[Fatal electric injury connected with electric welding. 5 cases].
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Accidents, Occupational↗
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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↗
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↗
[Diagnostic and therapeutic difficulties in a case of severe craniocerebral injury caused by an electric injury and a fall].
The authors describe a 37-year-old man suffering electric shock caused by high-voltage current 3 000 Volt. The shock caused a fall with severe craniocerebral injury with fracture of occipital squama and subacute epidural haematoma in the posterior cerebral fossa. The injury was associated with vascular disturbances of the brain and brain stem which caused difficulties in disclosing typical signs of epidural heaematoma. Good therapeutic effects were obtained not only by surgical intervention and also by intensive treatment with antioedematous agents and drugs improving cerebral circulation.
Adult↗
[Intracerebral measurement of electric tensions following peripheral electric injury].
The present research has originated from observing a 25-year-old man who - after an electrotrauma-- showed a hydrocephalus internus in the pneumoencephalogram. The review of the literature available at that time resulted in obtaining only one information concerning this nexus of related problems; thus the search of patients suffering from this trauma began, but as well experiments on animals. Most of the cats being injured by A.C. actually showed a dilatation of the lateral ventricles. Further experiments on dogs have shown that not only in case of transcerebral but also of peripheral injuries by electric currents of certain strength, distinct states of paling on the brain surface could be observed occurring in consequences of the extreme vasosoconstriction of the meningeal vessels. By a further series of experiments on dogs, there was finally demonstrated that also after peripheral electric irritations resp. injuries of different variations, electric tensions in the brain can be measured by intracerebrally installed electrodes at varying irritatnt voltages; up to now, this possibility has been in contest. Neuropathological investigations showed intracerebral and subarachnoid haemorrhages of different size in all injured animals.
Animals↗
Induced ischemia: means of prediction of demarcation line of necrosis after electrical injury. An experimental study on rabbit ear.
Necrosis due to an electrical injury extends by progressive obstruction of blood vessels. Means of inhibiting expansion of necrosis and predicting early the demarcation line after an electric injury were studied in the local electric injury of a rabbit ear produced by application of an electric current of 50 Hz, 1800 V for 1 sec between the right ear and the right posterior leg. Although no effective method of inhibiting expansion of necrosis was obtained, a method of predicting a demarcation line of necrosis was obtained by inducing ischemia of the ear early after the application of an electric current. From three hours to three days after the application of the electric current, ischemia of the ear was induced by compressing it between a pair of blood pressure cuffs at a pressure of 300 mmHg. As a result, the area proximal to the expected demarcation line of necrosis became white by ischemia, while the peripheral part remained dark red because of thrombi, and the expected demarcation line was clearly observed. Two to three weeks after the application of the electric current, the ear almost invariably fell off at this expected line. Therefore, in the electric injury of the hand, it can be distinguished clinically whether or not the area will become necrotic by inducing ischemia from the tips of the fingers to the upper arm early after the electric injury.
Animals↗
Xenon-133 determination of muscle blood flow in electrical injury.
Xe-133 washout determination of muscle blood flow (MBF) was used to detect muscle ischemia in electrical injury of an experimental animal model and three patients. The control MBF of rabbit hindlimbs, which averaged 11.29 +/- 1.07 cc/min/100 gm, was significantly reduced by electrical injury, to 5.82 +/- 1.49 cc/min/100 gm (p less than 0.001). An electrical injury of 4,000 watt-seconds or greater was associated with uniform MBF less than 1.00 cc/min/100 gm and with histopathologic alterations of muscle necrosis. Thenar MBF less than 1.00 cc/min/100 gm in two patients was associated with muscle necrosis requiring distal arm amputation. The remaining patient with sequential muscle blood flows above this level had uneventful healing of hand electrical injuries. Xe-133 determination of MBF may be a useful objective technique to determine the extent of electrical injury in muscle.
Adult↗
[Electrical injuries in childhood (author's transl)].
11 children were admitted with electrical injuries to the Department of Paediatrics, University of Graz, over the 10-year period 1965 to 1974. The electricity was of low voltage in the case of 9 of these children, who were injured whilst playing with plug sockets of defective cables and of high voltage in 4 case. 1 child was stuck by lightning. Cessation of respiration occurred in 4 of the patients and was successfully counteracted in all cases by prompt mouth-to-mouth breathing. 7 children were still shocked on admission. All children showed the characteristic skin lesions of electrical injury (current marks of linear, round or spidery form). The boy injured by high voltage electricity received extensive burns, in addition. The modes of electrical injury in childhood, the various forms of the resultant lesions, especially of the skin and the treatment of electrical burns are discussed.
Adolescent↗
Salvage and reconstruction of electrical hand injuries.
Electrical injury results in serious damage or amputation of the upper extremity in a significant percentage of survivors. Fourteen of sixteen patients with electrical injuries followed over a two and a half year period had major hand wounds. Careful wound assessment, management, and closure combined with appropriate reconstructive technics now available provide the greatest potential for restoration of satisfactory quality of life. Because these injuries are often of an industrial nature, occupational vigilance and prevention remain essential.
Abdomen↗
Amputations resulting from electrical injury: a review of 22 cases.
Twenty-two cases of electrical injury with a combined total of 43 major amputations are reviewed. Electrical injury resulting from contact with high-voltage current (greater than 1000 volts) commonly results in significant systemic damage. The purpose of this study was to develop statistical data on the rehabilitation and eventual outcome of these patients. Most of the injuries were job related and involved young male adults. Upper-extremity amputations were predominant, and more than 50% of the patients had two or more limbs amputated. In addition to major amputations, other obstacles to rehabilitation included skin burns and limitation of joint motion. The length of hospitalization in a rehabilitation facility for these amputees was greater than for patients with amputations due to other causes. Prostheses were fitted for 95% of the amputated limbs. At the follow-up stage of rehabilitation, 50% of the patients were either employed or pursuing career training or educational goals.
Adult↗
Severe electric injuries of the hand and forearm.
Electrical injuries of the upper limb produce major destruction of tissue mainly affecting the forearm, since the hand is usually the site of entry of current. Limb salvage, if it is to be successful, requires the rapid institution of a number of surgical procedures. Vein grafting to restore blood supply is frequently required and just as frequently requires skin flap cover following adequate debridement. The most commonly used flap is the groin flap. Despite the progression of necrosis beneath the flap for a period of up to three weeks, healing is usually successful and it is usually possible to avoid amputation. Several surgical procedures are required as a rule. The initial surgery is followed, in order, by nerve graft, tendon transfer and skin transfer following the use of tissue expanders. Results long term, with regard to function and appearance, were judged good.
Adolescent↗
Electrical injuries and lightning.
Prolonged cardiopulmonary resuscitation is key to the resuscitation of lightning strike victims. Multiple accounts exist of successful revival of victims thought to be "dead" or in patients who have what is often believed to be unresuscitatable cardiac dysrhythmia. Victims of lightning injury may, in addition to their electrical injury, have secondary injuries that require expedient care if significant morbidity is to be avoided. They should be treated as any victim of trauma, that is, with a complete and thorough evaluation including hospitalization if warranted. In the absence of a cardiac arrest or serious secondary injury, care for the lightning strike victim is generally supportive in nature.
Electric Injuries↗
High tension electrical injury of the upper extremity.
A group of 18 patients received a high tension electrical injury of the upper extremity. The over-all results were dismal. Opportunity for improvement appears to lie in a regimen of rapid and complete removal of devitalized skin and muscle, avoidance of contamination and desication and the early provision of blood supply and wound coverage with pedicled flap coverage.
Arm Injuries↗
Electrical injuries to the eye.
The effect of electric current on the eyes of experimental animals was studied. An apparatus was constructed to allow single and multiple shock exposures from 0 to 600 volts at variable exposure times. The current was measured on a Tectronex Storage Oscilloscope. Mature Dutch rabbits were used as experimental animals. When rabbit eyes were subjected to a current of 500 volts for no less than 250 milliseconds and 400 milliamperes or more, a permanent decrease in the amplitude of the b-wave of the Electroretinogram resulted in some animals. No histological or ophthalmological alterations in the retina, optic nerve or vasculature could be observed using conventional techniques. The cataractogenic properties of electric current were also studied. Most previous observations dealing with this subject utilized a multiple shock technique--something which is unlikely to occur in any accidental exposure. This study focussed on the production of lens changes in rabbit eyes following single exposures of measured electric current. The biomicroscopic characteristics of these changes were described. Minimal lens changes were produced by single shock exposures ranging from 6 to 26 watts per second while typical electrical anterior subcapsular cataracts were produced by current of 23 to 80 watts per second. Exposure times were mostly 250 milliseconds or less since the survival rate of animals subjected to longer exposures made such studies unfeasible. Three patients with electrical injuries were presented and some of the pertinent literature was reviewed.
Adult↗
Electrical injuries, with special reference to the upper extremities. A review of 182 cases.
A twenty year experience in the management of 182 patients with electrical injuries has been reviewed. Males predominate. The average age is thirty-six years. Bodily contact with high tension wires by linemen constituted the most common accidents. High voltage injuries were sustained by 67% of patients. Burns were sustained by 74% of our cases and of these, 71% involved the upper extremities. Complications developed in three fourths of patients, and one third of patients suffered some degree of permanent disability. Mortality (2.1%) was largely due to septicemia, pneumonia, and renal failure. The wide variety of injuries necessitates individualization in treatment. Prevention offers greatest hope in management.
Accidents, Occupational↗
The treatment of electrical injury compared to burn injury: a review of pathophysiology and comparison of patient management protocols.
Because of basic differences in pathophysiology, patients with electrical injury require therapeutic measures quite separate and distinct from patients with flame burns. Fluid requirements are much greater for the electrical-injured patient due to the depth of the injury and frequent occurrence of pigment in the urine. Fasciotomy with surgical exploration for determination of tissue viability is usually required in areas of obvious or questionable viability in patients with electrical injury. Sulfamylon is preferred for topical antibacterial therapy in electrical injury, because of its excellent penetration into deeper tissues. With this regimen of conservative surgical debridement of necrotic tissue, in many patients we have been able to salvage limbs and, in particular, preserve function.
Burns↗
Epidemiology of high-tension electrical injuries in children.
Twenty-seven acute high-tension electrical injuries were seen in seven years at the Shriners Burns Institute. All were in boys 7 to 16 years old; 13 suffered amputation(s) and 2 died. Most accidents occurred when boys climbed utility poles (9), trespassed, generally around transformer substations (9), or contacted power lines when tree climbing (5). All occurred in daylight, generally between 4 and 6 PM, on weekends in warm weather with boys in groups. Preventive education directed to this high-risk population should illustrate properties of high-voltage electricity, effects on the body, and how to cope with peer pressures in unstructured time.
Adolescent↗
The pathophysiology of acute electric injuries.
Results of the present investigation indicate that an electric burn is simply a thermal injury. The tissue damage associated with an electric injury occurs when electric energy is converted to thermal energy or heat. An electric burn is self limiting: once the current arcs, no further skin and muscle damage is possible because amperage falls to zero. Tissue temperature is the critical factor in determining the magnitude of tissue injury before the current arcs. With the exception of skin resistance, resistances of individual tissues seem not relevant to amount of tissue damage in electric injuries. Living tissue acts as a volume conductor; once skin resistance has been overcome all internal tissue resistance, with the exception of bone, is negligible to current flow. In the present study the volume of tissue traversed by the electric current was more closely related to the extent of tissue injury than the internal resistance of the individual tissues. Muscle injury occurred at the time of initial thermal insult and progressive or de novo muscle necrosis was not seen in this model.
Acute Disease↗