily available and have a rapid onset of mood elevation eects. Paint thinner is commercially available and therefore it is much more easy to obtain than narcotics and other neuroleptics and is frequently being abused by school children in Hong Kong. In a large-scale survey among Japanese high school students, 3% had purposely inhaled thinner and 1% had abused it [1]. Paint thinner is very toxic and aects major organs including CNS, lung, liver, kidney and adrenal gland [2]. Thinner sning is potentially fatal. There are reports on acute thinner intoxication causing ventricular ®brillation [3] and cardiac arrest, rhabdomyolysis, polyneuropathy, chemical pneumonia and coma [4]. Chronic intoxication can result in a signi®cant loss of mylinated nerve ®bers, diuse cerebral and cerebellar cortex atrophy and giant axonopathy causing neurological and behavioral disturbances [5, 6]. Owing to the alteration in mental status, thinner sniing is associated with numbers of accidents. Smoking during and immediately after sning this in¯ammable * Corresponding author. Tel.: +852-2632-2639; Fax: 852-26377974.
agents can cause burn disaster with inhalation injury. Unfortunately, thinner abusers are commonly smokers. Four patients who suered from burn injuries during thinner sning were admitted to the Burns Unit of the Prince of Wales Hospital over the period 1996±1997. Besides the burn insults, their hidden family, social and psychological problems were also explored and managed.
2. Patients All these four patients were male, 13±17 years old, secondary school students. They came from lower social class, one from a single-parent family and three from disputed families. They all had a history of school delinquency with 2±13 months experience of thinner sning. The cause of their burn injuries was due to the ignition of a cigarette during thinner inhalation and they sustained 3±25% TBSA ¯ame burn. None of them had evidence of thinner intoxication as judged by blood screening. One of the cases had accidentally spilt the thinner onto his head and neck region, anterior chest wall and upper limbs and sustained 25% TBSA deep burn and inhalation injury which required 48 h intubation for airway support (Fig. 1). Subsequent skin grafting was needed for wound coverage.
0305-4179/98/$19.00 # 1998 Elsevier Science Ltd for ISBI. All rights reserved. PII: S 0 3 0 5 - 4 1 7 9 ( 9 8 ) 0 0 1 0 3 - X
758
W. Ho et al. / Burns 24 (1998) 757±759
Fig. 1. 17 year-old boy who sustained 25% TBSA deep burn during thinner sning. He required immediate intubation for his airway injury.
Another boy sustained 15% TBSA deep burn involving the same areas of the head and neck region, anterior chest wall and both upper limbs (Fig. 2). He also had inhalation injury and was admitted to the ICU for intensive airway monitoring for 24 h. Again, skin grafting was required. The remaining two patients had 3±5% TBSA super®cial to intermediate burn to head and neck region without signi®cant airway injury. They were managed conservatively. Because of the region of injuries, all of them were screened for eye injury and their eyes were observed to be intact.
3. Psychosocial management This group of patients were socially deprived and being neglected. They had diculties in their schooling, problems in getting along with their peer groups and had family disputes. Perhaps, they had cried for help but being ignored had later used thinner sning to escape from unhappy events without realizing the price to pay. The burn incidences oered a golden opportunity to explore and solve these problems. Our psychiatrist was involved in managing their acute psychological stress from their admission. With considerable eort, we were able to establish a good rap-
port with the patients during their burn treatment. Finally, we gained their trust and their social and family problems were disclosed. After having managed the acute phase of their burns, multiple interviews were conducted. Parents, school teachers and social workers were invited to join the burns team that consisted of plastic surgeons, psychiatrist, nursing specialists, physiotherapists and occupational therapists. Patients were involved in small group sessions in discussing and solving their problems in thinner sning, burn scar management, family, school and peer group relationship. Regular follow-ups and visits were arranged to make sure that they have continuous care and attention. With vigorous intervention, their vicious cycles of self destruction were broken and they are now able to enjoy normal social and family lives.
4. Discussion There is no dierence in treating burn injuries during thinner inhalation from other ¯ame burns. However, special attention should be paid to possible airway injury and thinner intoxication. We should also bear in mind that this group of patients are likely to have hidden social and family problems with severe physical and psychological disturbances. It has been
W. Ho et al. / Burns 24 (1998) 757±759
759
Fig. 2. Similar burn pattern (2 weeks postburn) in another 16 year-old boy who also sustained 15% TBSA burn with inhalation injury.
shown by McGarvey et al. that family problems, including a history of running away from home, breaking rules and ®ghting with parents, and delinquent behaviors, including earlier personal use of drugs, selling illegal drugs, buying drugs from dealers, committing crimes while under the in¯uence, committing crimes to get money to buy drugs and threatening to hurt people were higher among those youth with a history of inhalant use [7]. A cross-sectional study was conducted by Tapia-Conyer et al. to examine the relationship between known risk factors and inhalant abuse among a group of Mexican juvenile oenders. Of the 626 subjects studied, gender, low socio-economic level and labor status were the principal risk factors associated with inhalant abuse [8]. Our patients had similar social background and they were at risk of committing crimes. Early recognition of their psychosocial problems and prompt intervention is the only way to bring them back to normal lives and prevent further tragedy.
References [1] Matsushita S, Suzuki K, Higuchi S, Takeda S, Hayashida M. Alcohol and substance use among Japanese high school students. Alcohol Clin. Exp. Res. 1996;20(2):379±83. [2] Carabez A, Sandoval F, Palma L. Ultrastructural changes of tissues produced by inhalation of thinner in rats. Microsc. Res. Tech. 1998;40(1):56±62. [3] Nee PA, Llewellyn T, Pritty PE. Successful out-of-hospital de®brillation for ventricular ®brillation complicating solvent abuse. Arch. Emerg. Med. 1990;7:220±3. [4] Akisu M, Mir S, Genc B, Cura A. Severe acute thinner intoxication. Turk. J. Pediatr. 1996;38(2):223±5. [5] Means ED, Prockop LD, Hooper GS. Pathology of lacquer thinner induced neuropathy. Ann. Clin. Lab. Sci. 1976;6(3):240± 50. [6] Escobar A, Aruo C. Chronic thinner intoxication: clinicopathologic report of a human case. J. Neurol. Neurosurg. Psychiatr. 1980;43(11):986±94. [7] McGarvey EL, Canterbury RJ, Waite D. Delinquency and family problems in incarcerated adolescents with and without a history of inhalant use. Addict. Behav. 1996;21(4):537±42. [8] Tapia-Conyer R, Cravioto P, De La Rosa R, Velez C. Risk factors for inhalant abuse in juvenile oenders: the case of Mexico. Addiction 1995;90(1):43±9.