Gunpowder Injuries Prove Challenging for Surgeons

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12 May 2017

The Royal Australasian College of Surgeons (RACS) has today heard how injuries from home-made gunpowder are presenting an added conundrum for surgeons in the management of burn injuries.

Dr Michael Rooke, presented his research to the RACS Annual Scientific Congress (ASC) today in Adelaide.

His findings were prompted by his own experience treating a young female patient at the Royal Adelaide Hospital (RAH), after she suffered burns from home-made gunpowder.

Dr Rooke said that although these types of injuries were rare, when they did occur they were challenging cases for the clinical team to manage.

"The management of any type of gun-powder injury is difficult, but when the gunpowder is home-made we are faced with a more complex scenario," Dr Rooke said.

"Obviously the substance isn't going to come with a box telling you all of its ingredients.

"Therefore the clinical team is often in the unenviable position of having to treat the injury without knowing the exact composition of the chemicals that caused it.

"Agents used in the manufacture of these powders are often strong alkalis, necessitating management as both chemical and heat-related injuries.

"Home-made mixtures usually carry impurities due to the manner in which they were developed, which can lead to further injuries," Dr Rooke said.

In the case of the young RAH patient, the initial response was to deliver emergency first aid medical treatment and resuscitation of the patient. The alkali substance of the burn was neutralised, and infected tissue was removed.

Dr Rooke and his team followed the RAH Burns Unit Protocol for chemical burns injuries. Once her condition stabilised she was treated with silver dressing (commonly used to treat and prevent wound infection).

A literature review was then performed to determine which chemical compounds the patient may have been exposed to.

Dr Rooke said that although all emergency departments already clinical guidelines for managing burn injuries, he hoped his presentation would provide added insight.

"When we initially treated the patient we didn't have time to identify the properties of the substance, or to conduct the sort of extensive literature review that we would have liked to.

"Of the recipes identified, the majority consisted of combining an alkaline metal, with an inorganic salt oxidising agent. Such compounds would produce the injuries we observed.

"By sharing our own experiences we hope to provide guidance to other medical professionals who may encounter the same sorts of circumstances that we did."

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