Occupational Electrical Injury. Proceedings of the 3rd International Conference on Electrical Injury and Safety. Shanghai, China, October 26-28, 1998.
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Accidents, Occupational↗
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[INCIDENCE OF EXTERNAL LESIONS CAUSED BY ELECTRIC INJURY IN AN ELECTRICAL PLANT].
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Burns↗
[The after-treatment of the accidentally-injured from modern viewpoints. Part 1. General viewpoints, injuries, tetanus, burns, electrical injuries].
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Aftercare↗
[Fatal electric injury connected with electric welding. 5 cases].
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Accidents, Occupational↗
Electrical injuries: current concepts.
Electrical injuries are often dramatic accidents and are potentially fatal. The systemic involvement which characterizes many of these injuries, requires familiarity with the broad spectrum of clinical manifestations and possible complications. While many victims of electrocution are killed before help can be provided, survivors may suffer severe injuries that need proper treatment. The pathophysiological aspects of electrical injuries and therapeutic principles are therefore discussed in this review as well as preventive measures.
Cardiovascular System↗
Management of early complications of the electrical injury and repair of the injured hands.
OBJECTIVE: To explore the management of early complications and repair of hand injuries in electrically injured patients. METHODS: Forty-five patients with electrical injuries admitted during 1995 and 2001 were analyzed retrospectively in terms of the incidences of early complications and the deformity of the injured hands repaired using different approaches. RESULTS: In the order of incidence, the complications arising in the early stages after electrical injuries included electric shock, hypovolemic shock, cardiac dysfunction, hemorrhage of the digestive tract, pulmonary infection, massive bleeding of the wound and renal dysfunction. The incidence of deformity of the hands was 79%. CONCLUSION: Proper management of early complications and repair of the injured hands are of great importance in cases of electrical surgery.
Adolescent↗
Autonomic nervous system disorders and reflex sympathetic dystrophy in lightning and electrical injuries.
Both lightning and electrical injuries can cause autonomic nervous system (ANS) symptoms and signs (Table 1). Published descriptions of ANS involvement occurring with lightning and electrical injuries are rare. The most often reported neurologic complications of lightning injuries involve the central nervous system. ANS abnormalities have been documented with lightning, although the descriptions are scant. There is a lack of complete clinical information or ANS testing data in these cases. This is usually a result of the transient nature of ANS complications. In electrical injuries, ANS involvement is less well described than for lightning. Electrical injuries can be associated with peripheral nerve damage. As a result of peripheral nerve damage, reflex sympathetic dystrophy (RSD) may occur in patients with electrical injuries. Various treatment strategies for RSD associated with electrical injuries are found in single case reports. This article summarizes ANS involvement, predominantly in lightning injuries, and describes RSD and its treatment, predominantly in electrical injuries.
Autonomic Nervous System Diseases↗
[Application of digital subtraction angiography and type B ultrasonography in the evaluation of vascular injury in patients with high voltage electrical injury].
OBJECTIVE: To compare the difference between digital subtraction angiography (DSA) and type B ultrasonography in the evaluation of vascular injury in patients inflicted with high voltage electrical injury. METHODS: Nineteen patients with high voltage electrical injury of upper limbs were enrolled in the study as burn group, and another 12 healthy volunteers as controls. The endovascular membrane, vascular wall thickness, intra-vascular blood flow and endovascular thrombosis formation of ulnar and radial arteries at wound site and in regions 5, 10 and 15 cm proximal to the wounds were examined by DSA and type B ultrasonography and compared with imagings of healthy volunteers as control. The injury degree of the ulnar and radial arteries was examined during operation for evaluation to corroborate with DSA and ultrasonography findings. Necrotic and/or thrombotic vessels were excised and sent for pathomorphological examination. RESULTS: By DSA images abnormal signs as thrombosis, vascular lumen stenosis and blood flow deceleration were found in 14 ulnar and 11 radial arteries, and the signs were more pronounced in ulnar arteries. By type B ultrasonography, abnormal signs as roughing of tunica intima, swelling or exfoliation, thickening of vascular wall, lumen stenosis, decreased blood flow, even necrosis of vascular wall and thrombosis were identified in 19 ulnar and 16 radial arteries in burn group (P < 0.05 approximately 0.01). The blood flow in ulnar artery 5 cm to the approximal part of the wound edge was obvious lower than that of the control (31.60 +/- 13.90 ml/min vs 47.70 +/- 9.60 ml/min, P < 0.05). CONCLUSION: Type B ultrasonography and DSA could be helpful in the evaluation of vascular injury in patients inflicted with high voltage electrical injury.
Adult↗
A new explanation for the progressive tissue loss in electrical injuries.
A reproducible electrical injury to the hind limb was produced in rats, an injury characterized by progressive tissue necrosis. Serial histochemical examinations of cross sections with a peroxidase-antiperoxidase method revealed increased production of arachidonic acid metabolites, especially thromboxane, at distal sites near the entrance wound and in periosseous tissues more proximally. Levels of these vasoactive substances remained elevated during the time of progressive necrosis and demarcation of seemingly normal, uninjured tissue. Treatment with agents capable of blocking thromboxane production allowed tissue salvage, as evidenced by a decreased autoamputation rate and an increased total surviving length. From this study it appears that an electrical injury is thermal trauma, producing elevated levels of arachidonic acid metabolites in areas of greatest heat production. Prolonged thromboxane excess, with resultant vasoconstriction and thrombosis in the microcirculation, is seen to play a key role in the progressive tissue loss characteristic of the injury. The use of antithromboxane agents may be of benefit in halting this progression and salvaging tissue in these devastating injuries.
Animals↗
Functional reconstruction following electrical injury.
Worldwide, high voltage electrical injury continues to cause significant morbidity, disability, and mortality despite improvements in electrical safety. Joule heating and cell membrane disruption are two mechanisms important in understanding the pathophysiology of electrical injury. The degree of tissue damage is often more extensive than initially perceived on clinical exam. Using modern reconstructive techniques, the functional outcome of electrical injury victims can be improved. The type of reconstruction selected for each injury can be selected from a number of options from the reconstructive ladder. Donor site considerations, risks of the surgery, team experience, and patient preference are important factors in this selection.
Accidents, Occupational↗
A series of models of non-thermal high voltage electrical injuries.
Although many models of electrical injury have been established, none of them are completely typical of the clinical features of electrical injury. As a result, research based on these models were incapable of explaining many clinical phenomena such as continuous tissue necrosis and also were unable to cope with high ratio of amputation of extremities. In order to investigate the mechanism of electrical injuries and better model the condition with similar clinical characteristics we developed a new model. Seventy-five New Zealand rabbits were employed in this study, of them 45 were used in a preliminary experiment including the selection of the size of electrode plate area, damaged extent, time length of electrical injury and interval length between two injuries and so on. Another 30 rabbits were equally divided into five groups with electrical injury times of 6, 12, 18, 24 and 30 cycles, respectively. Observations were made using clinical anatomical exploration, with quantification using an IDBI scale on the 2nd, 8th, 24th, 48th hours and 5th, 15th days, and TC-99m-DMP isotope scanning and gamma photography at 2nd hour and 5th day in post-injury, respectively. The results showed the effective electric field strength was 17,000 V/m, mean current intensity was 554 mA, average current density was 137 mA/cm(2) beneath the small electrode plate with 21 mA/cm(2) beneath big one, and average increase of tissue temperature was 1.73 degrees C during injury process which excluded the possibility of thermal injury. One single wound injury beneath the small plate of the experimental rabbits with loss of injured extremities from 5th to 15th post-injury days in groups 3-5 and obviously progressive tissue necrosis in and outside the wounds were obtained. A series of electrical injured models from mild, moderate, severe, extra severe, and destructive which was exactly similar to the clinical features of electrical injury cases was established.
Animals↗
[Electrical injuries during laparoscopy].
Electrical injury is uncommon during surgical laparoscopy, but may be serious. Following a comprehensive literature review, we describe five mechanisms of burn injuries: direct contact, electric arc, insulation failure, direct or capacitive coupling. We discuss these mechanisms and suggest simple preventive measures designed to ensure optimal safety.
Burns, Electric↗
The natural history of electrical injury.
The natural history of electrical injury, exclusive of electrical flash burns, was determined in 64 patients. These patients sustained relatively small burns (x=11%); only nine patients (14%) had burns greater than 25%. Forty-six patients suffered 114 major complications. EKG abnormalities occurred in 36%, including major cardiac arrhythmias in ten patients. One-fourth of the patients developed neurologic sequelae (CNS-8, peripheral-8). Electrical vascular injury with subsequent arterial occlusion was responsible for many of the major amputations. Nineteen patients required 32 amputations (digits-17, hand-1, foot-2, leg-3, arm-9). Early patient referral and vigorous fluid resuscitation minimized renal failure (1.5%) and mortality (3.1%). Early fasciotomy and vigorous debridement appeared to decrease wound sepsis (8%), but apparently had little if any effect on major limb salvage. The unsolved problems of electrical injury, namely neurological and vascular sequelae, are major contributors to the high morbidity of electrical injury.
Adolescent↗
Electrical injuries: a 20-year review.
Electrical injuries continue to present problems with devastating complications and long-term socioeconomic impact. The purpose of this study is to review one institution's experience with electrical injuries. From 1982 to 2002, there were 700 electric injury admissions. A computerized burn registry was used for data collection and analysis. Of these injuries, 263 were high voltage (> or =1000 V), 143 were low voltage (<1000 V), 277 were electric arc flash burns, and 17 were lightning injuries. Mortality was highest in the lightning strikes (17.6%) compared with the high voltage (5.3%) and low voltage (2.8%) injuries, and mortality was least in electric arc injuries without passage of current through the patient (1.1%). Complications were most common in the high-voltage group. Mean length of stay was longest in this group (18.9 +/- 1.4 days), and the patients in this group also required the most operations (3 +/- 0.2). Work-related activity was responsible for the majority of these high-voltage injuries, with the most common occupations being linemen and electricians. These patients tended to be younger men in the prime of their working lives. Electrical injuries continue to make up an important subgroup of patients admitted to burn centers. High-voltage injuries in particular have far reaching social and economic impact largely because of the patient population at greatest risk, that is, younger men at the height of their earning potential. Injury prevention, although appropriate, remains difficult in this group because of occupation-related risk.
Accidents, Occupational↗
Lightning and electrical injuries.
Lightning and electrical injuries are similar in that both produce immediate tissue injury from burn and trauma induced by fall and both can arrest the heart and respiratory center. Immediate support of circulation and respiration is life-saving. Subsequently the nervous system may show signs of injury, and seizures, cerebral edema, and muscle and nerve lesions should be handled as the indications arise. Prevention of the injury is more effective than any postinjury treatment. Outdoors hikers and campers must take shelter to minimize their exposure; indoors properly installed equipment and attention to the relation of the equipment user to the electrical ground are the key elements in avoiding electrocution.
Electric Injuries↗
Electrical injuries in children.
Electrical injuries in children continue to account for substantial morbidity and mortality. This review describes the responsible pathogenetic mechanisms and five separate types of injury. Multisystem complications are discussed as well as current concepts of patient management. We emphasize the importance of prevention and include a pediatrician's "reminder" list for parent education.
Burns, Electric↗
[Heart damage after electric injury].
Death from electrical accident due to low voltage (220 Volt/380 Volt) is usually caused by ventricular fibrillation. In humans who sustain non fatal electrical injury abnormal ECG findings due to myocardial damage are rare. 243 (76%) of 320 ECGs of survivors of an electrical accident were diagnosed as normal. In 42 patients (13%) unspecific electrographic changes were seen and in 35 (11%) abnormal ECGs were found. In comparison to findings in normal populations no significant accumulation of ECG changes was observed. A causal relationship between abnormal ECG findings and electrical accident is only then probable if ECG abnormalities are documented immediately after injury and serial ECG controls demonstrate significant changes in comparison to the initial abnormality.
Adolescent↗
Neurorehabilitation of lightning and electrical injuries.
Lightning and electrical (L/E) injuries can be among the most dramatic of all events that damage the nervous system. The three major classes of neurologic sequelae that require the expertise of the neurorehabilitationist are: (1) cerebral disorders, either global or focal; (2) neuropsychologic sequelae; and (3) spinal cord injury. Neurorehabilitation management necessary for each of these three areas will be discussed. From the viewpoint of the neurorehabilitationist, therapy principles are the same for L/E trauma as for other more common forms of injury. The goal is to maximize the functional return given the specific impairment.
Brain Injuries↗