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Yolola E, Kipenge R, Malamba-Lez D, Ngoy D. Acute myocardial infarction due to accidental electrocution — A case report of a 26-year-old African male patient. Ann Cardiol Angeiol (Paris) 2024; 73:101743. [PMID: 38640884 DOI: 10.1016/j.ancard.2024.101743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 04/21/2024]
Abstract
We report a case of fatal myocardial infarction (MI) after electrocution in a 26-year-old male patient without cardiovascular risk factors. The patient was admitted to the Emergency Department of the University Clinics of Lubumbashi for management of accidental electrocution on a high-voltage power line. The admission ECG showed lesions consistent with myocardial infarction. Despite treatment, the patient died 30 minutes after admission.
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Affiliation(s)
- Eric Yolola
- University Clinics of Lubumbashi, Cardiology Training and Research Unit, DRCongo; Lubumbashi Cardiology Center, DRCongo
| | - Richie Kipenge
- University Clinics of Lubumbashi, Cardiology Training and Research Unit, DRCongo.
| | - Didier Malamba-Lez
- University Clinics of Lubumbashi, Cardiology Training and Research Unit, DRCongo
| | - Dophra Ngoy
- University Clinics of Lubumbashi, Cardiology Training and Research Unit, DRCongo; Lubumbashi Cardiology Center, DRCongo
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2
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Bounasri M, Mokline A, Houichi M, Fraj H, Messadi AA. [HIGH VOLTAGE ELECTRICAL INJURIES IN CHILDREN: A TUNISIAN SERIES]. ANNALS OF BURNS AND FIRE DISASTERS 2024; 37:118-123. [PMID: 38974794 PMCID: PMC11225276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/25/2022] [Indexed: 07/09/2024]
Abstract
Electrical burn injuries (EBI) affect both adults and children and are responsible for a very high number of major limb amputations. Their management is still a major challenge. This retrospective review concerns 42 children, admitted to an intensive burn care department in Tunisia for high electrical burns, from January 2016 to September 2022. The average age of our patients was 12 years, with a male predominance (90.5%). Electrotrauma was accidental in the majority of cases (93%) and secondary to a domestic accident in 54.8% of cases. Total body surface area was 19%. Burns were second degree in 2/3 of cases and third degree in 1/3 of cases. The most affected areas were distal extremities in 2/3 of the cases. Rhabdomyolysis was observed in 93% of cases and troponins were elevated in half of the patients. Escharotomy was required in 38% of cases. Amputation was performed in 18 children (43%): one limb (n=10); 2 limbs (n=6) and 3 limbs (n=2). The outcome was favorable in 9 children (21.4%); functional and cosmetic sequelae with an impact on schooling and psychology were reported in 25 cases. Mortality was 16.7%.
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Affiliation(s)
- M. Bounasri
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
| | - A. Mokline
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
- Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brulés, Tunis, Tunisie
| | - M. Houichi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
| | - H. Fraj
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
- Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brulés, Tunis, Tunisie
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Alhazmi L. Reversibility of Sinus Bradycardia-Induced Syncope Resulting From Low-Voltage Electrical Injury: A Case Report. Cureus 2023; 15:e50509. [PMID: 38222168 PMCID: PMC10787379 DOI: 10.7759/cureus.50509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
Electric shocks pose a serious threat to public health. The heart is among the organs that are most commonly impacted. Electrical harm can cause a number of potentially fatal heart conditions, including asystole, ventricular fibrillation, and myocardial rupture. Some patients had sinus bradycardia diagnosed at the time of admission. In this case report, we describe a 43-year-old male patient who had an electrical injury that resulted in syncope and sinus bradycardia. After 24 hours of cardiac monitoring, the patient was found to not require a pacemaker. This suggests that patients with symptomatic sinus bradycardia should have cardiac monitoring. If, after 24 hours, cardiac monitoring revealed no new episodes of sinus bradycardia and the patient remained asymptomatic, the patient is unlikely to require a pacemaker. There are differing guidelines and suggestions regarding the supervision of patients following electrical damage, and further study in this area is necessary to enable the unification of guidelines.
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Affiliation(s)
- Luai Alhazmi
- Department of Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
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Seyfrydova M, Rokyta R, Rajdl D, Huml M. Arrhythmias and laboratory abnormalities after an electrical accident: a single-center, retrospective study of 333 cases. Clin Res Cardiol 2023; 112:1835-1847. [PMID: 37526697 DOI: 10.1007/s00392-023-02274-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Even though electrical injuries are common in the emergency room, guidelines, consensus, and general recommendations for the management of these patients do not exist in Europe. Documented cases of delayed arrhythmias are rare and their connection with electrical injury has not been fully confirmed. We also use cardio-specific markers for the risk stratification of myocardial injury, but there is no significant study referring to their utility in this clinical situation. These reasons led us to retrospectively analyze all cases of electrical injuries over 23 years to determine the prevalence of cardiac arrhythmias (mainly malignant arrhythmias and delayed arrhythmias). METHODS We retrospectively searched all patients admitted to the University Hospital in Pilsen, CZ, with a diagnosis of electric injury (ICD diagnostic code T754) from 1997 to 2020. The hospital´s information system was used to research the injury; data were drawn from patient medical records. RESULTS We identified 333 cases of electrical injury in our hospital. Men accounted for about two-thirds, and women one-third. Children accounted for about one-third of cases. Most were low-voltage injuries (< 1000 V, 91.6%). All participants had an initial ECG, and 77.5% of patients had continuous ECG monitoring, usually lasting 24 h. Cardiac arrhythmias were noticed in 39 patients (11.7%). The most frequent arrhythmias were: ventricular fibrillation, sinus tachycardia, bradycardia and arrhythmia, atrial fibrillation, and supraventricular tachycardia. The ECG showed cardiac conduction abnormalities in 28 patients (8.1%), and ten patients (3%) had supraventricular or ventricular extrasystoles. In ten cases (3%), we found changes in ST segments and T waves on the initial ECG. Thirty-one patients (9.3%) suffered a loss of consciousness and 50 patients (15.02%) reported paresthesia. The most frequent ion disbalances were hypokalemia (18%) and hypocalcemia (3.3%). Patients with an ion disbalance had significantly more arrhythmias and newly diagnosed cardiac conduction abnormalities. Troponin levels (cTnI or hs-cTnT) were measured in 258 cases (77.48%) and found to be elevated above the 99th percentile in 19 cases (5.7%). Almost one-third of patients had burns of various degrees of seriousness, and 41 patients (12.3%) had concomitant traumatic injuries. Eleven patients underwent pre-hospital resuscitation, three died in the hospital, and another died as result of intracranial hemorrhage. CONCLUSION All malignant arrhythmias occurred immediately after the electrical injury, delayed life-threatening arrhythmias were not observed, and no predictive factors of malignant arrhythmias were found. While elevations of cardiac troponins were observed sporadically, they did not appear helpful for risk stratification. In patients with arrhythmias, ion disbalance may be more critical. We concluded that asymptomatic, uninjured adult and pediatric patients with normal initial ECG findings do not need continuous ECG monitoring and may be discharged home. Recommendations for high-risk patients and patients with mild ECG abnormalities at admission are less obvious.
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Affiliation(s)
- Miroslava Seyfrydova
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Charles University, Pilsen, Czech Republic.
| | - Richard Rokyta
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Charles University, Pilsen, Czech Republic
| | - Daniel Rajdl
- Institute of Clinical Biochemistry and Laboratory Diagnostics, University Hospital and Faculty of Medicine Pilsen, Charles University, Pilsen, Czech Republic
| | - Michal Huml
- Department of Pediatrics, University Hospital and Faculty of Medicine Pilsen, Charles University, Pilsen, Czech Republic
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Corrall S, Laws S, Rice A. Low-voltage electrical injuries and the electrocardiogram: is a 'normal' electrocardiogram sufficient for safe discharge from care? A systematic review. Br Paramed J 2023; 8:27-36. [PMID: 38046790 PMCID: PMC10690487 DOI: 10.29045/14784726.2023.12.8.3.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Introduction The current Joint Royal Colleges Ambulance Liaison Committee guidelines in the United Kingdom provide clear national guidance for low-voltage electrical injury patients. While patients can be considered safe to discharge with an apparently 'normal' initial electrocardiogram (ECG), some evidence questions the safety profile of these patients with a risk of a 'delayed arrhythmia'. This review aims to examine this as well as identifying the frequency and common arrhythmias that require patients to be conveyed to hospital for further monitoring post electrical injury. It will also aim to improve the understanding of potentially clinically significant arrhythmias that may require clinical intervention or even admission within an in-hospital environment. Methods A systematic review using three electronic databases (CINAHL, MEDLINE, AMED) was conducted in January 2022. A preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach was used to identify relevant studies with a suitable quality to support a critical review of the topic. A modified Critical Appraisal Skills Programme quality assessment checklist was used across suitable studies and a descriptive statistics approach was adopted to present the findings. Results Seven studies, largely retrospective reviews, met the inclusion criteria. The findings showed 26% of patients had an arrhythmia on initial presentation (n = 364/1234) with incidences of sinus tachycardia, sinus bradycardia and premature ventricular contractions. However, making definitive statements is challenging due to the lack of access to individual patients' past ECGs. Within these arrhythmias' ST segment changes, atrial fibrillation and long QT syndrome could be considered potentially significant, however associated prognosis with these and electrical injuries is unknown. Only six (0.5%) patients required treatment by drug therapy, and a further three died from associated complications. Most patients with a normal ECG were discharged immediately with only a limited follow-up. No presentation of a 'delayed arrhythmia' was identified throughout the studies. Conclusion The data for low-voltage electrical injuries are limited, but the potential arrhythmias for this patient group seldom require intervention. The entity of the 'delayed arrhythmia' may not be a reason to admit or monitor patients for prolonged periods. Further studies should consider the safety profile of discharging a patient with a normal ECG.
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Obeso-Martinez I. Low-Dose Electrocution and Atrial Fibrillation. Adv Emerg Nurs J 2023; 45:295-300. [PMID: 37885083 DOI: 10.1097/tme.0000000000000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Emergency electrocution incidents present with various injuries, which can range from minor to severe injuries including death. Cardiac-related complications have a higher mortality incidence among patients with low-voltage injuries (M. R. Zemaitis et al., 2023). When managing electrical injury patients, the literature recommends managing them as both trauma and cardiac cases. However, the diagnostic approach is based on each individual case and patient presentation. Electrical injury complications include arrhythmias, myocardial tissue damage, and conduction disturbances (Pilecky et al., 2019). The purpose of this case study is to discuss a postelectrocution atrial fibrillation case and common related arrhythmias associated with electrical injuries.
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Dharanindra M, Pothineni RB, Gontla DK, P SR, Shriram Dhanasekaran K. Successful Management of an Occupational High-Voltage Electric Injury Associated With High-Risk Factors and a Clinically Significant Arrhythmia. Cureus 2023; 15:e41940. [PMID: 37588334 PMCID: PMC10425699 DOI: 10.7759/cureus.41940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 08/18/2023] Open
Abstract
Electric injuries are uncommon but can lead to numerous long-term complications as well as death. Occupational exposure is the most common cause of injury among the affected population. Both low-voltage and high-voltage electrocution are associated with significant morbidity and mortality. Patients with certain presentations are at a high risk of arrhythmia post-injury. Here, we discuss the presentation and management of high-voltage electrocution in a 35-year-old electrician.
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Farzan R, Ziabari S, Jafaryparvar Z, Homaierad E, Ismaili Shoja E, Tolouei M. A Review of Electrocardiography Changes in Electrical Burn Injury: Is It Time To Revise Protocol? ANNALS OF BURNS AND FIRE DISASTERS 2023; 36:132-138. [PMID: 38681949 PMCID: PMC11041879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 02/02/2022] [Indexed: 05/01/2024]
Abstract
This descriptive cross-sectional study aimed to evaluate electrocardiography (ECG) changes in patients with electrical burn injury and determine their predictive extent during hospitalization. The study population consisted of all patients with electrical injury admitted to Velayat Hospital, Rasht, Iran, during 2007-2019. The ECG information of all patients assessed by a cardiologist in terms of dysrhythmic and ischemic changes at the time of admission, demographic information including age, gender, voltage, the severity and path of the current, and degree of burn were recorded in the relevant checklist. The data were analyzed using the SPSS software version 18 (IBM, USA). Out of 192 studied patients, 183 (95%) were male, and the mean age of patients was 32 years. The ECGs of 167 patients were normal (86%), 13 cases had arrhythmia (6.7%), and 12 individuals had ischemia (6.2%). Arrhythmic and ischemic abnormalities in the ECGs of patients had no predictive value during hospitalization (P<0.05). Heart injury caused by electrical injury may be deadly in some cases, and it can be complicated to save the patient. Moreover, the predictive value of ECG in predicting the consequences and duration of hospitalization is weak.
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Affiliation(s)
- R. Farzan
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - S.M.Z. Ziabari
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Z. Jafaryparvar
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - E. Homaierad
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - E. Ismaili Shoja
- Razi Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran
| | - M. Tolouei
- Razi Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran
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Goffeng LO, Skare Ø, Brinchmann BC, Bjørnsen LP, Veiersted KB. Low-voltage electrical accidents, immediate reactions and acute health care associated with self-reported general health 4 years later. Burns 2023; 49:329-343. [PMID: 35610077 DOI: 10.1016/j.burns.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Electricians frequently experience low-voltage electrical accidents. Some such accidents involve long-term negative health consequences. Early identification of victims at risk for long-term injury may improve acute medical treatment and long-term follow-up. This study aimed to determine acute exposure, health effects and treatment associated with general health ≥ 2 years after low-voltage electrical accidents. METHODS In a cross-sectional study, 89 male electricians who had experienced an electrical accident between 1994 and 2001 participated in a 2003 follow-up health examination. They were identified from a registry of low-voltage electrical accidents and included in the study. Based on exposure descriptions in the original accident reports, they were stratified into the following three groups: a current arc accident group (N = 34, mean age 38.8 years [standard deviation, SD = 12.2, range = 21-59]) and two groups with the passage of current through the body, either fixed to the current source ("no-let-go" group; N = 35, mean age 34.0 years [SD = 10.5, range = 21-57]) or not ("let-go" group; N = 20, mean age = 38.7 years [SD = 10.3, range = 21-63]). They retrospectively described acute reactions and assessed their current general health at the health examination. Multivariate linear regression, ordinal logistic regression and Fisher's exact test were used to compare acute reactions with health at follow-up in each exposure group. RESULTS The multivariate analysis indicated that after accidents with the passage of current through the body, severe acute headache (β = - 0.56, p = 0.013), years since the accident (β = - 0.16, p = 0.017) and the accident being perceived as frightening (β = - 0.48, p = 0.040) were negatively associated with general health ≥ 2 years later (R2 = 0.25, p = 0.002). If the exposure included a no-let-go experience, then acute severe body numbness (β = - 0.53, p = 0.029) was also negatively associated with general health (R2 = 0.38, p = 0.002). Without such experience, only acute confusion (β = - 0.90, p = 0.029) was negatively associated with the health at follow-up (R2 = 0.24, p = 0.029). In univariate analyses, after the passage of current through the body, acute dizziness (p = 0.029), apathy (p = 0.028), confusion (p = 0.007) and irregular heartbeat (p ≤ 0.05) were associated with poor long-term general health. The no-let-go group, more often than the let-go group, reported panic (p = 0.001), fear of death (p = 0.029), confusion (p = 0.014), exhaustion (p = 0.009), bodily numbness (p = 0.013) and immediate unconsciousness (p = 0.019). Acute symptoms beyond the first day after a current arc accident were associated with poor long-term general health (p = 0.015). DISCUSSION AND CONCLUSIONS The acute reactions negatively associated with general health ≥ 2 years after low-voltage electrical accidents should alert the clinician in the acute phase after an electrical accident to the risk of developing negative long-term health effects. Future studies should specify long-term health beyond the concept of general health.
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Affiliation(s)
- Lars Ole Goffeng
- Group for Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway.
| | - Øivind Skare
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Bendik C Brinchmann
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway; Department of Environmental Health, Norwegian Institute of Public Health, N-0403 Oslo, Norway
| | - Lars Petter Bjørnsen
- Clinic of Emergency Medicine and Prehospital Care, St. Olav's Hospital-Trondheim University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kaj Bo Veiersted
- Group for Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway
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Wold A, Rådman L, Norman K, Olausson H, Thordstein M. Clinical Evaluation of Nerve Function in Electrical Accident Survivors with Persisting Neurosensory Symptoms. Brain Sci 2022; 12:brainsci12101301. [PMID: 36291235 PMCID: PMC9599311 DOI: 10.3390/brainsci12101301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: Work related electrical accidents are prevalent and can cause persisting symptoms. We used clinical neurophysiological techniques to assess neurosensory function following electrical accidents and correlated test results with the patients’ symptoms. Methods: We studied 24 patients who reported persisting neurosensory symptoms following a workplace electrical accident. We assessed nerve function using quantitative sensory testing (QST), thermal roller testing, laser evoked potential (LEP), and electroneurography. The patients’ results were compared with previously established normative data. Results: Altogether, 67% of the patients showed at least one neurosensory impairment with a large heterogeneity in test results across patients. At a group level, we observed significant deviations in in QST, LEP, and sensory and motor neurography. Overall, we found a weak correlation between test results and self-reported symptoms. Conclusions: In a majority of patients with neurosensory symptoms after a workplace electrical accident, neurosensory testing confirmed the existence of an underlying impairment of the nervous system.
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Affiliation(s)
- Andrew Wold
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
- Correspondence:
| | - Lisa Rådman
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
- Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
| | - Kerstin Norman
- National Unit for Health and Safety, Swedish Police Authority, 10226 Stockholm, Sweden
| | - Håkan Olausson
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
- Neuro, Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
| | - Magnus Thordstein
- Neuro, Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
- Department of Clinical Neurophysiology, Region Östergötland University Hospital, 58185 Linköping, Sweden
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Douillet D, Kalwant S, Amro Y, Gicquel B, Arnaudet I, Savary D, Le Bastard Q, Javaudin F. Use of troponin assay after electrical injuries: a 15-year multicentre retrospective cohort in emergency departments. Scand J Trauma Resusc Emerg Med 2021; 29:141. [PMID: 34565432 PMCID: PMC8474711 DOI: 10.1186/s13049-021-00955-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/14/2021] [Indexed: 02/07/2023] Open
Abstract
Background Patients with electrical injury are considered to be at risk of cardiac arrhythmia. Assessing the risk of developing a major adverse cardiac event (MACE) is the cornerstone of patient management. The aim of this study was to assess the performance of initial troponin and troponin rise to predict Major Adverse Cardiac Events (MACEs) in all patients with electrical injuries admitted to the Emergency Department. Methods This is a multicentre retrospective study in which consecutive patients with electrical injuries admitted to the Emergency Departments (ED) (adult and paediatric) of five French Hospitals were included between 2005 and 2019. The threshold for troponin elevation is based on the European Society of Cardiology guidelines for patients presenting without persistent ST segment elevation. The primary endpoint was the rate of MACE. Results A total of 785 included patients were admitted to ED with a first diagnosis of electrical injury during the study period. Troponin assays were performed in 533 patients (67.9%), including 465 of 663 adults (70.1%) and 68 of 122 children (55.7%) and 17/533 (3.2%) of patients had an initial elevated troponin. If none of the clinical criteria for MACE were present (i.e., previous known heart disease, exposure to a high voltage of ≥ 1000 Volts, initial loss of consciousness, or an abnormal initial ECG), this defined a low-risk subgroup (n = 573, 76.0%) that could be safely discharged. The initial positive troponin assay had a sensitivity of 83.3 (95% CI 35.9–99.6%), a specificity of 97.7 (95% CI 96.1–98.8%), a positive likelihood ratio 36.6 (95% CI 18.8–71.1%) and a negative predictive value of 99.9 (95% CI 99.2–99.9%) in predicting a MACE. Conclusions Troponin assay appears to be a predictive marker of MACE risk and should be considered in high-risk patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00955-6.
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Affiliation(s)
- Delphine Douillet
- Département de Médecine d'Urgence, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49100, Angers, France. .,UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, Univ of Angers, FCRIN, INNOVTE, Angers, France.
| | | | - Yara Amro
- Département de Médecine d'Urgence, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49100, Angers, France
| | - Benjamin Gicquel
- Emergency Department, Nantes University Hospital, Nantes, France
| | - Idriss Arnaudet
- Emergency Department, Nantes University Hospital, Nantes, France
| | - Dominique Savary
- Département de Médecine d'Urgence, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49100, Angers, France.,UMR MitoVasc CNRS 6015 - INSERM 1083, Health Faculty, Univ of Angers, FCRIN, INNOVTE, Angers, France.,Emergency Department, Nantes University Hospital, Nantes, France.,Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR), University of Nantes, Nantes, France.,EHESP, Irset, Inserm, UMR S1085, CAPTV CDC, University of Rennes, Rennes, France
| | - Quentin Le Bastard
- Emergency Department, Nantes University Hospital, Nantes, France.,Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR), University of Nantes, Nantes, France
| | - François Javaudin
- Emergency Department, Nantes University Hospital, Nantes, France.,Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR), University of Nantes, Nantes, France
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Rattan A, Goyal D. ECG monitoring in high voltage electric injury patients presenting with normal ECG: Time to revisit practice? J Electrocardiol 2021; 68:164-166. [PMID: 34464883 DOI: 10.1016/j.jelectrocard.2021.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
Advanced Trauma Life Support (ATLS) recommends prolonged ECG monitoring of patients with high risk factors post electric injuries, for detecting and treating potentially life threatening arrhythmias. We hereby present our experience of high voltage electric injuries (HVEI) patients with high risk factors, managed at a level 1 Trauma Centre. Seven patients of high voltage electric injuries with significant burns (BSA > 10% of 2nd degree and above) were admitted over a year (Jan 1, 2019 to Dec 31, 2019), age ranging from 11 to 51 (median 25 yrs). Six out of seven patients (85.7%) were males. Mode of injury was recreational in one, workplace related in one and accidental in five (71.4%). Six patients had entry wounds in extremities, and three underwent emergency limb saving surgery (all escharotomies). Three patients underwent eventual amputation of injured extremity. Serum creatine kinase was monitored in all and multisystem involvement was seen in three patients; one patient (referred) required haemodialysis due to renal failure. There was no mortality. In all cases, 24 h continuous ECG monitoring was carried out as per ATLS and ERC (European Resuscitation Council) guidelines. There was no episode of paroxysmal or persistent rhythm disturbance in our patients during in-hospital stay or follow up. Review of pertinent literature suggests similar experiences of other authors. HVEI is a rare injury and most centres have reported on their experience with small number of patients as in our study. Currently, continuous ECG monitoring post HVEI seems to be the safe practice for patients with cardiac co-morbidities. Further studies are required to find other subsets of HVEI patients likely to benefit from ECG monitoring, and the clinical significance of 'delayed arrhythmias' post HVEI.
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Affiliation(s)
- Amulya Rattan
- Assistant Professor, Trauma Surgery, Trauma Centre, AIIMS, Rishikesh, India.
| | - Divakar Goyal
- M.Ch. Trainee, Trauma Surgery & Critical Care, Trauma Centre, AIIMS, Rishikesh, India
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Ahmed J, Stenkula C, Omar S, Ghanima J, Bremtun FF, Bergan J, Raouf N, Ghanima W. Patient outcomes after electrical injury - a retrospective study. Scand J Trauma Resusc Emerg Med 2021; 29:114. [PMID: 34362435 PMCID: PMC8344194 DOI: 10.1186/s13049-021-00920-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/14/2021] [Indexed: 01/18/2023] Open
Abstract
Introduction People exposed to electrical injuries are often admitted to hospital for observation. Current evidence suggests that patients who have a normal ECG on admission after a low-voltage injury, with no loss of consciousness or initial cardiac arrest may be discharged home after a short observation time. Currently, there are no established standards for the duration of monitoring after electric shock, but 24 h of observation is the most commonly adopted approach. We carried out a retrospective study of patients admitted after electrical injuries to determine the in-hospital outcomes and 30-day mortality in these patients. Methods We performed a chart review of all patients with electrical injuries admitted to Østfold Hospital, Norway between the years 2001 and 2019, to determine in-hospital and 30-day mortality and the frequency of various cardiac and non-cardiac complications. Results Mean age of 465 included patients (88% males) was 31 years. Of all injuries, 329 (71%) were work-related, 17 (3.7%) involved loss of consciousness. Furthermore, 29/437 (6.6%) were high voltage (> 1000 V), and 243/401 (60.6%) were transthoracic injuries. 369 (79.4%) were discharged same day. None of the admitted patients died in hospital nor did any die within 30 days of admission, yielding a 30-day mortality of 0% (95% CI 0–0.8). At admission troponin was elevated in three (0.6%) patients, creatinine kinase (CK) in 30 (6.5%) and creatinine in six (1.3%). Electrocardiogram (ECG) abnormalities were described in 85 (18%) patients. No serious arrhythmias were detected. When comparing high- vs low-voltage or transthoracic vs other injuries, there were no significant differences between most of the outcomes, except for more ECG abnormalities in the transthoracic group, whereas more patients had elevated CK, and fewer discharged the same day in high-voltage injuries. Conclusion No in-hospital nor 30-day mortality or serious arrhythmias were encountered in those who were assessed, regardless of the type of injury. Troponin and creatinine were rarely elevated. It seems that conscious patients admitted with a normal ECG following a low-voltage injury may safely be discharged home after a quick clinical assessment including ECG.
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Affiliation(s)
- Jamal Ahmed
- Department of Emergency Medicine, Østfold Hospital Trust, Gralum, Norway.
| | - Charlotte Stenkula
- Department of Emergency Medicine, Østfold Hospital Trust, Gralum, Norway
| | - Sherwan Omar
- Department of Emergency Medicine, Østfold Hospital Trust, Gralum, Norway
| | - Josef Ghanima
- Department of Emergency Medicine, Østfold Hospital Trust, Gralum, Norway
| | | | - Jonas Bergan
- Department of Research Østfold Hospital Trust, Gralum, Norway
| | - Nezar Raouf
- Department of Emergency Medicine, Østfold Hospital Trust, Gralum, Norway
| | - Waleed Ghanima
- Department of Emergency Medicine, Østfold Hospital Trust, Gralum, Norway.,Department of Research Østfold Hospital Trust, Gralum, Norway.,Department of Hematology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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14
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Evaluation of Tp-e / QTc ratio in determining the risk of arrhythmia in electric shocks in children. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.865000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Richardson C, Johnston K. An unusual case of high-voltage electrical injury involving fractal wood burning. J Am Coll Emerg Physicians Open 2021; 2:e12330. [PMID: 33521782 PMCID: PMC7819263 DOI: 10.1002/emp2.12330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 11/06/2022] Open
Abstract
A 26-year-old female was brought to the emergency department after an apparent electrocution. She was unresponsive, pulseless, and found to be in ventricular fibrillation upon arrival. The patient achieved return of spontaneous circulation after defibrillation. Further examination showed partial to full thickness burns to both hands, right chest wall, and buttocks. She was stabilized and then transferred to a regional burn center for additional care. Further history revealed the patient had learned how to create art with Lichtenberg figures using a high-voltage transformer extracted from a home microwave oven and a wooden canvas, a process called fractal wood burning. There are countless online video tutorials that describe how to replicate this process; however, the dangers of this practice are frequently omitted and have now become a growing public health concern. This article hopes to expand on the previous single publication, discuss the exceedingly high mortality rate, motivate emergency medicine providers and other clinicians to publish cases related to fractal wood burning-related injuries, and promote public awareness of this perilous practice.
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16
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Warenits AM, Aman M, Zanon C, Klimitz F, Kammerlander AA, Laggner A, Horter J, Kneser U, Bergmeister-Berghoff AS, Schrögendorfer KF, Bergmeister KD. International Multi-Center Analysis of In-hospital Morbidity and Mortality of Low-Voltage Electrical Injuries. Front Med (Lausanne) 2020; 7:590758. [PMID: 33262992 PMCID: PMC7686652 DOI: 10.3389/fmed.2020.590758] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/16/2020] [Indexed: 11/24/2022] Open
Abstract
Background : Patients with high- and low-voltage electrical injuries differ in their clinical presentation from minor symptoms to life-threatening conditions. For an adequate diagnosis and treatment strategy a multidisciplinary team is often needed, due to the heterogeneity of the clinical presentation. To minimize costs and medical resources, especially for patients with mild symptoms presenting after low-voltage electrical injuries, risk stratification for the development of further complications is needed. Methods : During 2012–2019 two independent patient cohorts admitted with electrical injuries in two maximum care university hospitals in Germany and Austria were investigated to quantify risk factors for prolonged treatment, the need of surgery and death in low-voltage injuries. High-voltage injuries were used as reference in the analysis of the low-voltage electrical injury. Results : We analyzed 239 admitted patients with low-voltage (75%; 276 ± 118 V), high-voltage (17%; 12.385 ± 28.896 V) or unclear voltage (8%). Overall mortality was 2% (N = 5) associated only with high-voltage injuries. Patients with low-voltage injuries presented with electrocution entry marks (63%), various neurological symptoms (31%), burn injuries (at least second degree) (23%), pain (27%), and cardiac symptoms (9%) including self-limiting thoracic pain and dysrhythmia without any therapeutic need. Seventy three percentage of patients with low-voltage injury were discharged within 24 h. The remaining patients stayed in the hospital (11 ± 10 days) for treatment of entry marks and burns, with an overall need for surgery of 12% in all low-voltage injuries. Conclusions : The only identified risk factors for prolonged hospital stay in patients with low-voltage electrical injuries were the treatment of burns and electric marks. In this multi-center analysis of hospitalized patients, low-voltage electrical injuries were not associated with cardiac arrhythmia or mortality. Therefore, we suggest that asymptomatic patients, without preexisting conditions, with low-voltage injury can be discharged after an initial check-up without prolonged monitoring.
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Affiliation(s)
| | - Martin Aman
- Center for Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Hand-, Plastic, and Reconstructive Surgery, Burn Center, University of Heidelberg, Heidelberg, Germany
| | - Clara Zanon
- Center for Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Felix Klimitz
- Department of Hand-, Plastic, and Reconstructive Surgery, Burn Center, University of Heidelberg, Heidelberg, Germany.,Department of Hand- and Plastic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Andreas A Kammerlander
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Anton Laggner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Johannes Horter
- Department of Hand-, Plastic, and Reconstructive Surgery, Burn Center, University of Heidelberg, Heidelberg, Germany.,Department of Hand- and Plastic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic, and Reconstructive Surgery, Burn Center, University of Heidelberg, Heidelberg, Germany.,Department of Hand- and Plastic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | | | - Klaus F Schrögendorfer
- Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Konstantin D Bergmeister
- Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Poelten, St. Poelten, Austria
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17
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Guimarães F, Camões J, Mesquita A, Gomes E, Araujo R. A Case Report: Low Voltage Electric Injuries Culminating in Cardiac Arrest and Direct Lung Injury. Cureus 2020; 12:e11261. [PMID: 33274138 PMCID: PMC7707888 DOI: 10.7759/cureus.11261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Serious electrical injuries are rare but may have life-threatening consequences. Voltage exposure injuries are divided into low voltage injury (LVI) or high voltage injury (HVI). An LVI current can result in severe injury, depending on the length of exposure, the size of the individual, the cross-sectional area in contact with the electrical source, and environmental humidity. The authors present a 31-year-old male with accidental electrocution with low voltage current and cardiopulmonary arrest. A detailed revision by organs and systems is presented. LVI is uncommon and can occur with a variety of clinical presentations, rarely presenting with direct lung injury. Early recognition and support are the cornerstones of treatment.
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Affiliation(s)
- Filipa Guimarães
- Internal Medicine Department, Unidade Local de Saúde de Matosinhos (ULSM) - Hospital Pedro Hispano, Porto, PRT
| | - João Camões
- Intensive Care Unit, Unidade Local de Saúde de Matosinhos (ULSM) - Hospital Pedro Hispano, Porto, PRT
| | - Ana Mesquita
- Intensive Care Unit, Unidade Local de Saúde de Matosinhos (ULSM) - Hospital Pedro Hispano, Porto, PRT
| | - Ernestina Gomes
- Intensive Care Unit, Unidade Local de Saúde de Matosinhos (ULSM) - Hospital Pedro Hispano, Porto, PRT
| | - Rui Araujo
- Intensive Care Unit, Unidade Local de Saúde de Matosinhos (ULSM) - Hospital Pedro Hispano, Porto, PRT
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18
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Machine learning-based risk prediction of intrahospital clinical outcomes in patients undergoing TAVI. Clin Res Cardiol 2020; 110:343-356. [PMID: 32583062 DOI: 10.1007/s00392-020-01691-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/16/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Currently, patient selection in TAVI is based upon a multidisciplinary heart team assessment of patient comorbidities and surgical risk stratification. In an era of increasing need for precision medicine and quickly expanding TAVI indications, machine learning has shown promise in making accurate predictions of clinical outcomes. This study aims to predict different intrahospital clinical outcomes in patients undergoing TAVI using a machine learning-based approach. The main clinical outcomes include all-cause mortality, stroke, major vascular complications, paravalvular leakage, and new pacemaker implantations. METHODS AND RESULTS The dataset consists of 451 consecutive patients undergoing elective TAVI between February 2014 and June 2016. The applied machine learning methods were neural networks, support vector machines, and random forests. Their performance was evaluated using five-fold nested cross-validation. Considering all 83 features, the performance of all machine learning models in predicting all-cause intrahospital mortality (AUC 0.94-0.97) was significantly higher than both the STS risk score (AUC 0.64), the STS/ACC TAVR score (AUC 0.65), and all machine learning models using baseline characteristics only (AUC 0.72-0.82). Using an extreme boosting gradient, baseline troponin T was found to be the most important feature among all input variables. Overall, after feature selection, there was a slightly inferior performance. Stroke, major vascular complications, paravalvular leakage, and new pacemaker implantations could not be accurately predicted. CONCLUSIONS Machine learning has the potential to improve patient selection and risk management of interventional cardiovascular procedures, as it is capable of making superior predictions compared to current logistic risk scores.
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19
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Tsioufis K, Chrysohoou C, Kariori M, Leontsinis I, Dalakouras I, Papanikolaou A, Charalambus G, Sambatakou H, Siasos G, Panagiotakos D, Tousoulis D. The mystery of "missing" visits in an emergency cardiology department, in the era of COVID-19.; a time-series analysis in a tertiary Greek General Hospital. Clin Res Cardiol 2020; 109:1483-1489. [PMID: 32506198 PMCID: PMC7275652 DOI: 10.1007/s00392-020-01682-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the era of the current COVID-19 health crisis, the aim of the present study was to explore population behavior as regards the visits in the Εmergency Cardiology department (ECD) of a tertiary General Hospital that does not hospitalize SARS-CoV-2 infected patients METHODS AND RESULTS: Daily number of visits at the EDC and admissions to Cardiology Wards and Intensive Care Unit of a tertiary General Hospital, in Athens, Greece, were retrieved from hospital's database (January 1st-April 30th 2018, 2019 and 2020). A highly significant reduction in the visits at ECD of the hospital during March and April 2020 was observed as compared with January and February of the same year (p for linear trend < ·001); in particular the number of visits was 41.1% lower in March 2020 and 32.7% lower in April 2020, as compared to January 2020. As the number of confirmed COVID-19 cases throughout the country increased (i.e., from February 26th to April 2nd) the number of visits at ECD decreased (p = 0.01), whereas, the opposite was observed in the period afterwards (p = 0.01).The number of acute Myocardial infarctions (MI) cases in March 2020 was the lowest compared to the entire three year period (p < 0·001); however, the number of acute MI cases in April 2020 was doubled as compared to March 2020, but still was lower than the preceding years (p < 0·001). CONCLUSIONS It is hard to explain the mystery of the "missing" emergency hospital visits. However, if this decline in cardiovascular disease related hospital visits is "true", it is something that needs to be rigorously studied, to learn how to keep these rates down.
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Affiliation(s)
- Konstantinos Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece.
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
| | - Maria Kariori
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
| | - Ioannis Leontsinis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
| | - Ioannis Dalakouras
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
| | - Angelos Papanikolaou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
| | | | - Helen Sambatakou
- 2nd Department of Internal Medicine, HIV Unit, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Siasos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
| | | | - Dimitrios Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
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20
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Jingo K, Kondo Y, Hirano Y, Inoue J, Kawasaki T, Miyoshi Y, Ishihara T, Okamoto K, Tanaka H. Evaluating the risks of arrhythmia following electrical injury: Two cases of electrical injuries in the upper limbs. SAGE Open Med Case Rep 2020; 8:2050313X20920421. [PMID: 32477561 PMCID: PMC7234342 DOI: 10.1177/2050313x20920421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 03/26/2020] [Indexed: 11/30/2022] Open
Abstract
Electrical injuries induce ventricular arrhythmias, which are lethal. Therefore, it is important to evaluate the risk of arrhythmias at initial presentation to the emergency department in cases of electrical injuries. Here, we report two cases with electrical injuries, where current flowed between the upper limbs, requiring 24-h hospitalization for arrhythmia monitoring. The patients were 57- and 30-year-old men, who sustained separate electrical injuries (6600 V, line voltage), with current flow from one hand to the other. They did not develop any ventricular arrhythmias during hospitalization and were discharged. The risk for ventricular arrhythmias is lower for electrical injuries occurring between the upper limbs than for those occurring between the upper and lower limbs. We conclude that 24-h hospitalization for monitoring of patients with electrical injuries of the upper limbs may be sufficient.
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Affiliation(s)
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Yohei Hirano
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Juri Inoue
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Takaaki Kawasaki
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Yukari Miyoshi
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Tadashi Ishihara
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Ken Okamoto
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Hiroshi Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
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