[Rare case of death from lightning].
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Electrical burn injuries are complicated because of damage to many structures including: blood vessels, muscles, nerves, tendons, bone and skin. Surgeons must confront many problems such as wound healing coverage, scarring, loss of nerve and tendons, progressive joint stiffness and amputation. The goals of burn therapists are to achieve wound healing, functional recovery, and good cosmetic results. Rehabilitation is both preventive and therapeutic and is a fundamental part of managing these patients. In this article, rehabilitation is discussed with emphasis on the following: pain management, wound coverage, positioning, splinting, and exercises (range-of-motion and ambulation). The treatment and prevention of hypertrophic scarring is evaluated. Finally, the use of engineering and assistive technologies for rehabilitation of the electrical burn injured patient is discussed. Successful management of electrical burn injured patients involves communication among the different burn specialists, such as surgeons, anesthesiologists, neurologists, nurses, and kinesitherapists; engineers from the garments/prostheses companies; psychologists; and the patient him/herself.
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Two cases of patients struck by lightning are described. One instance occurred while the victim was using the telephone; the other victim received a direct lightning strike to the head. Both patients had acoustic shock injuries and one developed a cerebral infarct. The mechanisms of these injuries are discussed and the relevant literature is reviewed.
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.
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Recreational activity sometimes leads to injury caused by environmental conditions, such as lightning. A familiarity with the effects of electricity, lightning, hyperthermia, and poisoning is essential for providers of care to the critically injured. This article discusses the pathophysiology and treatment of injuries caused by the environment.
The bicycle, an invention that provides joy and transportation to millions of people, can also be a source of disabling injuries and death. The victims of bicycle accidents are usually in good health and often young. Most of the fatal head injury cases are teenagers. In this article, I have chosen four areas of bicycle trauma that frequently brings the bicycle patient to the attention of a neurologist. These areas are (1) head trauma as a consequence of road collisions; (2) compressive ulnar neuropathy; (3) impotence, probably due to compression of the pudendal nerve or its branches; and (4) lightning-related bicycle injuries. The one thing that all four categories have in common is that they are often preventable. Helmet usage and common sense would lower the number of serious head trauma cases by 50%. Compressive ulnar and pudendal neuropathies can be prevented or reduced if the cyclist would frequently change his or her position in relation to the handlebar and saddle. In the majority of cases of compressive neuropathies, the symptoms improve if the patient takes a holiday from bike riding. Lightning injuries can be avoided or lessened if the cyclist takes proactive measures to limit his or her exposure during thunderstorms. These proactive measures include knowing the climate patterns of the area and knowing where the nearest safe shelter is located.
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