|
Modern concepts of treatment and prevention of electrical burns.
J Long Term Eff Med Implants.
2005;15(5):511-32.
Electric
injuries account for 1,000 deaths in the United States, with a
mortality rate of 3--15%. As the widespread use of electricity and
injuries from it increase, all health professionals involved in burn
care must appreciate its physiological and pathological effects as
well as management of electrical current injury. Electric current
exists in two forms: alternating current and direct current. The
effects of electricity on the body are determined by seven factors:
(1) type of current, (2) amount of current, (3) pathway of current,
(4) duration of current, (5) area of contact, (6) resistance of the
body, and (7) voltage. Electrical accidents can be divided into less
than 1,000 V (low-voltage accidents) and greater than 1,000 V
(high-voltage accidents). In any electrical accident, the witness
must turn off the power source and initiate treatment at the scene
of the injury. Low-voltage electric burns almost exclusively involve
either the hands or oral cavity. Surgical treatment will vary with
the severity of the injury.Burns caused by contact with a
high-voltage alternating electric circuit conforms to two types:
burns from an electric arc and burns from an electric current.
High-voltage electric current injuries have a wide variety of
systemic manifestations, including neurologic complications,
cardiovascular and pulmonary manifestations, vascular damage, and
abdominal, bone, eye and joint complications. An organized approach
to the management of these complications is outlined in this
article. The best treatment of burn injuries remains prevention.
Because the majority of burn injuries are due to occupational
electrical injuries, the regional burn centers must work effectively
with industry to prevent these potentially life-threatening
accidents.
Electrical
injuries.Medicina
(Kaunas). 2007;43(3):259-66.
Electrical
trauma can be caused by low-voltage current (from 60 to 1000 V,
usually 220 or 360 V), high-voltage (more than 1000 V) current,
lightning, and voltaic arc. Often victims are little children,
teenagers, and working-age adults. Electrical injuries and clinical
manifestations can vary a lot and range from mild complaints not
demanding serious medical help to life-threatening conditions.
Lightning causes serious injuries in 1000-1500 individuals every
year worldwide. The case fatality rate is about 20-30%, with as many
as 74% of survivors experiencing permanent injury and sequela. The
primary cause of death in victims of lightning strike or other
electrical trauma is cardiac or respiratory arrest. That is why
appropriate urgent help is essential. Subsequently electrical burns,
deep-tissue and organ damage caused by electricity, secondary
systemic disorders often demand intensive care and prompt, usually
later multistage surgical treatment; therefore, prevention of
electrical trauma, which would help to reduce electrical injuries in
children and working-age population, is very actual. The most
important is to understand the possible danger of electricity and to
avoid it.
Pattern of
severe electrical injuries in a Nigerian regional burn centre.Niger
J Clin Pract. 2006 Dec;9(2):124-7.
BACKGROUND: Electrical injuries, though uncommon usually have
devastating consequences. They are largely preventable. The
objectives of the study were to highlight the pattern of severe
electrical injuries seen in our environment, the management problems
faced here compared with other studies and proffer suggestions for
improvement and prevention. METHODS: A 10-year retrospective study
of case files of patients seen with electrical injuries in our
centre was carried out from January 1995 to December 2004. Case
notes were retrieved and data collated from them were analysed by
descriptive statistics. RESULTS: Twenty four (24) case files met the
inclusion criteria and were analysed. Electrical burns constituted
2.8% of total burn admissions. Patients' ages ranged from 15 months
to 42 years. Male: Female ratio was 4.8:1. Seven (29%) had high
voltage injuries, mostly work-related. Sixteen (67%) had low voltage
injuries while one (4%) had a lightening injury. Fourteen (58%)
presented or were referred more than 24 hours post injury. Fifteen
(63%) had a form of surgical treatment with wound debridement (33%)
skin grafting (38%) and amputations (29%) being the commonest ones.
The mortality was 12.5% with septicaemia as the leading cause of
death. CONCLUSION: Late presentation of patients to specialised
centres, inadequate management at the primary centres of treatment,
poverty and inadequate facilities even at the specialised centres
were the main problems encountered. We recommend re-education of the
populace including medical practitioners, enforcement of safety
rules in the home and workplaces and upgrading of our health
facilities to decrease the menace of severe electrical injuries.
Electrical injuries.
Crit Care Med. 2002 Nov;30(11 Suppl):S424-30.
Electrical injury is a relatively infrequent but potentially
devastating form of multisystem injury with high morbidity and
mortality. Most electrical injuries in adults occur in the
work-place, whereas children are exposed primarily at home. In
nature, electrical injury occurs due to lightning, which also
carries the highest mortality. The severity of the injury depends on
the intensity of the electrical current (determined by the voltage
of the source and the resistance of the victim), the pathway it
follows through the victim's body, and the duration of the contact
with the source of the current. Immediate death may occur either
from current-induced ventricular fibrillation or asystole or from
respiratory arrest secondary to paralysis of the central respiratory
control system or due to paralysis of the respiratory muscles.
Presence of severe burns (common in high-voltage electrical injury),
myocardial necrosis, the level of central nervous system injury, and
the secondary multiple system organ failure determine the subsequent
morbidity and long-term prognosis. There is no specific therapy for
electrical injury, and the management is symptomatic. Although
advances in the intensive care unit, and especially in burn care,
have improved the outcome, prevention remains the best way to
minimize the prevalence and severity of electrical injury.
High voltage accidents, characteristics and treatment.Unfallchirurg.1995
Apr;98(4):218-23.
High-voltage
injuries cause localised entrance and exit burns, extensive arc,
flame and flash burns and, even more dangerous, necrosis of the
underlying muscles on the pathway of the current through the body.
Therefore it should be recognized that the ensuing disease is more
like a crush injury than a thermal burn. The extent of injury cannot
be judged by the percentage and depth of the skin burn. Diagnostic
fasciotomies, radical debridement, and in many cases early
amputation are necessary to prevent life-threatening complications.
Over a period of 10 years, 43 patients with high-voltage injuries
have been treated at the Hamburg Burn Center, 36 of them in primary
care. Common causes of injury were accidents in railway areas (28%),
using portable aluminium ladders near overhead power lines (9.3%),
and working on electrical equipment (30.2%). Six of the primary care
patients died (16.6%), and 34.9% had an amputation of one or more
extremities. Nearly all patients underwent several debridement and
split-skin graft procedures. In 30% of cases additional free and
pedicled flaps were needed to cover soft tissue defects. Ten
patients (23.3%) sustained fractures and other injuries from falls,
seven (16.3%) of them severe polytrauma. Initial cardiac arrhythmics
were diagnosed in 16.6% of the primarily treated patients. Thirty
per cent of our patients had neurological complications such as
peripheral paresis, tetraplegia and paraplegia, 20.7% of these
caused solely by the electric current.
|
