Electrical injury and burns and their management

2021 ◽  
pp. 193-204
Author(s):  
David C.G. Sainsbury ◽  
Joel Fish
Keyword(s):  
High Voltage ◽  
Low Voltage ◽  
Electrical Current ◽  
Systemic Effects ◽  
Electrical Injury ◽  
Current Passing ◽  
Partial Thickness ◽  
Complex Reconstruction ◽  
Electrical Injuries

Though responsible for just 4% of burn centre admissions, electrical injuries present in a myriad of ways. From small, innocuous, partial-thickness injuries on the fingertip, to a high-voltage injury requiring amputation and complex reconstruction, the burn surgeon must be equipped with the knowledge and skill to deal with such varying injuries. This chapter describes the epidemiology of electrical injury and the pathophysiology of electrical current passing through the patient. The management of high- and low-voltage wounds is described, as is the treatment of the systemic effects of the electrical injury.

561 Bilateral Upper Extremity Amputation After High Voltage Electrical Injury: A Case Report

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S130-S131
Author(s):  
Andrew Khalifa ◽  
Anzar Sarfraz ◽  
Jacob B Avraham ◽  
Ronnie Archie ◽  
Matthew Kaminsky ◽  
...  
Keyword(s):  
Case Report ◽  
High Voltage ◽  
Troponin I ◽  
Low Voltage ◽  
Foley Catheter ◽  
The United States ◽  
Upper Extremities ◽  
Full Thickness ◽  
Electrical Injuries

Abstract Introduction Electrical injuries represent 0.4–3.2% of admissions to burn units and are responsible for >500 deaths per year in the United States. Approximately half occur in the workplace and are the fourth leading cause of work-related-traumatic death. The extent of injury can be drastically underestimated by total body surface area percentage (TBSA). Along with cutaneous burns, high voltage electrical injuries can lead to necrosis of muscle, bone, nervous tissue, and blood vessels. Aggressive management allows for patient survival, but at significant cost. Newer technologic advances help improve functional outcomes. Methods This case-report was conducted via retrospective chart review of the case presented. Results A 43-year-old male sustained a HVEI (>10, 000 V) after contacting an active wire while working as a linesman for an electric company. He presented after less than 15-minute transport from an outside hospital with full thickness burns and auto-amputation to all fingers on both hands and the distal third of the left hand (Images 1 and 2). There were full thickness circumferential burns to the entire left and right upper extremities with contractures, with the burns extending into the axilla, and chest wall musculature. The patient had 4th degree burns and a large wound to the left shoulder with posterior extension to the scapula, flank and back with approximately 25% TBSA (Image 3). Compartments were tense in both upper extremities. Patient was sedated and intubated to protect the airway and placed on mechanical ventilation. A femoral central line was then placed, and the patient was given pain control, continued fluid resuscitation, and blood products. Dark red colored urine from a foley catheter that was immediately identified as rhabdomyolysis induced myoglobinuria. Labs drawn demonstrated elevated troponin I, CK >40,000. BUN 18, creatinine 1.0, K+ 5.2 and phosphate 5.6. Decision was made immediately for operative intervention with emergent amputation of both upper extremities in the light of rhabdomyolysis secondary to tissue necrosis and oliguria. During the patient’s hospital course, he underwent multiple operations for further debridement with vacuum-assisted closure therapy and skin grafting of sites, as well as targeted muscle reinnervation (TMR) 6 months later at an outside hospital. Conclusions Although HVEI only account for a small percentage of burn admissions, they are associated with greater morbidity than low-voltage injuries. Patients with HVEI often incur multiple injuries, more surgical procedures, have higher rates of complications, and more long term psychological and rehabilitative difficulties. Despite the need for amputation in some of these critically ill patients, options exist that allow for them to obtain long term functional success.

scholarly journals US and CT of the Liver after Electric Shock

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Amela Sofić ◽  
Nermina Bešlić ◽  
Alma Efendić ◽  
Aladin Čarovac ◽  
Jusuf Šabanović ◽  
...  
Keyword(s):  
Cell Membrane ◽  
High Voltage ◽  
High Mortality ◽  
Electric Shock ◽  
Electrical Current ◽  
Coagulation Necrosis ◽  
Electrical Injury ◽  
Mortality And Morbidity ◽  
Right Hand ◽  
Liver Injuries

Liver injuries caused by high voltage electricity are rare and result in high mortality and morbidity. They are produced by the resistance to the passage of electrical current through the tissue, which creates heat that leads to coagulation necrosis and rupture of the cell membrane. We present a case of an electrical injury to the liver, diagnosed by ultrasound and CT in a 39-year-old man who presented with skin burns on his right hand and right hemiabdomen. Injuries occurred after the contact with 220 kV high voltage electricity.

scholarly journals Different Types of Maculopathy in Eyes after a High-Voltage Electrical Shock Injury

2019 ◽  
Vol 10 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Hye Rim Choe ◽  
Un Chul Park
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
High Voltage ◽  
Electrical Current ◽  
Final Visit ◽  
Electrical Injury ◽  
Electrical Shock ◽  
Retinal Atrophy ◽  
Different Types ◽  
The Right

Background: We report a case of different types of maculopathy in eyes after a high-voltage electrical shock injury. Case Report: A 43-year-old male suffered high-voltage electrical injury through his left arm. He underwent cataract surgery in both eyes 3 months after the injury, but there was no vision improvement. Ocular examination, including spectral domain optical coherence tomography, revealed diffuse retinal atrophy in the left eye which did not change until the final visit. In the right eye, an impending macular hole was observed but regressed spontaneously 9 months after the injury, and the visual acuity improved to 20/32 at the final visit. Conclusion: Two different types of maculopathy can occur in each eye after high-voltage electrical shock injury, and this might be due to asymmetric pathogenesis of the eyes according to the proximity to the route of electrical current.

scholarly journals Cardiac Arrhythmias in Patients with Electrical Injury: Hospital Based Study

2020 ◽  
Vol 17 (2) ◽  
pp. 29-32
Author(s):  
Bishnu Mani Dhital ◽  
Sudhir Regmi ◽  
Shyam Raj Regmi ◽  
Bidhan Shrestha ◽  
Keshav Budhathoki ◽  
...  
Keyword(s):  
High Voltage ◽  
Cardiac Arrhythmias ◽  
Low Voltage ◽  
Sinus Bradycardia ◽  
Electrical Injury ◽  
Medical College ◽  
Presenting Symptoms ◽  
Injury Group ◽  
Increased Risk ◽  
Significant Difference

Background: Electrical injury and its consequences after exposure to electric shock has been associated with an increased risk of developing immediate and delayed cardiac arrhythmias. The aim of this study was to evaluate the prevalence of cardiac arrhythmias and different symptoms in patient with high voltage and low voltage electrical injury. Methods: All 50 consecutive patients who were admitted in Chitwan Medical College from April 2018 to March 2020 were prospectively studied. Patients were categorized into high and low voltage injury group and their variables were compared. Results: The mean age of the patients was 32.3±10.4 years among them 41 (82%) were male. Patients who sustain high voltage electrical injury (>1000V) were 18 (36%) and low voltage injury (<1000V) were 32 (64%). Cardiac arrhythmias like sinus tachycardia (11.1% vs 6.2%, p=0.054), sinus bradycardia (11.1% vs 3.1% p=0.254), ventricular premature beats (5.6% vs3.1%, p=0.674), atrial fibrillation (11.1% vs 0%, p=0.054) were observed in high voltage and low voltage group. The commonest presenting symptoms in both groups were pain (77.8% vs 84.4% p=0.560) and fatigue (55.6% vs 40.6%, p=0.328). Conclusion: In this study few non fatal cardiac arrhythmias were observed in both high and low voltage electrical injury group. There is no significant difference in the presenting symptoms and types of arrhythmias observed between low voltage and high voltage injury group.

Hypokalaemia with flaccid paralysis following high-voltage electrical injury in an adolescent patient

Trauma ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 317-320
Author(s):  
R Bird ◽  
S Naji ◽  
B Vowles ◽  
A Shaw ◽  
NA Martin
Keyword(s):  
Case Report ◽  
High Voltage ◽  
Clinical Picture ◽  
Flaccid Paralysis ◽  
Electrical Injury ◽  
Adolescent Patient ◽  
Potassium Homeostasis ◽  
Electrical Arc ◽  
Electrical Injuries

The authors present a case report of a previously healthy 15-year-old male who experienced global weakness in the presence of profound hypokalaemia following a high-voltage electrical arc injury. The clinical picture is discussed in the context of our evolving understanding of electrical injuries and potassium homeostasis.

Unilateral facial nerve paralysis after electrocution injury

2006 ◽  
Vol 121 (5) ◽  
pp. 494-496 ◽  
Author(s):  
I Ahmed ◽  
W Farhan ◽  
L Durham
Keyword(s):  
Facial Nerve ◽  
Low Voltage ◽  
Penetrating Trauma ◽  
Electrical Current ◽  
Neurological Function ◽  
Electrical Injury ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis ◽  
Neurological Condition

We present a case of acute, unilateral facial nerve paralysis in a patient who had received a low voltage electrical current. This is an extremely rare cause of this neurological condition. The patient regained complete neurological function approximately three months after the incident. Unilateral facial nerve paralysis most commonly occurs due to infection or blunt or penetrating trauma; it has not been previously reported as a result of low voltage electrical injury.

Electrical Injuries in Children: A 10-Year Experience at a Tertiary Pediatric Burn Center

2021 ◽  
Author(s):  
Sabri Demir ◽  
Tugba Ornek Demir ◽  
Ahmet Erturk ◽  
Can İhsan Oztorun ◽  
Dogus Guney ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Surface Area ◽  
Surgical Procedures ◽  
High Voltage ◽  
Low Voltage ◽  
Average Length ◽  
Burn Center ◽  
Average Length Of Stay ◽  
The Right ◽  
Electrical Injuries

Abstract Electrical injuries comprise 4% of cases but have higher morbidity and mortality. This study aims to share our experiences with pediatric electrical injuries and propose strategies to prevent them. The files of pediatric electrical injuries between 2010 and 2020 were reviewed retrospectively. The following were investigated: age, gender, cause, length of stay in the pediatric burn center, total burned surface area, voltage-type, and surgical procedures performed. The patients from low- and high-voltage groups were compared. Eighty-five patients were treated in the last 10 years. Seventy were males, the mean age was 9.9 years, the average length of stay in pediatric burn center was 18.2 days, and the average total burned surface area was 11.7%. Forty-three patients were injured with high-voltage and 42 with low-voltage electricity. Fasciotomy was performed in 25 patients, grafting in 40 patients, and amputation in 12 patients. The most often amputated limb was the right arm/forearm. Psychiatric disorders developed in 24 patients. One patient died. In conclusion, the incidence of high-voltage electrical injuries increases with age. They are more prevalent in males, more often accompanied by additional trauma, and have higher total burned surface area, surgical procedures are performed more often, and hospitalization times are longer. For prevention, precautions should be taken by governments and families, and education is critical.

Morphological cardiac changes in electrocution deaths: A literature review

2021 ◽  
Vol 61 (1_suppl) ◽  
pp. 130-135
Author(s):  
Matteo Favia ◽  
Federica Mele ◽  
Francesco Introna ◽  
Antonio De Donno
Keyword(s):  
Literature Review ◽  
Cardiac Death ◽  
Literature Search ◽  
Low Voltage ◽  
Electrical Current ◽  
Heart Tissue ◽  
Forensic Pathologist ◽  
Conducting Tissue ◽  
Cardiac Lesions ◽  
Electrical Injuries

Electrical injury may lead to damage to the conducting tissue, myocardial changes and even sudden cardiac death. Victims of low-voltage electrocution may have no electric marks, burns or other signs typical of electrical injuries. In these cases, the absence of other specific findings could make the identification of the cause of death very difficult. A broad spectrum of cardiac changes in cases of electrocution has been described in the literature, including the break-up of myocardial fibres, cardiomyolysis, haemorrhagic areas, the separation of myofibres and alternating hypercontracted–hyperdistended myocytes. All the described alterations, however, cannot be exclusively attributed to electrocution, since no specific morphological cardiac findings have so far been identified in electrocution. However, a few histological patterns recur, and their knowledge may be important for the forensic pathologist. This literature review describes the main pathological patterns observed in cases of fatal electrocution based on a literature search carried out up to September 2019 in the databases PubMed and Scopus. The search criteria included the keywords for cardiac lesions and electrocution. On the grounds of the literature data, a list of major and minor diagnostic markers for the passage of the electrical current through the heart tissue was created.

scholarly journals Schizoaffective Disorder That Is Induced By Electrical Voltage That Is Treated with Risperidone

2019 ◽  
Vol 7 (16) ◽  
pp. 2667-2670
Author(s):  
Ihsan Fadhilah ◽  
Mustafa M. Amin
Keyword(s):  
Psychiatric Disorders ◽  
Psychotic Disorders ◽  
Life Support ◽  
Low Voltage ◽  
Human Life ◽  
Psychotic Symptoms ◽  
Electrical Injury ◽  
Post Traumatic Stress ◽  
History Of ◽  
Electrical Injuries

BACKGROUND: Electricity is a necessity for humans to carry out their daily activities, wherein modern times there are many human life support devices require electricity that makes humans depend on their existence, it cannot be denied that electricity is the energy needed by humans in everything that supports human activities, that increased injury due to electric shocks such as the cardiovascular system, nervous system, respiratory system, cutaneous injuries, burns, neurotransmitter system and death. Psychiatric disorders such as psychosis, mania, depression, post-traumatic stress disorder, conversion disorder, adjustment disorders and schizophrenia have been reported as diseases triggered by electrical injuries. CASE REPORT: This study reports cases of electrical injuries that cause psychotic symptoms such as schizophrenia. After low voltage electrical injury. A 20 years old male, Malay, Indonesian, graduated from high school, worked, unmarried, a history of psychiatric disorders was not found, family history of experiencing the same disease was not found. Reported to have suffered an injury due to electricity twice the first injury occurred, and caused a change in behaviour and emotions, and the second injury caused obvious psychotic symptoms, aggressive behaviour and mood enhancement. A brief review of the literature on the occurrence of psychiatric disorders in these injuries is also presented. CONCLUSION: Electrical injuries can cause sequelae such as psychotic disorders, the increased mood has occurred after an electrical injury in someone without prior mood disorders and personality. This is associated with circulatory hormone changes that occur in the hippocampus.

Patterns and outcomes of high-voltage versus low-voltage pediatric electrical injuries: an 8-year retrospective analysis of a tertiary-level burn center

2021 ◽  
Author(s):  
Kayhan Gurbuz ◽  
Mete Demir
Keyword(s):  
High Voltage ◽  
Parental Education ◽  
Burn Injury ◽  
Low Voltage ◽  
Total Body Surface Area ◽  
Power Lines ◽  
Age Group ◽  
Voltage Versus ◽  
Burn Center ◽  
Electrical Injuries

Abstract Introduction Although electrical injuries (EIs) are rare traumas in the pediatric age group, they are considered one of the most devastating injuries. We aimed to evaluate the patterns and outcomes of pediatric high-voltage (HVI) vs. low-voltage injuries (LVIs), admitted to the burn center within the efforts of determining evidence-based data for contributing to burn prevention strategies. Methods A retrospective study was conducted on children with EIs hospitalized in the Burn Center of Adana City Training and Research Hospital (ACTRH) for eight years (2013-2020). Data including the patients’ clinical and demographic characteristics, the percentage of total body surface area with burns (TBSA%), length of hospital stay (LOS), exposure place, electrical current type, and treatment results were collected and analyzed. Results EIs were detected in 57 (2.5%) of 2243 acute pediatric burn injury admissions. EIs were most frequently observed in the form of HVIs, among children within the age range of 13-18 years, mostly in residential outdoor environments, where the high-power lines still passing close to the home roofs and balconies, resulting from contact with them. Besides, with a lesser extent in LVIs, in the home environment among children under five years, which was caused by connection with substandard electrical cords/poor-quality electrical devices and inserting an object into the electric sockets. Concerning the mean of TBSA%, HVIs suffered more extensive burns than LVIs. The most frequently affected anatomical regions among HV and LVIs were the upper limb, followed by the lower limb. While superficial partial- and deep partial-thickness burns were significantly more common among the LVIs, full thickness burns were more prevalent among the HVIs. The amputation rate was 12% which only one of them was major amputation (forearm above the elbow joint). HVIs had more elevated CK and CK-MB levels than LVIs but were not correlated with ECG findings. Only one death (caused by HVI) was observed, with a mortality rate of 1.8%. Conclusion Pediatric EIs are less common than scald or fire-flame related burns in this age group but can cause significant morbidity and even mortality, especially in severe burns. It is possible to prevent possible morbidity and mortality by strengthening compliance with safety precautions, especially with parental education and raising social awareness. In this context, taking necessary precautions for passing high voltage power lines under the ground, the standardization of electrical cables by the relevant legal regulations, the use of socket covers in homes, promoting the widespread use of residual current relays and arrangements to be taken against the use of illegal electricity are among measures for the prevention strategy.

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