Penetrating facial injury from angle grinder use: management and prevention

Injuries resulting from the use of angle grinders are numerous. The most common sites injured are the head and face. The high speed disc of angle grinders does not respect anatomical boundaries or structures and thus the injuries produced can be disfiguring, permanently disabling or even fatal. However, aesthetically pleasing results can be achieved with thorough debridement, resection of wound edges and careful layered functional closure after reduction and fixation of facial bone injuries. A series of penetrating facial wounds associated with angle grinder use are presented and the management and prevention of these injuries discussed

A clinical study to evaluate the cardiopulmonary characteristics of two different anaesthetic protocols (tiletamine/zolazepam +/- medetomidine) and to evaluate their suitability for the immobilisation of healthy chimpanzees

Objective: To characterise the cardiopulmonary characteristics of two different anaesthetic protocols (tiletamine/zolazepam +/- medetomidine) and their suitability for the immobilisation of healthy chimpanzees undergoing cardiac assessment. Study design: Prospective, clinical, longitudinal study Animals: Six chimpanzees (Pan troglodytes) aged 4 - 16 years weighing 19.5 - 78.5 kg were anaesthetized on two occasions Methods: Anaesthesia was induced with tiletamine/zolazepam (TZ) (3-4 mg kg-1) or tiletamine/zolazepam (2 mg kg-1) and medetomidine (0.02 mg kg-1) (TZM) via blow dart (IM) and maintained with intermittent boluses of ketamine (IV) or zolazepam/tiletamine (IM) as required. The overall quality of the anaesthesia was quantified based on scores given for: quality of induction, degree of muscle relaxation and ease of intubation. The time to achieve a light plane of anaesthesia, number of supplemental boluses needed and recovery characteristics were also recorded. Chimpanzees were continuously monitored and heart rate (HR), pulse rate (PR), respiratory rate (fR) oxygen saturation of heamoglobin (SpO2), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), rectal temperature, mucous membrane colour and capillary refill time recorded. During the first procedure (TZ) animals underwent a 12 channel ECG, hematology, biochemistry and cardiac biomarker assessment to rule out the presence of pre-existing cardiovascular disease. A detailed echocardiographic examination was carried out by the same blinded observer during both procedures. Data were compared using Student’s paired t-test or Wilcoxon rank tests as appropriate. Results: There was a significant difference for the area under the curves between anaesthetic protocols for HR, SAP, MAP and fR. No significant differences in the echocardiographic measurements were evident. Quality of anaesthesia was significantly better with TZM and no additional boluses were required. The TZ protocol required multiple supplemental boluses. Conclusions and clinical relevance: Both combinations are suitable for immobilization and cardiovascular evaluation of healthy chimpanzees. Further work is required to evaluate the effect of medetomidine in cardiovascular disease

A multidisciplinary approach to management of extensive facial injuries resulting from the use of an angle grinder.

Angle grinders utilise a rapidly rotating metal or carbon disc to cut, grind and polish metal, concrete and other hard surfaces. Improper use with disregard to safety procedures can result in serious injuries, most commonly involving the face and upper limbs. Although these injuries can be mutilating, they are rarely fatal and in most patients a good aesthetic result is achievable with meticulous debridement, reduction and fixation of any facial fractures and layered closure of the soft tissues. We report the successful treatment of a patient with life-threatening injuries resulting from accidental trauma involving an angle grinder. The complex, penetrating and open soft tissue injury and associated fractures involving the facial skeleton, required multi-specialty intervention for maintenance of the airway, arrest of facial haemorrhage, debridement and closure of the soft tissue defect, reduction and fixation of mandibular fracture, microscopic reconstruction of the parotid and lacrimal ducts, and embolisation of the internal maxillary artery