TY - JOUR
AU1 - MD, Tamir Gil,
AU2 - MD, Issa Metanes,
AU3 - MD, Yaron Har-Shai,
AB - Abstract In this case report, we present a patient who used a nasal cannula for oxygen supplementation and suffered deep, second-degree burns to his nose and left leg when an electrical spark shot out of the cable's connection socket while the cellular phone was ringing and the cable was, simultaneously, being disconnected from the socket. The cellular phone, a device commonly thought by many people to be both useful and safe, thus has the potential to serve as a heat source that might ignite and cause burns. A 56-year-old man had been hospitalized for a left upper lobectomy in the thoracic surgery department. His past medical history revealed heavy smoking, up to a year, before his hospital admission and, subsequently, severe chronic obstructive pulmonary disease. On the sixth postoperative day, deep second-degree burns of both nostrils and the left upper shin were observed (Figure 1).The patient, who had been using a nasal cannula for oxygen supplementation, with a flow of 5 liters/min, had disconnected his cellular phone from its electrical charger cable while it had been ringing. As he pulled the cable out of the socket, the patient noted a spark originating from the cable's connection socket. The spark ignited the patient's plastic (polyvinyl) nostril cannula tubing, causing deep second-degree burns to both nostrils and to the nasal mucosa. In addition, the melted drops of the cannula caused a second-degree burn to his left shin and set his dressing gown on fire. The patient managed to remove the cannula and put out the fire. The patient suffered no consequent respiratory distress and was discharged on the next day, with a conservative burn treatment plan. Figure 1. View largeDownload slide Left, a 56-year-old man who suffered second-degree burns to both nostrils, nasal mucosa, and to his left shin (center), after an electrical spark emerged from his cellular phone's connection socket. Right, the patient demonstrates the disconnection of the cable from the cellular phone socket, which caused the spark and consequent combustion. Figure 1. View largeDownload slide Left, a 56-year-old man who suffered second-degree burns to both nostrils, nasal mucosa, and to his left shin (center), after an electrical spark emerged from his cellular phone's connection socket. Right, the patient demonstrates the disconnection of the cable from the cellular phone socket, which caused the spark and consequent combustion. DISCUSSION Currently, there are more than 1 billion mobile phones worldwide, and most patients are assumed to own one. Cellular phones allow hospitalized patients to communicate with flexibility and ease with their families, home, and friends. In addition, a significant percentage of hospitalized patients receive supplemental oxygen, and the combination of these two factors has the potential to lead to the unusual burn situation described in this report. Various health hazards associated with mobile phones have been examined extensively, including intracranial tumors,1 damage to cognitive function,2 male infertility,3 damage to auditory function,4 undesireable effects on medical electronic devices,5 and more. However, the hazard of potential combustion near an oxygen source is yet to be described in the literature. In general, a “fire triangle” consists of a heat source, fuel, and an oxidizer. The aim of conventional fire prevention is to remove at least one of these three fire elements. Unfortunately, in the case of this patient, these three elements coexisted: an electrical spark (heat source), a nasal cannula (fuel), and oxygen. The “Heat Source” During the execution of plastic surgery procedures, the main common heat sources are the electrosurgical unit itself and, to a lesser degree, lasers. The plastic surgeon is warned against their use in an oxygen-enriched atmosphere, which is defined as any oxygen concentration greater than 21%6; yet, to date, the use of a cellular phone in an oxygen-enriched environment has not been identified as a potential hazard. The only case of a fire caused by a cellular phone7 that has ever been described involved the ignition of petrol fumes in a gas station that occurred simultaneously with the ringing of a mobile phone. Although there are sparse data on the potential for the ignition of flammable fumes in petrol stations and, in fact, many consider it to be an urban myth,8 oil companies and the chemical industry have fairly stringent protocols to prohibit the use of cellular phones in high-risk, explosive areas.9 This risk is also acknowledged by certain mobile phone manufactures.10 Mobile phones can, theoretically, cause a fire in the presence of flammable vapor, either by sparks from the batteries, the ringer, from static electricity, or by electromagnetic waves.11 In the case presented here, the patient saw the spark originating from the phone's cable connection socket just as the active charging cable was disconnected from the ringing phone. The spark served as the heat source in the “fire triangle.” The Oxygen The use of supplemental oxygen in home therapy for chronic obstructive pulmonary diseases,12 temporary supplemental oxygen in operating rooms,13 and during the postoperative period poses both fire and burn hazards. The majority of reported operating room fires occur in oxygen-enriched environments. Most of the burns occurring during treatment with supplemental oxygen are localized in the head and neck regions. This fact is attributed to the oxygen-rich atmosphere in the proximity of nasal cannulas and endotracheal tubes. The Fuel Devices made of plastic (polyvinyl chloride), such as endotracheal tubes, are a potential source for ignition during surgery when heat sources such as the electrosurgical unit14 or lasers15 are used near them and comprise the third element of the “fire triangle.” The polyvinyl chloride is a polymer that is derived from ethylene, which is a carbon obtained from petroleum and used chiefly as a raw material in the manufacture of alcohol and plastics. Previous reports in the literature have shown that polyvinyl chloride may serve as a fuel for fire. The melting point of polyvinyl plastics is 212°C.16 One of the principles of fire chemistry as related to oxygen is as follows: as the oxygen concentration increases, the autoignition temperature of materials decreases. As so, materials that cannot be ignited in normal air may burn in oxygen-enriched atmospheres, such as the one formed surrounding a nasal cannula. Under this principle, plastics may burn fiercely in an oxygen-enriched atmosphere.17 Therefore, ignition temperature of polyvinyl is decreased in the oxygen enriched environment and consequently would have been surpassed by the flames temperature (greater than 500°C). It is the authors' understanding that a direct flame created by the spark in the oxygen-enriched environment around the nasal cannula, caused the burn to both nostrils and ignited the PVC cannula, whereas the second-degree burn to the patients shin was due to hot melted drops of polyvinyl. The broadening indications for supplemental oxygen have increased the number of home oxygen units. It is estimated that more than 600,000 oxygen units are operating in the United States.12 Because of the increasing prevalence of these home oxygen units, and the ubiquity of mobile phones, the risk of cell phones causing combustion burns during supplemental oxygen therapy must not be overlooked or dismissed lightly. The scarcity of such reports in the medical literature indicates that the actual risk for such an event is low, yet it poses a potentially serious and significant danger. The American Lung Association has published guidelines for the safe use of home oxygen18 that prohibit smoking in any room in which oxygen is being used and warns that the oxygen source should be kept at least 10 feet from a heat source or an electrical device which may spark. It is our recommendation that patients and surgeons be further educated for safer use of cellular phones, ie, that they refrain from charging or using such phones near an oxygen source. ACKNOWLEDGMENTS We extend our thanks to Liron Har-shai, BSc, MSc, an electrical engineer, for his scientific contribution, and Sarit Hochberg-Klein, MD, for her help in preparing the manuscript for publication. REFERENCES 1. Hardell L, Mild KH, Carlberg M. Case-control study on the use of cellular and cordless phones and the risk for malignant brain tumours. Int J Radiat Biol 2002 Oct;78:931–6. 2. Rubin GJ, Hahn G, Everitt BS, Cleare AJ, Wessely S. Are some people sensitive to mobile phone signals? Within participants double blind randomised provocation study. Bmj 2006 Apr 15;332:886–91. 3. Derias EM, Stefanis P, Drakeley A, Gazvani R, Lewis-Jones DI Growing concern over the safety of using mobile phones and male fertility. Arch Androl  2006; 52: 9– 14. Google Scholar CrossRef Search ADS PubMed  4. Hamblin DL, Wood AW, Croft RJ, Stough C Examining the effects of electromagnetic fields emitted by GSM mobile phones on human event-related potentials and performance during an auditory task. Clin Neurophysiol  2004; 115: 171– 8. Google Scholar CrossRef Search ADS PubMed  5. Tri JL, Severson RP, Firl AR, Hayes DL, Abenstein JP Cellular telephone interference with medical equipment. Mayo Clin Proc  2005; 80: 1286– 90. Google Scholar CrossRef Search ADS PubMed  6. Lowry RK, Noone RB Fires and burns during plastic surgery. Ann Plast Surg  2001; 46: 72– 6. Google Scholar CrossRef Search ADS PubMed  7. Potokar T, Ross AD, Clewer G, Dickson WA Mobile phones–a potential fire hazard? Burns  2003; 29: 493– 4. Google Scholar CrossRef Search ADS PubMed  8. The Economist. Anatomy of a techno-myth. 2005 Available from: http://www.economist.com/printedition/displayStory.cfm?Story_ID=3786384; Internet; accessed December 28, 2006. 9. CNN report. Exxon warns dealers of cell phone risks. 1999. Available from: http://urbanlegends.about.com/gi/dynamic/offsite.htm?site=http://cnn.com:80/US/9906/24/exxon.cellphones/index.html; Internet; accessed December 28, 2006. 10. Motorola Inc. Safety information—potentially explosive atmospheres. Motorola V Series Digital Mobile Telephone V. 2288 Instruction Manual English. Motorola Inc., EEC, p. 11. 11. Gibson A. Fire, smoke and steam: forecourt fear. New Scientist 1999;9.05:05. 12. Chang TT, Lipinski CA, Sherman HF. A hazard of home oxygen therapy. J Burn Care Rehabil 2001;22:71–4; discussion 0–1. 13. Daane SP, Toth BA Fire in the operating room: principles and prevention. Plast Reconstr Surg  2005; 115: 73e– 5e. Google Scholar CrossRef Search ADS PubMed  14. Awan MS, Ahmed I Endotracheal tube fire during tracheostomy: a case report. Ear Nose Throat J  2002; 81: 90– 2. Google Scholar PubMed  15. Kuo CH, Tan PH, Chen JJ, et al.   Endotracheal tube fires during carbon dioxide laser surgery on the larynx—a case report. Acta Anaesthesiol Sin  2001; 39: 53– 6. Google Scholar PubMed  16. Polyvinyl chloride. Available at: http://en.wikipedia.org/wiki/Polyvinyl_chloride; Internet; accessed December 28, 2006. 17. Fire hazards of oxygen and oxygen enriched atmospheres. European Industrial Gases Association Document 04/00/E. 1999; 4. 18. American Lung Association. Use your breathing aids. In: Life and breath (online publication) 1999;1(3). Available at: http://www.lungusa.org/site/apps/5/content.asp?c=dvLUK900E&b=34706&ct=1471537; Internet; accessed December 28, 2006. Copyright © 2007 by the American Burn Association
TI - Mobile Phone-Triggered Thermal Burns in the Presence of Supplemental Oxygen
JF - Journal of Burn Care & Research
DO - 10.1097/BCR.0B013E318031A28F
DA - 2007-03-01
UR - https://www.deepdyve.com/lp/oxford-university-press/mobile-phone-triggered-thermal-burns-in-the-presence-of-supplemental-C9kSX0vWqP
SP - 348
EP - 350
VL - 28
IS - 2
DP - DeepDyve
ER -