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Koenig V, Tratnig-Frankl P, Pittermann A, Windpassinger M, Joestl J, Aszmann O. Train Climbing-A new old trend in adolescents: Treatment of high voltage injuries and planning of a pilot project to raise awareness. Wien Klin Wochenschr 2024:10.1007/s00508-024-02399-1. [PMID: 39172198 DOI: 10.1007/s00508-024-02399-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/29/2024] [Indexed: 08/23/2024]
Abstract
INTRODUCTION An increasing number of high voltage electric burn injuries in a typically younger patient collective of train surfers and climbers at our level I center for burns was recognized. The purpose of this study was a retrospective data evaluation and as a consequence the implementation of an awareness program against train surfing. MATERIAL AND METHODS In a retrospective analysis of prospectively collected data, 17 patients with high voltage injuries, who had been treated at our unit between January 2022 and January 2023, were identified. Of these patients seven were treated for injuries due to train surfing or climbing and therefore included in this study. The patients were assessed clinically for total burn surface area (TBSA), degree of burn, associated Injuries, hospital length of stay, number and type of surgeries (fasciotomy, minor/major amputations, defect coverage split skin graft or flaps). RESULTS A total of seven males formed the basis of this report with an average age of 17.7 years (range 14-21 years). The highest ABSI (Abbreviated Burn Severity Index) score was 12, leading to the death of the 21-year-old patient who had 80% TBSA as well as multiple comorbidities including severe brain damage. The mean duration of stay at the intensive care unit (ICU) was 24.8 days and the mortality rate was 14.29%. CONCLUSION This study highlighted the severity of injuries, with a mean TBSA of 41.42% and a mortality rate of 14.29% among the study population. Train climbing and surfing patients presented with severe injuries and fatal long-term consequences. A pilot project involving several stakeholders was initiated in order to raise awareness of the dangers of electric arcs and the risk involved.
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Affiliation(s)
- Viktoria Koenig
- Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Philipp Tratnig-Frankl
- Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Anna Pittermann
- Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Marita Windpassinger
- Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Julian Joestl
- Private Clinic Priv.-Doz. Dr. Julian Joestl, PhD, MSc., Spitalgasse 19, 1090, Vienna, Austria
| | - Oskar Aszmann
- Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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MacQuene T, Kleintjes W, Nieuwoudt W, Camp S, Lydon G, Chu K. An increase in electrical burns during the covid lockdown in Western Cape, South Africa. Burns 2024; 50:1174-1179. [PMID: 38461080 DOI: 10.1016/j.burns.2024.02.011] [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: 07/27/2023] [Revised: 02/05/2024] [Accepted: 02/21/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND A severe Covid lockdown in South Africa may have changed burn patterns due to the downturn of the economy and stay-at-home policies. We describe the volume and type of burn admitted to a tertiary hospital before and during the Covid lockdown. MATERIALS AND METHODS This was a retrospective study from before (April 2019-March 2020) and during (April 2020-March 2021) the Covid pandemic. Patient demographics, burn etiology, and clinical outcomes were described. Logistic regression was used to model associations between burn etiology and the Covid period. RESULTS Of 544 burns, 254 (46.7%) occurred before and 290 (53.3%, p = 0.051) during Covid. The proportion of electrical burns doubled during Covid n = 20, 32.3% vs n = 42, 67.7%, (p = 0.053) periods. At least half were associated with suspected cable or copper theft. On multivariate analysis, flame burns (OR=2.42, p < 0.001), electrical burns (OR=4.88, p < 0.001), and paying patients (OR=4.21, p < 0.001) were more likely to be associated with the Covid period. CONCLUSION Electrical burns doubled during Covid, potentially related to an increase in cable and copper wire theft, a phenomenon described during hard economic times in other settings. More studies to understand this potential relationship are indicated to prepare burn centers during future pandemics and/or economic hardship.
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Affiliation(s)
- Tamlyn MacQuene
- Centre for Global Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Wayne Kleintjes
- Burn Unit, Tygerberg Academic Hospital, Cape Town, South Africa; Department of Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Willa Nieuwoudt
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sarah Camp
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Georgia Lydon
- Department of Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Kathryn Chu
- Centre for Global Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Department of Surgery, University of Botswana, Gaborone, Botswana.
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Ali S, Jaishinghani A. A case of high-tension electrical injury of the upper extremity. TRAUMA-ENGLAND 2023. [DOI: 10.1177/14604086231157116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Sajjad Ali
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Aman Jaishinghani
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
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Jiang H, Zhang Y, Zhang J, Li B, Zhu W, Liu C, Deng S, Du Y, Meng Z. Acupuncture for the treatment of thalamencephalic and mesencephalic injury secondary to electrical trauma: A case report. Front Neurosci 2023; 17:1139537. [PMID: 36950129 PMCID: PMC10025331 DOI: 10.3389/fnins.2023.1139537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/16/2023] [Indexed: 03/08/2023] Open
Abstract
In a case of thalamencephalic and mesencephalic injury secondary to electrical trauma, a 29-year-old patient has been receiving manual acupuncture for 17 months in National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion. As a result of treatment, the patient's self-care ability and quality of life have greatly improved. In order to fully understand how acupuncture can benefit neurological sequelae resulting from electrical trauma, further research is needed. Additionally, there should be consideration given to the promotion of acupuncture therapy in the neurological sequelae of electric shock.
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Affiliation(s)
- Hailun Jiang
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yi Zhang
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jieying Zhang
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Boxuan Li
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Weiming Zhu
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chaoda Liu
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shizhe Deng
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuzheng Du
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- *Correspondence: Yuzheng Du
| | - Zhihong Meng
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Zhihong Meng
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Chauveau N, Renard A, Gasperini G, Cazes N. Long-term consequences of electrical injury without initial signs of severity: The AFTER-ELEC study. Am J Emerg Med 2021; 50:518-525. [PMID: 34543835 DOI: 10.1016/j.ajem.2021.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/24/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND There is no specificity of emergency or long-term management of benign electrical injuries (EI). The main objective of our work was to describe the occurrence of long-term complications of EI considered as benign. METHODS Single-center retrospective study of a cohort of adult patients who consulted for EI without initials signs of severity in an emergency department between 2012 and 2019. All included patients were secondarily contacted by telephone at least one year after their EI to complete a questionnaire. RESULTS 76 adult patients visited the emergency department and 48 of them could be contacted by phone. 82% of the recalled patients had at least one complication following their EI. The main long-term complications were neurological (65%), psychological (58%) and cardiological (31%). Patients recalled eight years after EI had higher rates of neuropsychological complications than those recalled one year after EI. Only the time spent in the emergency department was statistically longer in patients who developed long-term complications compared to those who did not. DISCUSSION The occurrence of long-term neuropsychological complications predominates. The knowledge and management of these long-term consequences must be particularly well known by emergency physicians because they are often the first medical contact of the patient. Our results also seem to show a crescendo in time of the occurrence of long-term complications. CONCLUSION all health professionals involved in the care of victims of a EI must be made widely aware of the occurrence of these long-term complications, particularly neuropsychological ones, in order to improve the long-term patient care.
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Affiliation(s)
- Nathan Chauveau
- Service des urgences, Hôpital d'Instruction des Armées Sainte-Anne, 83000 Toulon, France
| | - Aurélien Renard
- Groupement Santé, Service médical d'urgence, Bataillon de marins-pompiers de Marseille, 13233 Marseille cedex 20, France
| | - Guillaume Gasperini
- Service des urgences, Hôpital d'Instruction des Armées Sainte-Anne, 83000 Toulon, France
| | - Nicolas Cazes
- Groupement Santé, Service médical d'urgence, Bataillon de marins-pompiers de Marseille, 13233 Marseille cedex 20, France.
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Dash S, Arumugam PK, Muthukumar V, Kumath M, Sharma S. Study of clinical pattern of limb loss in electrical burn injuries. Injury 2021; 52:1925-1933. [PMID: 33902868 DOI: 10.1016/j.injury.2021.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Electrical burn injuries are devastating and cause not only loss of life but also severe disabilities in the form of limb loss. Increase in urbanization, industrialization and overcrowding has led to an increase in electric injuries. MATERIAL AND METHODS The study was prospective in nature evaluating electric burns and studied the pattern of limb loss for a duration of 18 months from October 2016 to March 2018. Parameters recorded were demographic data, clinical data regarding the electrical injuries, complications, and outcomes. RESULTS Male patients made up 85.3% of cases. Mean TBSA was 24.76 ± 19.18%. Mean age was 27.59 ± 13.73 years. Pediatric patients made up 17%. High voltage burns constituted 68.2 %. Electric contact burn was the most common type making up 49.5% of cases. The most common cause was occupational (38.9%). A fasciotomy was required in 22% of cases with an amputation rate of 38% (209 out of 550). There were 190 major amputations and 106 minor amputations. Overall, the right upper limb amputations were twice as common as the left. The ratio of upper limb: lower limb amputation was 4:1. Fifty patients (23.9%) required revision amputation. The age group 11 to 30 years made up 55.5% of amputations. There was no statistical difference in amputation rates between males (31.31%) and females (41.97%). In patients with TBSA less than 25% amputation rate was 47.77% as compared to patients with more than 25% TBSA, 19.47% (p<0.001). Most amputations occurred due to electric contact burns (74.16%). In the high voltage group, 46.1% underwent amputation vs low voltage group -20.6% (p<0.001). Overall mortality rate was 12.7%. Three hundred patients (55%) had low level of awareness regarding consequences of electric injury. Thirty one percent had medium level of awareness and only 14 % had high level of awareness. There was a significant correlation between education level and awareness in adult patients (p<0.001). Seventy percent of persons with occupational injuries used only footwear and no other protective equipment. CONCLUSION Increasing public awareness, safety measures at workplaces are measures that will help reducing electrical burns which reduce limb and life loss.
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Affiliation(s)
- Suvashis Dash
- Department of Burns, Plastic & Maxillofacial Surgery, VM Medical College & Safdarjung Hospital, New Delhi.
| | - Praveen Kumar Arumugam
- Department of Burns, Plastic & Maxillofacial Surgery, VM Medical College & Safdarjung Hospital, New Delhi.
| | - Vamseedharan Muthukumar
- Department of Burns, Plastic & Maxillofacial Surgery, VM Medical College & Safdarjung Hospital, New Delhi.
| | - Manish Kumath
- Dept. of Forensic Medicine, V.M. Medical College & Safdarjung Hospital, New Delhi, 110029, India.
| | - Shardendu Sharma
- Department of Burns, Plastic & Maxillofacial Surgery, VM Medical College & Safdarjung Hospital, New Delhi
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AlQasas T, Galet C, Wibbenmeyer L. Delayed Spinal Cord Injury From Electrical Burns: Two Cases. J Burn Care Res 2021; 42:560-563. [PMID: 33022703 DOI: 10.1093/jbcr/iraa177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Spinal cord injury has been described in only 2% to 5% of electrical injuries. When its presentation is delayed for several days to weeks after the initial injury, recovery is not the rule. Herein, we describe two patients who developed spinal cord injury from electrical burns. Case 1: A 60-year-old male presented with a 40% TBSA after contacting a power line. On hospital day 6, he developed lower extremity weakness that progressed to flaccid paralysis. Case 2: A 58-year-old male sustained a 9% TBSA high-voltage injury. On hospital day 2, he started to have progressive weakness of his lower extremities that progressed to flaccid paralysis. Neither case was judged to have experienced additional significant trauma. Neurological complications after electrical injuries are protean. Delayed spinal cord injury is rare and associated with variable degrees of recovery. Neurological follow-up with rehabilitation is essential for a successful recovery.
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Affiliation(s)
- Tareq AlQasas
- Department of Surgery, Acute Care Surgery Division, University of Iowa, Iowa City
| | - Colette Galet
- Department of Surgery, Acute Care Surgery Division, University of Iowa, Iowa City
| | - Lucy Wibbenmeyer
- Department of Surgery, Acute Care Surgery Division, University of Iowa, Iowa City
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Knuth CM, Auger C, Jeschke MG. Burn-induced hypermetabolism and skeletal muscle dysfunction. Am J Physiol Cell Physiol 2021; 321:C58-C71. [PMID: 33909503 DOI: 10.1152/ajpcell.00106.2021] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Critical illnesses, including sepsis, cancer cachexia, and burn injury, invoke a milieu of systemic metabolic and inflammatory derangements that ultimately results in increased energy expenditure leading to fat and lean mass catabolism. Burn injuries present a unique clinical challenge given the magnitude and duration of the hypermetabolic response compared with other forms of critical illness, which drastically increase the risk of morbidity and mortality. Skeletal muscle metabolism is particularly altered as a consequence of burn-induced hypermetabolism, as it primarily provides a main source of fuel in support of wound healing. Interestingly, muscle catabolism is sustained long after the wound has healed, indicating that additional mechanisms beyond wound healing are involved. In this review, we discuss the distinctive pathophysiological response to burn injury with a focus on skeletal muscle function and metabolism. We first examine the diverse consequences on skeletal muscle dysfunction between thermal, electrical, and chemical burns. We then provide a comprehensive overview of the known mechanisms underlying skeletal muscle dysfunction that may be attributed to hypermetabolism. Finally, we review the most promising current treatment options to mitigate muscle catabolism, and by extension improve morbidity and mortality, and end with future directions that have the potential to significantly improve patient care.
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Affiliation(s)
- Carly M Knuth
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Auger
- Department of Biological Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Marc G Jeschke
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Immunology, University of Toronto, Toronto, Ontario, Canada.,Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Hand Bionic Score: a clinical follow-up study of severe hand injuries and development of a recommendation score to supply bionic prosthesis. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-020-01679-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Background
Severe hand injuries significantly limit function and esthetics of the affected hand due to massive trauma in skeletal and soft tissues. Surgical reconstruction is often unsatisfactory, so bionic prostheses are a consideration. However, assessment of functional outcomes and quality of life after surgical reconstruction to guide clinical decisions immediately after injury and in the course of treatment remain difficult.
Methods
We conducted a prospective follow-up analysis of patients with severe hand injuries during 2016–2018. We retrospectively evaluated initial trauma severity and examined current functional status, quality of life, general function, and satisfaction in everyday situations of the hand. We also developed a novel Hand Bionic Score to guide clinical recommendation for selective amputation and bionic prosthesis supply.
Results
We examined 30 patients with a mean age of 53.8 years and mean initial severity of hand injury (iHISS) of 138.4. Measures indicated moderate quality of life limitations, moderate to severe limitation of overall hand function, and slight to moderate limitation of actual hand strength and function. Mean time to follow-up examination was 3.67 years. Using the measured outcomes, we developed a Hand Bionic Score that showed good ability to differentiate patients based on outcome markers. Appropriate cutoff scores for all measured outcome markers were used to determine Hand Bionic Score classifications to guide clinical recommendation for elective amputation and bionic prosthetic supply: < 10 points, bionic hand supply not recommended; 10–14, bionic supply should be considered; or > 14, bionic supply is recommended.
Conclusions
While iHISS can guide early clinical decisions following severe hand injury, our novel Hand Bionic Score provides orientation for clinical decision-making regarding elective amputation and bionic prosthesis supply later during the course of treatment. The score not only considers hand function but also psychological outcomes and quality of life, which are important considerations for patients with severe hand injuries. However, future randomized multicenter studies are needed to validate Hand Bionic Score before further clinical application.
Level of evidence: Level III, risk/prognostic study.
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Uslu A. Reconstruction of the Distal Leg and Foot Using Free Anterolateral Thigh Flaps in Patients With High-Voltage Electrical Burns. J Burn Care Res 2020; 40:703-709. [PMID: 31032512 DOI: 10.1093/jbcr/irz070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In a patient with a high-voltage electrical burns, the extent of burning is greatest at the entrance and exit points of the electric current. As the exit point is usually the ankle and/or foot, these areas may be the most severely damaged. As local tissue is limited in this region, free tissue transfer is usually required for reconstruction. Eleven anterolateral thigh free flaps were placed for the reconstruction of foot and ankle defects caused by electrical burns. When the defects were large, we placed the flaps with two or three perforators. In six patients, recipient vessels were prepared in the trauma region or immediately adjacent thereto. Reconstructions were performed at an average of 23.18 days after the burns, and the average hospitalization time was 42.27 days. Patients with burns on the dorsum of the foot often required toe amputations. In patients who underwent direct reconstruction (without debridement), re-operations were required because of graft loss in other burnt areas. The foot and ankle are the regions most damaged by electrical burns. Vessels in the trauma zone or immediately proximal thereto can serve as recipient vessels. Even when the defect is sizeable, a large anterolateral thigh flap with multiple perforators can be harvested. No vascular problem was encountered during early or late reconstruction. The free flap is very reliable when used to reconstruct foot tissue defects caused by electrical burns.
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Affiliation(s)
- Asım Uslu
- Department of Plastic and Reconstructive Surgery, University of Health Sciences, Antalya Education and Research Hospital, Turkey
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11
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Chen CW, Lin YK, Yeh YS, Chen CW, Lin TY, Chang SH. Low-Voltage Electricity-Associated Burn Damage of Lung Parenchyma: Case Report and Literature Review. J Emerg Med 2020; 60:e33-e37. [PMID: 33097353 DOI: 10.1016/j.jemermed.2020.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/25/2020] [Accepted: 09/12/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Electrical injuries are common in daily life. The severity of electrical injury depends on the electric current, and assessing electrical damage is difficult because there appears to be no correlation between skin burns and visceral injury. We report a case of bilateral lung injury with pulmonary hemorrhage after exposure to low-voltage electricity. CASE REPORT A 23-year-old man was shocked by a low-voltage (110 V) electric current while at work. He had temporary loss of consciousness and twitching in the extremities, but soon regained consciousness and spontaneously stopped twitching. Electrical burn wounds were discovered on his back and forehead. Dyspnea and hemoptysis were noted. A computed tomography scan of the chest revealed patchy infiltration and consolidation of both lungs. The patient received treatment of tranexamic acid and prophylactic antibiotics for electricity-induced lung injury and pulmonary hemorrhage. Resolution of chest radiograph abnormalities was recorded on day 7. The mild dyspnea ceased approximately 2 weeks later. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Electricity-induced lung injury should be considered in patients with electrical injury through a suspicious electrical current transmission pathway, respiratory symptoms, and corresponding imaging findings. Pulmonary complications can be serious and require early intervention.
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Affiliation(s)
- Chi-Wei Chen
- Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Ko Lin
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Sung Yeh
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chao-Wen Chen
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Yin Lin
- Department of Family Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Sheng-Huang Chang
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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13
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Babu VS, Sharma S, Manas RK, Kaur C, R R. Study of serum creatine kinase and lactate dehydrogenase levels and their correlation in high-voltage electric contact burns. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01695-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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14
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Yoshino Y, Hashimoto A, Ikegami R, Irisawa R, Kanoh H, Sakurai E, Nakanishi T, Maekawa T, Tachibana T, Amano M, Hayashi M, Ishii T, Iwata Y, Kawakami T, Sarayama Y, Hasegawa M, Matsuo K, Ihn H, Omoto Y, Madokoro N, Isei T, Otsuka M, Kukino R, Shintani Y, Hirosaki K, Motegi S, Kawaguchi M, Asai J, Isogai Z, Kato H, Kono T, Tanioka M, Fujita H, Yatsushiro H, Sakai K, Asano Y, Ito T, Kadono T, Koga M, Tanizaki H, Fujimoto M, Yamasaki O, Doi N, Abe M, Inoue Y, Kaneko S, Kodera M, Tsujita J, Fujiwara H, Le Pavoux A. Wound, pressure ulcer and burn guidelines – 6: Guidelines for the management of burns, second edition. J Dermatol 2020; 47:1207-1235. [DOI: 10.1111/1346-8138.15335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 01/28/2023]
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15
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Stockly O, Wolfe A, Espinoza L, Simko L, Kowalske K, Carrougher G, Gibran N, Bamer A, Meyer W, Rosenberg M, Rosenberg L, Kazis L, Ryan C, Schneider J. The impact of electrical injuries on long-term outcomes: A Burn Model System National Database study. Burns 2020; 46:352-359. [DOI: 10.1016/j.burns.2019.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/17/2019] [Accepted: 07/24/2019] [Indexed: 12/21/2022]
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Analyse des accidents électriques chez les salariés d’une entreprise de distribution d’énergie électrique au Togo. ARCH MAL PROF ENVIRO 2020. [DOI: 10.1016/j.admp.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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17
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Moehrlen T, Landolt MA, Meuli M, Moehrlen U. Non intentional burns in children: Analyzing prevention and acute treatment in a highly developed country. Burns 2019; 45:1908-1917. [PMID: 31601428 DOI: 10.1016/j.burns.2019.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 11/26/2022]
Abstract
The objective of this study was to evaluate where and when pediatric burn injuries occurred. Furthermore the quality of first aid treatment, ratio of skin grafting and length of hospital stay were evaluated. The patient records of 749 children with acute burns admitted to the University Children's Hospital of Zurich, Switzerland, were retrospectively reviewed over an 11-year period. Burn injuries in children with an immigrant background were overrepresented in our study population, whereby the proportion of immigrants decreased with rising age. Sixty-five percent of all patients received some form of first aid. Of those 4.5% did not comply with the current guidelines. Furthermore initial assessment of total body surface area (TBSA) by the first line physician was overestimated in 76% of cases. Flame injuries occurred mainly in summertime in outdoor settings and needed significant more often skin grafts than scalds, which mainly occurred indoors and in wintertime. As a result, patients with flame injuries had to stay significantly longer in hospital (flames: 21 days (range: 1-259 days; median: 30; interquartile range (IQR): 30) versus scalds: 7 days (range: 1-130 days; median: 7; IQR: 12); p < 0.001). Furthermore high voltage injuries often resulted in lower-leg amputations (n = 3; 43%). Based on these facts, targets for the improvement of a prevention campaign and the treatment for burned children were named.
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Affiliation(s)
- Theres Moehrlen
- Department of Pediatric Surgery, University Children's Hospital Zurich, Switzerland
| | - Markus A Landolt
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Switzerland; Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Martin Meuli
- Department of Pediatric Surgery, University Children's Hospital Zurich, Switzerland
| | - Ueli Moehrlen
- Department of Pediatric Surgery, University Children's Hospital Zurich, Switzerland.
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18
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Abstract
Volume resuscitation of patients with high-voltage electrical injuries (>1000 V) is a more complex challenge than standard burn resuscitation. High voltages penetrate deep tissues. These deep injuries are not accounted for in resuscitation formulae dependent on percentage of cutaneous burn. Myonecrosis occurring from direct electrical injury and secondary compartment syndromes can result in rhabdomyolysis, compromising renal function and urine output. Urine output is the primary end point, with a goal of 1 mL/kg/h for adult patients with high-voltage electrical injuries. As such, secondary resuscitation end points of laboratory values, such as lactate, base deficit, hemoglobin, and creatinine, as well as hemodynamic monitoring, such as mean arterial pressure and thermodilution techniques, can become crucial in guiding optimum administration of resuscitation fluids. Mannitol and bicarbonates are available but have limited support in the literature. High-voltage electrical injury patients often develop acute kidney injury requiring dialysis and have increased risks of chronic kidney disease and mortality. Continuous venovenous hemofiltration is a well-supported adjunct to clear the myoglobin load that hemodialysis cannot from circulation.
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Radulovic N, Mason SA, Rehou S, Godleski M, Jeschke MG. Acute and long-term clinical, neuropsychological and return-to-work sequelae following electrical injury: a retrospective cohort study. BMJ Open 2019; 9:e025990. [PMID: 31092649 PMCID: PMC6530314 DOI: 10.1136/bmjopen-2018-025990] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To determine acute and long-term clinical, neuropsychological, and return-to-work (RTW) effects of electrical injuries (EIs). This study aims to further contrast sequelae between low-voltage and high-voltage injuries (LVIs and HVIs). We hypothesise that all EIs will result in substantial adverse effects during both phases of management, with HVIs contributing to greater rates of sequelae. DESIGN Retrospective cohort study evaluating EI admissions between 1998 and 2015. SETTING Provincial burn centre and rehabilitation hospital specialising in EI management. PARTICIPANTS All EI admissions were reviewed for acute clinical outcomes (n=207). For long-term outcomes, rehabilitation patients, who were referred from the burn centre (n=63) or other burn units across the province (n=65), were screened for inclusion. Six patients were excluded due to pre-existing psychiatric conditions. This cohort (n=122) was assessed for long-term outcomes. Median time to first and last follow-up were 201 (68-766) and 980 (391-1409) days, respectively. OUTCOME MEASURES Acute and long-term clinical, neuropsychological and RTW sequelae. RESULTS Acute clinical complications included infections (14%) and amputations (13%). HVIs resulted in greater rates of these complications, including compartment syndrome (16% vs 4%, p=0.007) and rhabdomyolysis (12% vs 0%, p<0.001). Rates of acute neuropsychological sequelae were similar between voltage groups. Long-term outcomes were dominated by insomnia (68%), anxiety (62%), post-traumatic stress disorder (33%) and major depressive disorder (25%). Sleep difficulties (67%) were common following HVIs, while the LVI group most frequently experienced sleep difficulties (70%) and anxiety (70%). Ninety work-related EIs were available for RTW analysis. Sixty-one per cent returned to their preinjury employment and 19% were unable to return to any form of work. RTW rates were similar when compared between voltage groups. CONCLUSIONS This is the first investigation to determine acute and long-term patient outcomes post-EI as a continuum. Findings highlight substantial rates of neuropsychological and social sequelae, regardless of voltage. Specialised and individualised early interventions, including screening for mental health concerns, are imperative to improvingoutcomes of EI patients.
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Affiliation(s)
- Nada Radulovic
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Stephanie A Mason
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sarah Rehou
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Matthew Godleski
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Physical Medicine and Rehabilitation, St. John's Rehab Hospital, Toronto, Ontario, Canada
| | - Marc G Jeschke
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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20
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Boyd AN, Hartman BC, Sood R, Walroth TA. A voltage-based analysis of fluid delivery and outcomes in burn patients with electrical injuries over a 6-year period. Burns 2019; 45:869-875. [PMID: 30935702 DOI: 10.1016/j.burns.2018.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/02/2018] [Accepted: 08/10/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Electrical injuries are associated with significant morbidity for affected patients. While cardiac and surgical interventions have been extensively reported, no practice guidelines or studies have specifically addressed fluid delivery and associated outcomes of patients with electrical injuries. The study objective was to evaluate the differences in fluid delivery in patients with high (≥1000V) and low (<1000V) voltage electrical injuries. METHODS This retrospective, observational study included adult electrical injury patients admitted for acute care. Patients with reported voltages were classified into high and low voltage subgroups. Primary outcomes of fluid administration and urine output over the first 24h after injury were assessed between subgroups. Secondary outcomes included renal, cardiac, surgical, and additional complications such as mortality, cost, and length of stay. RESULTS Data were analyzed in 36 patients with reported voltages, including 26 patients in the high and 10 patients in the low voltage subgroups. Patients in the high voltage subgroup had a statistically significant higher median (IQR) total IV fluid given [46.6 (22.4-61.9) vs. 22.5 (8.3-31.4) mL/kg, p=0.033] in the first 24h to achieve a similar urine output to the low voltage subgroup. The high voltage patients had higher rates of myoglobinuria, rhabdomyolysis, and creatinine kinase elevation. Patients in the high voltage vs. low voltage group had significantly longer median (IQR) length of stay (days) [11 (2-19) vs. 1 (1-6); p=0.015] and higher cost of hospital stay [$124,608 (19,486-296,991) vs. $16,165 (12,409-69,659); p=0.033]. CONCLUSIONS These results reinforce the importance of assessing electrical injuries and obtaining a voltage to provide patient-specific care, as high voltage electrical injuries receive more fluid than estimated maintenance rates. This study is the first of its kind to characterize fluid given for high and low voltage electrical injuries and effects on patient outcomes.
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Affiliation(s)
- A N Boyd
- Eskenazi Health, Department of Pharmacy, 720 Eskenazi Avenue, Indianapolis, IN, 46202, United States.
| | - B C Hartman
- Eskenazi Health, Richard M. Fairbanks Burn Center, 720 Eskenazi Avenue, Indianapolis, IN, 46202, United States.
| | - R Sood
- Eskenazi Health, Richard M. Fairbanks Burn Center, 720 Eskenazi Avenue, Indianapolis, IN, 46202, United States.
| | - T A Walroth
- Eskenazi Health, Department of Pharmacy, 720 Eskenazi Avenue, Indianapolis, IN, 46202, United States.
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21
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Tapking C, Hundeshagen G, Popp D, Lee JO, Herndon DN, Zapata-Sirvent R, Branski LK. The Frequency and Reason For Amputations in Electrically Burned Pediatric Patients. J Burn Care Res 2019; 40:107-111. [PMID: 30371857 DOI: 10.1093/jbcr/iry056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Electrical injuries induce substantial morbidity and mortality. Amputations are often necessary to enable survival and based on tissue nonviability, development of life-threatening infection, or expected nonfunctional outcome. They analyzed occurrence and type of amputations in their institution for electrical and nonelectrical pediatric burns and the number of reconstructive operations. Patients who underwent any amputation between 1999 and 2017 were identified. Patients with electrical burns (EB) were matched regarding age, sex, and percent total body surface area (%TBSA) burned to patients with nonelectrical burns (NEB). Both groups (n = 35 EB, n = 70 NEB) were comparable regarding age (EB, 11.6 ± 4.5 years; NEB, 11.1 ± 4.5 years, P = .550) and %TBSA (36.7 ± 15.4% and 37.7 ± 12.9%, P = .738). Major amputations (above wrist or ankle) were performed in 77% of EB vs 31% of NEB (P < .001). Amputations above knee or elbow were performed in 13 (37.1%) vs two patients (2.9%, P < .001). Eight (22.9%) vs six patients (8.6%) underwent combination of two or more major amputations (P = .042). In both groups, most amputations were performed for functional reasons. Length of stay was shorter in EB group (33 ± 27 vs 47 ± 38 days, P = .040). EB patients underwent 9.9 ± 7.1 total operations compared with 14.4 ± 5.1 operations (P < .001). Of these, 6.5 ± 3.6 and 7.9 ± 3.3 (P = .023) were performed during acute stay and 3.3 ± 4.8 and 6.5 ± 3.5 after acute stay (P < .001), respectively. Mortality was comparable. EB were associated with larger extent of limb loss and more major amputations than NEB with amputations. They furthermore required a smaller number of reconstructive procedures. EB require extra attention of caregivers, because of their extensive tissue damage.
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Affiliation(s)
- Christian Tapking
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children-Galveston® Galveston, Texas.,Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Gabriel Hundeshagen
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children-Galveston® Galveston, Texas.,Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Daniel Popp
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children-Galveston® Galveston, Texas.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Jong O Lee
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children-Galveston® Galveston, Texas
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children-Galveston® Galveston, Texas
| | - Ramón Zapata-Sirvent
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children-Galveston® Galveston, Texas
| | - Ludwik K Branski
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children-Galveston® Galveston, Texas.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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22
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Rolekar N, Kalra G, Sharma A. Changing trends in electrical burn injury due to technology. INDIAN JOURNAL OF BURNS 2019. [DOI: 10.4103/ijb.ijb_22_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Effects of high-voltage electrical burns and other burns on levels of serum oxidative stress and telomerase in children. Burns 2018; 44:2034-2041. [DOI: 10.1016/j.burns.2018.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/27/2018] [Accepted: 07/06/2018] [Indexed: 01/17/2023]
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24
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Abstract
There are an increasing number of injuries associated with ambulatory mobile phone use. Pokémon Go is one of the first widely used mobile phone augmented reality games and generated substantial media interest. We present a case of electrical burns in a Pokémon Go player and review literature on ambulatory mobile phone injuries.
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Affiliation(s)
- Kate Gemma Richards
- Department of Plastic Surgery, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Kai Yuen Wong
- Department of Plastic Surgery, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Mansoor Khan
- Department of Plastic Surgery, Salisbury NHS Foundation Trust, Salisbury, UK
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25
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Gille J, Schmidt T, Dragu A, Emich D, Hilbert-Carius P, Kremer T, Raff T, Reichelt B, Siafliakis A, Siemers F, Steen M, Struck MF. Electrical injury - a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors. Scand J Trauma Resusc Emerg Med 2018; 26:43. [PMID: 29855384 PMCID: PMC5984367 DOI: 10.1186/s13049-018-0513-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/21/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Electrical injuries represent life-threatening emergencies. Evidence on differences between high (HVI) and low voltage injuries (LVI) regarding characteristics at presentation, rhabdomyolysis markers, surgical and intensive burn care and outcomes is scarce. METHODS Consecutive patients admitted to two burn centers for electrical injuries over an 18-year period (1998-2015) were evaluated. Analysis included comparisons of HVI vs. LVI regarding demographic data, diagnostic and treatment specific variables, particularly serum creatinine kinase (CK) and myoglobin levels over the course of 4 post injury days (PID), and outcomes. RESULTS Of 4075 patients, 162 patients (3.9%) with electrical injury were analyzed. A total of 82 patients (50.6%) were observed with HVI. These patients were younger, had considerably higher morbidity and mortality, and required more extensive burn surgery and more complex burn intensive care than patients with LVI. Admission CK and myoglobin levels correlated significantly with HVI, burn size, ventilator days, surgical interventions, amputation, flap surgery, renal replacement therapy, sepsis, and mortality. The highest serum levels were observed at PID 1 (myoglobin) and PID 2 (CK). In 23 patients (14.2%), cardiac arrhythmias were observed; only 4 of these arrhythmias occurred after hospital admission. The independent predictors of mortality were ventilator days (OR 1.27, 95% CI 1.06-1.51, p = 0.009), number of surgical interventions (OR 0.47, 95% CI 0.27-0.834, p = 0.010) and limb amputations (OR 14.26, 95% CI 1.26-162.1, p = 0.032). CONCLUSIONS Patients with electrical injuries, HVI in particular, are at high risk for severe complications. Due to the need for highly specialized surgery and intensive care, treatment should be reserved to burn units. Serum myoglobin and CK levels reflect the severity of injury and may predict a more complex clinical course. Routine cardiac monitoring > 24 h post injury does not seem to be necessary.
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Affiliation(s)
- Jochen Gille
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, St. Georg Hospital, Delitzscher Str. 141, 04129, Leipzig, Germany
| | - Thomas Schmidt
- Department of Medical Psychology, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany
| | - Adrian Dragu
- Department of Plastic and Hand Surgery, Burn Center, St. Georg Hospital, Delitzscher Str. 141, 04129, Leipzig, Germany.,Department of Plastic and Hand Surgery, University Center of Orthopedics and Trauma Surgery, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Germany
| | - Dimitri Emich
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, St. Georg Hospital, Delitzscher Str. 141, 04129, Leipzig, Germany
| | - Peter Hilbert-Carius
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany
| | - Thomas Kremer
- Department of Plastic and Hand Surgery, Burn Center, St. Georg Hospital, Delitzscher Str. 141, 04129, Leipzig, Germany
| | - Thomas Raff
- Department of Plastic and Hand Surgery, Burn Center, St. Georg Hospital, Delitzscher Str. 141, 04129, Leipzig, Germany
| | - Beate Reichelt
- Department of Plastic and Hand Surgery, Burn Center, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany
| | - Apostolos Siafliakis
- Department of Plastic and Hand Surgery, Burn Center, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany
| | - Frank Siemers
- Department of Plastic and Hand Surgery, Burn Center, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany
| | - Michael Steen
- Department of Plastic and Hand Surgery, Burn Center, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany
| | - Manuel F Struck
- Department of Plastic and Hand Surgery, Burn Center, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany. .,Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
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26
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Shih JG, Shahrokhi S, Jeschke MG. Review of Adult Electrical Burn Injury Outcomes Worldwide: An Analysis of Low-Voltage vs High-Voltage Electrical Injury. J Burn Care Res 2018; 38:e293-e298. [PMID: 27359191 PMCID: PMC5179293 DOI: 10.1097/bcr.0000000000000373] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aims of this article are to review low-voltage vs high-voltage electrical burn complications in adults and to identify novel areas that are not recognized to improve outcomes. An extensive literature search on electrical burn injuries was performed using OVID MEDLINE, PubMed, and EMBASE databases from 1946 to 2015. Studies relating to outcomes of electrical injury in the adult population (≥18 years of age) were included in the study. Forty-one single-institution publications with a total of 5485 electrical injury patients were identified and included in the present study. Fourty-four percent of these patients were low-voltage injuries (LVIs), 38.3% high-voltage injuries (HVIs), and 43.7% with voltage not otherwise specified. Forty-four percentage of studies did not characterize outcomes according to LHIs vs HVIs. Reported outcomes include surgical, medical, posttraumatic, and others (long-term/psychological/rehabilitative), all of which report greater incidence rates in HVI than in LVI. Only two studies report on psychological outcomes such as posttraumatic stress disorder. Mortality rates from electrical injuries are 2.6% in LVI, 5.2% in HVI, and 3.7% in not otherwise specified. Coroner's reports revealed a ratio of 2.4:1 for deaths caused by LVI compared with HVI. HVIs lead to greater morbidity and mortality than LVIs. However, the results of the coroner's reports suggest that immediate mortality from LVI may be underestimated. Furthermore, on the basis of this analysis, we conclude that the majority of studies report electrical injury outcomes; however, the majority of them do not analyze complications by low vs high voltage and often lack long-term psychological and rehabilitation outcomes after electrical injury indicating that a variety of central aspects are not being evaluated or assessed.
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Affiliation(s)
- Jessica G Shih
- From the *Division of Plastic Surgery, Department of Surgery and †Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ‡Department of Immunology, University of Toronto, Ontario, Canada; and §Sunnybrook Research Institute, Toronto, Ontario, Canada
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27
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Retrospective Review of Free Anterolateral Thigh Flaps for Limb Salvage in Severely Injured High-Voltage Electrical Burn Patients. Ann Plast Surg 2018; 80:232-237. [PMID: 29309334 DOI: 10.1097/sap.0000000000001283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND High-voltage electrical injuries usually cause extensive and devastating damages to the extremities. Timely and effective coverage of the wounds to maximally preserve the viable tissue is important for salvage and the ultimate functional outcome of the involved extremities. In this study, free anterolateral thigh flaps with a single-perforator pedicle were conducted to maximize tissue salvage and decrease late skeletal and neuromuscular complications of the involved extremities injured by high-voltage electricity. METHODS From June 2012 to December 2015, 12 patients with high-voltage electrical injuries on the extremities were recruited. After primary or secondary debridement, free anterolateral thigh flaps with a single-perforator pedicle were used for limb salvage. Patients' clinical records, including etiology, sex, age, perforator type, defect location, duration before admission, defect and flap size, timing of reconstruction, and complications, were extracted and analyzed. RESULTS All patients were followed up ranging from 10 to 25 months, with an average follow-up of 15.9 months. Free anterolateral thigh flap with a single-perforator pedicle was performed for 12 consecutive patients with high-voltage electrical injuries. The mean time taken before the transplantation of the flap was 5.25 days, with a range from 2 to 8 days. The average size of the resultant defects after debridement was 187.0 cm (84-350 cm), the average size of the flaps was 265.3 cm (119-448 cm), and the average time of the surgical operation was 314.6 minutes (260-355 minutes). All flaps healed uneventfully without associated complications. No weakness of the donor thigh was observed in all cases. CONCLUSIONS Free anterolateral thigh flaps with a single-perforator pedicle were an effective and reliable therapeutic intervention for the management of severe high-voltage electrical injuries on the extremities.
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Aounzou S, Chraibi F, El Bahloul M, El Abdellaoui M, Benatiya Andaloussi I, Tahri H. [Bilateral cataract caused by electrocution: A case report]. J Fr Ophtalmol 2017; 40:e413-e414. [PMID: 29162283 DOI: 10.1016/j.jfo.2016.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 11/30/2016] [Accepted: 12/03/2016] [Indexed: 10/18/2022]
Affiliation(s)
- S Aounzou
- CHU Hassan II-Fès, centre hospitalier Hrazem, BP 1835, Atlas, avenue Hassan-II, 30110 Fès, Maroc.
| | - F Chraibi
- CHU Hassan II-Fès, centre hospitalier Hrazem, BP 1835, Atlas, avenue Hassan-II, 30110 Fès, Maroc
| | - M El Bahloul
- CHU Hassan II-Fès, centre hospitalier Hrazem, BP 1835, Atlas, avenue Hassan-II, 30110 Fès, Maroc
| | - M El Abdellaoui
- CHU Hassan II-Fès, centre hospitalier Hrazem, BP 1835, Atlas, avenue Hassan-II, 30110 Fès, Maroc
| | - I Benatiya Andaloussi
- CHU Hassan II-Fès, centre hospitalier Hrazem, BP 1835, Atlas, avenue Hassan-II, 30110 Fès, Maroc
| | - H Tahri
- CHU Hassan II-Fès, centre hospitalier Hrazem, BP 1835, Atlas, avenue Hassan-II, 30110 Fès, Maroc
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29
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Abstract
Contact with high- or low-voltage electricity can cause injury. Low-voltage damage is more common and widespread, although there is little information on it in the literature. Exposure to an electrical current can effect every organ system in the body. The degree of damage is related to many factors, including the duration of exposure, type of current, and nature of the affected tissue. An unusual low-voltage electrical injury with a serious pulmonary lesion is presented, including the clinical intervention and imaging findings. We present a 20-year-old male electrician who sustained direct electrical damage to the pulmonary parenchyma, with no signs of chest wall damage, when exposed to a 380 V shock while working. Imaging demonstrated an electrical burn of the posterior right lower lobe. This case demonstrates that a low-voltage electric current can cause lung damage. A timely diagnosis is required for treatment.
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Affiliation(s)
- Harun Karamanli
- Department of Respiratory Medicine, Ataturk Chest Disease and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - R. Akgedik
- Department of Respiratory Medicine, Ordu State Hospital, Ordu, Turkey
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30
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Hansen SM, Riahi S, Hjortshøj S, Mortensen R, Køber L, Søgaard P, Torp-Pedersen C. Mortality and risk of cardiac complications among immediate survivors of accidental electric shock: a Danish nationwide cohort study. BMJ Open 2017; 7:e015967. [PMID: 28851780 PMCID: PMC5629654 DOI: 10.1136/bmjopen-2017-015967] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Exposure to electric shock has been associated with an increased risk of developing delayed cardiac arrhythmias and cardiac diseases. We examined whether electric shock patients have an increased risk of developing cardiac disease, cardiac arrhythmias or death compared with the general Danish population. DESIGN Matched cohort study. SETTING A nationwide study in Denmark from 1994 to 2011. PARTICIPANTS We identified 11 462 Danish patients who visited an emergency ward or were admitted to a hospital due to electric shock from 1994 to 2011. Each patient was matched for age and sex with five random controls from the Danish population. MAIN OUTCOME MEASURES Mortality, cardiac procedures and cardiac diseases following electric shock. RESULTS A total of 7390 electric shock patients were seen at an emergency ward and 4072 electric shock patients were admitted to a hospital. The median patient age was 28.6 years (Q1-Q3, 21.3-37.7) for the emergency ward patients and 26.4 years (Q1-Q3, 18.3-37.4) for admitted patients. In both groups, most patients were male (74.0% and 76.8%). Few of the electric shock patients had a record of cardiovascular disease at baseline (364/11 462, 3.2%). The 5-year cumulative incidence of death was 0.47% (95% CI 0.29% to 0.65%) for emergency ward patients and 1.04% (95% CI 0.71% to 1.37%) for admitted patients. No difference in 5-year survival was observed compared with matched controls (emergency ward, p=0.10; admitted patients, p=0.80). Fewer than four patients received a pacemaker within 30 days. CONCLUSIONS This nationwide study did not demonstrate an increase in mortality among patients seen at hospitals after accidental electric shock compared with a background population. Cardiac procedures and diseases following electric shock were very rare. We suggest that nearly all patients can be discharged safely from the emergency room after electric shock without further observation.
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Affiliation(s)
- Steen Møller Hansen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Hjortshøj
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Rikke Mortensen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Hundeshagen G, Wurzer P, Forbes A, Voigt C, Collins V, Cambiaso-Daniel J, Finnerty CC, Herndon DN, Branski LK. The occurrence of single and multiple organ dysfunction in pediatric electrical versus other thermal burns. J Trauma Acute Care Surg 2017; 82:946-951. [PMID: 28431417 PMCID: PMC5407303 DOI: 10.1097/ta.0000000000001356] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Multiple organ failure (MOF) is a major contributor to morbidity and mortality in burned children. While various complications induced by electrical injuries have been described, the incidence and severity of single organ failure (SOF) and MOF associated with this type of injury are unknown. The study was undertaken to compare the incidence and severity of SOF and MOF as well as other complications between electrically and thermally burned children. PATIENTS AND METHODS Between 2001 and 2016, 288 pediatric patients with electrical burns (EB; n = 96) or thermal burns (CTR; n = 192) were analyzed in this study. Demographic data; length of hospitalization; and number and type of operations, amputations, and complications were statistically analyzed. Incidence of SOF and MOF was assessed using the DENVER2 classification in an additive mixed model over time. Compound scores and organ-specific scores for lung, heart, kidney, and liver were analyzed. Serum cytokine expression profiles of both groups were also compared over time. Significance was accepted at p < 0.05. RESULTS Both groups were comparable in age (CTR, 11 ± 5 years, vs EB, 11 ± 5 years), percent total body surface area burned (CTR, 33% ± 25%, vs EB, 32 ± 25%), and length of hospitalization (CTR, 18 ± 26 days, vs EB, 18 ± 21 days). The percentage of high-voltage injury in the EB group was 64%. The incidence of MOF was lower in the EB group (2 of 96 [2.1%]) than the CTR group (20 of 192 [10.4%]; p < 0.05). The incidence of single organ failure was comparable between groups. Incidence of pulmonary failure was comparable in both groups, but incidence of inhalation injury was significantly higher in the CTR group (p < 0.0001). Patients in the EB group had more amputations (p < 0.001), major amputations (p = 0.001), and combined major amputations (p < 0.01). Mortality was comparable between the groups. Serum cytokine expression profiles were also comparable between the groups. CONCLUSIONS In pediatric patients, electrical injury is associated with a lower incidence of MOF than other thermal burns. Early and radical debridement of nonviable tissue is crucial to improve outcomes in the electrical burn patient population. LEVEL OF EVIDENCE Retrospective chart review, level III.
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Affiliation(s)
- Gabriel Hundeshagen
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
- Shriners Hospitals for Children—Galveston, Galveston, Texas, USA
| | - Paul Wurzer
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
- Shriners Hospitals for Children—Galveston, Galveston, Texas, USA
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Abigail Forbes
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Charles Voigt
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
- Shriners Hospitals for Children—Galveston, Galveston, Texas, USA
| | - Vanessa Collins
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Janos Cambiaso-Daniel
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
- Shriners Hospitals for Children—Galveston, Galveston, Texas, USA
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Celeste C. Finnerty
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
- Shriners Hospitals for Children—Galveston, Galveston, Texas, USA
- Sealy Center for Molecular Medicine and the Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - David N. Herndon
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
- Shriners Hospitals for Children—Galveston, Galveston, Texas, USA
| | - Ludwik K. Branski
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
- Shriners Hospitals for Children—Galveston, Galveston, Texas, USA
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Comparison of the Results of Early Flap Coverage with Late Flap Coverage in High-Voltage Electrical Injury. J Burn Care Res 2017; 38:e568-e573. [DOI: 10.1097/bcr.0000000000000422] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aszmann OC, Vujaklija I, Roche AD, Salminger S, Herceg M, Sturma A, Hruby LA, Pittermann A, Hofer C, Amsuess S, Farina D. Elective amputation and bionic substitution restore functional hand use after critical soft tissue injuries. Sci Rep 2016; 6:34960. [PMID: 27721419 PMCID: PMC5056343 DOI: 10.1038/srep34960] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/15/2016] [Indexed: 11/20/2022] Open
Abstract
Critical soft tissue injuries may lead to a non-functional and insensate limb. In these cases standard reconstructive techniques will not suffice to provide a useful outcome, and solutions outside the biological arena must be considered and offered to these patients. We propose a concept which, after all reconstructive options have been exhausted, involves an elective amputation along with a bionic substitution, implementing an actuated prosthetic hand via a structured tech-neuro-rehabilitation program. Here, three patients are presented in whom this concept has been successfully applied after mutilating hand injuries. Clinical tests conducted before, during and after the procedure, evaluating both functional and psychometric parameters, document the benefits of this approach. Additionally, in one of the patients, we show the possibility of implementing a highly functional and natural control of an advanced prosthesis providing both proportional and simultaneous movements of the wrist and hand for completing tasks of daily living with substantially less compensatory movements compared to the traditional systems. It is concluded that the proposed procedure is a viable solution for re-gaining highly functional hand use following critical soft tissue injuries when existing surgical measures fail. Our results are clinically applicable and can be extended to institutions with similar resources.
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Affiliation(s)
- Oskar C Aszmann
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.,Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Ivan Vujaklija
- Institute of Neurorehabilitation Systems, Bernstein Focus Neurotechnology Göttingen, University Medical Center Göttingen, Georg-August University, Von-Siebold-Str. 6, 37075 Göttingen, Germany
| | - Aidan D Roche
- Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Stefan Salminger
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.,Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Malvina Herceg
- Department of Physical and Rehabilitation Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Agnes Sturma
- Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.,Master Degree Program "Health Assisting Engineering", University of Applied Sciences FH Campus Wien, Favoritenstraße 226, 1100 Vienna, Austria
| | - Laura A Hruby
- Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Anna Pittermann
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Christian Hofer
- Otto Bock Healthcare Products GmbH, Brehmstraße 16, 1110 Vienna, Austria
| | - Sebastian Amsuess
- Otto Bock Healthcare Products GmbH, Brehmstraße 16, 1110 Vienna, Austria
| | - Dario Farina
- Institute of Neurorehabilitation Systems, Bernstein Focus Neurotechnology Göttingen, University Medical Center Göttingen, Georg-August University, Von-Siebold-Str. 6, 37075 Göttingen, Germany
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Bose A, Chhabra CB, Chamania S, Hemvani N, Chitnis DS. Cardiac troponin I: A potent biomarker for myocardial damage assessment following high voltage electric burn. Indian J Plast Surg 2016; 49:406-409. [PMID: 28216824 PMCID: PMC5288919 DOI: 10.4103/0970-0358.197225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Myocardial infarction (MI) following high voltage electric burn is very rare, and its pathogenesis remains controversial. Electrical burns represent only 4% of all burns. Hence, clinical managements have taken a slow pace in developing. The recent guidelines laid down by the cardiology societies include cardiac troponin I (cTnI) as the gold standard marker for the assessment of myocardial damage assessment. Two patients were admitted to our hospital at the different time with the same kind of high voltage electric burn. Both patients had complained with chest discomfort during admission, and cardiac parameter assessment was done for both the patients. cTnI was also measured for both patients, and marked increase in the values was seen within 5 h of onset of myocardial damage and got into normal range within 72 h. Myocardial damage following electric burn needs to be suspected and assessed as early as possible. Hence, cTnI should be the valuable tool to detect the severity of myocardial damage incurred in the electric burn cases.
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Affiliation(s)
- Arindam Bose
- Department of Pathology, Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
| | - Chandra B. Chhabra
- Department of Cardiology, Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
| | - Shobha Chamania
- Department of Burn Surgery, Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
| | - Nanda Hemvani
- Department of Pathology, Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
| | - Dhananjay S. Chitnis
- Department of Pathology, Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
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Parvathy G, Shaji CV, Kabeer KA, Prasanth SR. High-voltage electrocution causing bulbar dysfunction. J Neurosci Rural Pract 2016; 7:453-5. [PMID: 27365968 PMCID: PMC4898119 DOI: 10.4103/0976-3147.181479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Electrical shock can result in neurological complications, involving both peripheral and central nervous systems, which may present immediately or later on. High-voltage electrical injuries are uncommonly reported and may predispose to both immediate and delayed neurologic complications. We report the case of a 68-year-old man who experienced a high-voltage electrocution injury, subsequently developed bulbar dysfunction and spontaneously recovered. We describe the development of bulbar palsy following a significant electrical injury, which showed no evidence of this on magnetic resonance imaging. High-voltage electrocution injuries are a serious problem with potential for both immediate and delayed neurologic sequelae. The existing literature has no reports on bulbar dysfunction following electrocution, apart from motor neuron disease.
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Affiliation(s)
- G Parvathy
- Department of Neurology, Government TD Medical College, Alappuzha, Kerala, India
| | - C V Shaji
- Department of Neurology, Government TD Medical College, Alappuzha, Kerala, India
| | - K A Kabeer
- Department of Neurology, Government TD Medical College, Alappuzha, Kerala, India
| | - S R Prasanth
- Department of Neurology, Government TD Medical College, Alappuzha, Kerala, India
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Rådman L, Gunnarsson LG, Nilsagård Y, Nilsson T. Neurosensory findings among electricians with self-reported remaining symptoms after an electrical injury: A case series. Burns 2016; 42:1712-1720. [PMID: 27317339 DOI: 10.1016/j.burns.2016.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/20/2016] [Accepted: 05/21/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Symptoms described in previous studies indicate that electrical injury can cause longstanding injuries to the neurosensory nerves. The aim of the present case series was to objectively assess the profile of neurosensory dysfunction in electricians in relation to high voltage or low voltage electrical injury and the "no-let-go phenomenon". METHODS Twenty-three Swedish male electricians exposed to electrical injury were studied by using a battery of clinical instruments, including quantitative sensory testing (QST). The clinical test followed a predetermined order of assessments: thermal perceptions thresholds, vibration perception thresholds, tactile gnosis (the Shape and Texture Identification test), manual dexterity (Purdue Pegboard Test), and grip strength. In addition, pain was studied by means of a questionnaire, and a colour chart was used for estimation of white fingers. RESULTS The main findings in the present case series were reduced thermal perceptions thresholds, where half of the group showed abnormal values for warm thermal perception and/or cold thermal perception. Also, the tactile gnosis and manual dexterity were reduced. High voltage injury was associated with more reduced sensibility compared to those with low voltage. CONCLUSION Neurosensory injury can be objectively assessed after an electrical injury by using QST with thermal perception thresholds. The findings are consistent with injuries to small nerve fibres. In the clinical setting thermal perception threshold is therefore recommended, in addition to tests of tactile gnosis and manual dexterity (Purdue Pegboard).
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Affiliation(s)
- Lisa Rådman
- Department of Occupational and Environmental Medicine, Faculty of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden; Department of Physiotherapy, School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden.
| | - Lars-Gunnar Gunnarsson
- Department of Occupational and Environmental Medicine, Faculty of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden; School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden.
| | - Ylva Nilsagård
- University Healthcare Research Centre, Faculty of Medicine and Health, Örebro University, SE 701 82 Örebro, Sweden.
| | - Tohr Nilsson
- Department of Occupational and Environmental Medicine, Umeå University, 90187 Umeå, Sweden.
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Krämer C, Pfister R, Boekels T, Michels G. Cardiac monitoring always required after electrical injuries? Med Klin Intensivmed Notfmed 2015; 111:708-714. [PMID: 26496987 DOI: 10.1007/s00063-015-0107-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 08/18/2015] [Accepted: 09/21/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Controversy still exists regarding inpatient monitoring of patients exposed to electrical injuries. MATERIALS AND METHODS In a monocentric retrospective study, we evaluated the medical records of 169 patients admitted to the University Hospital of Cologne from January 2000 to January 2014 because of electrical trauma. The electrocardiogram (ECG) data of 40 patients were missing. RESULTS Patients in our collective were predominantly young men (60 %) with an average age of 17.5 ± 17 years (1 year to 73 years). The electrical trauma occurred occupational (20 %), domestic (65 %), and during leisure time (15 %). In the high-voltage (≥ 1000 V) group (n = 7; 71 % male; 40.0 ± 19.4 years) one death was reported, related to an open intracranial injury and cardiac arrest. Of the six surviving patients five showed normal ECGs and one a sinus tachycardia. In the low-voltage (< 1000 V) group (n = 162, 56 % male; 5.0 ± 4.3 years) the ECG findings were as follows: 104 normal, 5 sinus tachycardia, 3 sinus arrhythmia, 6 ST segment changes, 3 premature atrial contraction, 1 premature ventricular contraction, 1 atrio-ventricular (AV)-Block and 1 delta wave. In all, one patient showed a self-limiting supraventricular tachycardia. CONCLUSION Asymptomatic and stable patients without any risk factors and with a normal initial ECG need no inpatient cardiac monitoring after an electrical injury.
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Affiliation(s)
- C Krämer
- Department of Internal Medicine III, University of Cologne, Kerpener-Str. 62, 50937, Cologne, Germany
| | - R Pfister
- Department of Internal Medicine III, University of Cologne, Kerpener-Str. 62, 50937, Cologne, Germany
| | - T Boekels
- Department of Internal Medicine III, University of Cologne, Kerpener-Str. 62, 50937, Cologne, Germany
| | - G Michels
- Department of Internal Medicine III, University of Cologne, Kerpener-Str. 62, 50937, Cologne, Germany.
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Nwadinigwe C, Olewe OS. Bilateral upper limb amputations in victims of high tension electrical injuries: Three case studies. Afr J Disabil 2015; 4:117. [PMID: 28730020 PMCID: PMC5433468 DOI: 10.4102/ajod.v4i1.117] [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: 02/20/2014] [Accepted: 11/05/2014] [Indexed: 11/01/2022] Open
Abstract
Bilateral upper limb amputations result in severe disability. High voltage electrical injury is a rare cause of such an outcome and injuries often occur as occupational hazards. We present three case reports of accidental high voltage injuries that occurred in a non-occupational setting. Victims were all initially managed at other centres before referral to our hospital and all subsequently had bilateral upper limb amputations. The high cost of treatment, importance of prevention, and need for rehabilitation are highlighted.
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Affiliation(s)
| | - Obidiche S. Olewe
- Department of Orthopaedics, National Orthopaedic Hospital, Enugu, Nigeria
- Correspondence to: Obidiche Olewe Postal address: NOHE PMB 01294, Enugu, Nigeria
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Electrical injury in relation to voltage, “no-let-go” phenomenon, symptoms and perceived safety culture: a survey of Swedish male electricians. Int Arch Occup Environ Health 2015; 89:261-70. [DOI: 10.1007/s00420-015-1069-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 06/24/2015] [Indexed: 11/26/2022]
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Abstract
Electrocution injuries account for a significant amount of burns unit admissions each year, and can be fatal. These injuries are divided into high-voltage (over 1000 volts) and low-voltage (less than 1000 volts) injuries, with lightning strikes (greater than 100 million volts) considered separately. Although the majority of electrocution injuries are of low voltage, most of the published reports concern industrial/high-voltage and lightning injuries. This disparity may trivialize low-voltage injuries in the minds of clinicians. We report a rare case of trineural (median, ulnar, and radial) injury in an upper limb after a low-voltage electrocution, and discuss the pathogenesis, investigation, and treatment of these injuries.
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Reichard AA, Konda S, Jackson LL. Occupational burns treated in emergency departments. Am J Ind Med 2015; 58:290-8. [PMID: 25678457 DOI: 10.1002/ajim.22407] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Despite reported declines, occupational burn injuries remain a workplace safety concern. More severe burns may result in costly medical treatment and long-term physical and psychological consequences. METHODS We used the National Electronic Injury Surveillance System-Occupational Supplement to produce national estimates of burns treated in emergency departments (EDs). We analyzed data trends from 1999 to 2008 and provided detailed descriptions of 2008 data. RESULTS From 1999 to 2008 there were 1,132,000 (95% CI: ±192,300) nonfatal occupational burns treated in EDs. Burn numbers and rates declined approximately 40% over the 10 years. In 2008, men and younger workers 15-24 years old had the highest rates. Scalds and thermal burns accounted for more than 60% of burns. Accommodation and food service, manufacturing, and construction industries had the largest number of burns. CONCLUSIONS Despite declining burn rates, emphasis is needed on reducing burn hazards to young food service workers and using job specific hazard analyses to prevent burns.
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Affiliation(s)
- Audrey A. Reichard
- Division of Safety Research; National Institute for Occupational Safety and Health; Centers for Disease Control and Prevention; Morgantown West Virginia
| | - Srinivas Konda
- Division of Safety Research; National Institute for Occupational Safety and Health; Centers for Disease Control and Prevention; Morgantown West Virginia
| | - Larry L. Jackson
- Division of Safety Research; National Institute for Occupational Safety and Health; Centers for Disease Control and Prevention; Morgantown West Virginia
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Acute vertebrobasilar ischemic stroke due to electric injury. Am J Emerg Med 2015; 33:992.e3-6. [PMID: 25684743 DOI: 10.1016/j.ajem.2014.12.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 12/29/2014] [Indexed: 11/22/2022] Open
Abstract
Electrical injuries are most commonly due to household accidents.Various factors determine the severity of electric injury, including type of current, amperage, voltage, tissue resistance, pathway of current,and duration of contact with the body. Various types of neurologic damage due to electrical injury have been described in literature. It may manifest as peripheral nerve injury, spinal cord damage, seizures, cerebellarataxia, hypoxic encephalopathy, and intracerebral hemorrhage. Acute ischemic stroke is an infrequent complication of electrical injury. Herein,we report a case of middle-aged man, who accidentally sustained high voltage electrical injury followed by acute vertebrobasilar ischemic stroke. Magnetic resonance imaging of the brain showed acute infarctin bilateral cerebellar and medial occipital regions. Computed tomographic angiogram of the brain and neck vessels was normal. Possibly,in our patient, the mechanism could be related to direct vascular injury due to electric current.
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Kumar V, Kumar V. Seasonal electrocution fatalities in free-range rhesus macaques (Macaca mulatta) of Shivalik hills area in northern India. J Med Primatol 2015; 44:137-42. [PMID: 25683769 DOI: 10.1111/jmp.12168] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The arboreal nature of rhesus macaques makes them vulnerable to electrocution from high-voltage industrial supply as well as low-tension domestic wires. The data on pattern of electrocution injuries and electrocution mortalities in free-ranging rhesus macaques are rarely reported. METHODS From January 2011 to 2013, the cases of accidental electrocution injuries were recorded in difference to sex, age group, season, body region distribution, contact details, and extent of injuries in free-ranging rhesus macaques (Macaca mulatta) of Shivalik hill areas. RESULTS electrocution injuries were highest in juveniles (52.05%), followed by adults (30.13%) and old (10.95%) rhesus macaques. Of the 73 cases recorded, 23 (31.50%) succumbed to death following severe electrocution and associated injuries. The intensity and body region distribution of electrocution injuries was recorded. CONCLUSION High-voltage current is the most common factor for fatal injuries. Strategies to avoid such electrocutions include burying all lines and transformers, shielding and insulating all high-tension lines, installing bridges that monkeys, and other arboreal species can use to move around.
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Affiliation(s)
- Vijay Kumar
- Veterinary Officer-Wild Life, Monkey Sterilization Centre, Kangra, India
| | - Vipin Kumar
- Veterinary Officer-Wild Life, Monkey Sterilization Centre, Hamirpur, India
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Bohórquez-López A, Gordillo-Escobar E, Egea-Guerrero JJ. [Acute spinal cord injury after severe electrical trauma]. Med Intensiva 2014; 39:383-4. [PMID: 25499905 DOI: 10.1016/j.medin.2014.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 09/08/2014] [Accepted: 09/17/2014] [Indexed: 11/24/2022]
Affiliation(s)
- A Bohórquez-López
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - E Gordillo-Escobar
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España; IBIS/CSIC, Universidad de Sevilla, Sevilla, España
| | - J J Egea-Guerrero
- Unidad de Neurocríticos, Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España; IBIS/CSIC, Universidad de Sevilla, Sevilla, España.
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Hop MJ, Polinder S, van der Vlies CH, Middelkoop E, van Baar ME. Costs of burn care: A systematic review. Wound Repair Regen 2014; 22:436-50. [DOI: 10.1111/wrr.12189] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 04/01/2014] [Indexed: 11/30/2022]
Affiliation(s)
- M. Jenda Hop
- Association of Dutch Burn Centers; Burn Center; Maasstad Hospital; Rotterdam The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery; MOVE Research Institute; VU University Medical Center; Amsterdam The Netherlands
| | - Suzanne Polinder
- Department of Public Health; Erasmus Medical Center; Rotterdam The Netherlands
| | | | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery; MOVE Research Institute; VU University Medical Center; Amsterdam The Netherlands
- Association of Dutch Burn Centers; Red Cross Hospital; Beverwijk The Netherlands
| | - Margriet E. van Baar
- Association of Dutch Burn Centers; Burn Center; Maasstad Hospital; Rotterdam The Netherlands
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Kym D, Seo DK, Hur GY, Lee JW. Epidemiology of electrical injury: Differences between low- and high-voltage electrical injuries during a 7-year study period in South Korea. Scand J Surg 2014; 104:108-14. [DOI: 10.1177/1457496914534209] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/08/2014] [Indexed: 11/16/2022]
Abstract
Background and Aims: Electrical burns are uncommon, but they result in high morbidity and mortality due to severe tissue damage. The purpose of this study is to analyze epidemiological variables of electrical injuries and identify preventable measures through them. Material and Methods: We retrospectively analyzed the clinical records of 625 patients admitted to Hangang Sacred Heart Hospital’s Department of Plastic Surgery from January 2005 to December 2011. We divided the patients into two groups: (1) low-voltage injury (under 1000 V) and (2) high-voltage injury (over 1000 V). We reviewed the following variables: age, sex, total burn surface area, injury type and mode, and surgical modalities. Results and Conclusions: The mean age of all patients was 33.4 ± 18.2 years. The ratio of males to females was 13.5 in the whole group. The mean total body surface are burned was 14.0% ± 13.8% in total. The majority of electrical burns in the low-tension group and high-tension group occurred in patients under 20 years and in patients aged 40–59 years, respectively. Steel chopstick insertions and high-voltage electrical work/repair were the most common injury modes in the low-tension group and the high-tension group, respectively. Groin and abdominal distant flap surgeries were commonly performed in both groups. It is recommended that these risks be prevented through education and safety measures to reduce the incidence of electrical injuries.
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Affiliation(s)
- D. Kym
- Department of Surgery, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - D. K. Seo
- Department of Plastic and Reconstructive Surgery, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - G. Y. Hur
- Department of Plastic and Reconstructive Surgery, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - J. W. Lee
- Department of Plastic and Reconstructive Surgery, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
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Salehi SH, Fatemi MJ, Aśadi K, Shoar S, Ghazarian AD, Samimi R. Electrical injury in construction workers: a special focus on injury with electrical power. Burns 2013; 40:300-4. [PMID: 23816398 DOI: 10.1016/j.burns.2013.05.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/14/2013] [Accepted: 05/27/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Electrical injury in construction workers due to contact with overhead power lines accounts for an important cause of admission at the emergency department. Due to lack of specific treatment options for this type of injury, prevention remains the mainstay of management. AIMS Our study aimed to demonstrate the characteristics of electrical injury in construction workers among one of the largest Iranian population at a burn care hospital. METHODS Through a retrospective review of hospital data base, patients with electrical injuries admitted to Motahari hospital in Tehran, Iran between March 2011 and June 2012 were included for analysis. Patients were divided into construction workers and other patients. Primary characteristics and final outcomes were then compared between the 2 study groups. RESULTS Of 202 patients included in this study, 105 patients (52%) were construction workers and 97 patients (48%) constituted the remainder. There was significant difference between the 2 groups in terms of mean age, gender, and average burn size. In contrast, mean duration of hospitalization and mortality rate did not differ significantly between the 2 study groups (p>0.05). Contacts with over head power-lines accounted for the most common mechanism of injury. There was significant difference between the 2 groups in terms of place of injury and electrical current power. However, total cost of treatment did not differ significantly between the 2 groups (p>0.05). Frequency of severe complications was higher in construction workers and this group underwent more invasive procedures such as limb amputation and fasciotomy. CONCLUSION The most common mechanism of electrical injuries in construction workers is due to contact with over head high voltage power-lines at workplace. This type of electrical injury is associated with higher use of fasciotomy, flap and limb amputation.
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Affiliation(s)
- Seyed Hamid Salehi
- Department of General Surgery, Motahari Burn Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Fatemi
- Department of Plastic and Reconstructive Surgery, Motahari Burn Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Aśadi
- Department of Plastic and Reconstructive Surgery, Motahari Burn Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Saeed Shoar
- Department of General Surgery, Motahari Burn Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Anita Der Ghazarian
- Department of General Surgery, Motahari Burn Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rogeieh Samimi
- Department of General Surgery, Motahari Burn Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Pediatric electrical burn injuries: experience of a large tertiary care hospital and a review of electrical injury. Pediatr Emerg Care 2013; 29:737-40. [PMID: 23714758 DOI: 10.1097/pec.0b013e318294dd64] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A retrospective review of all patients admitted between February 2004 and December 2009, with a diagnosis of burns associated with electrocution, was conducted at The Hospital for Sick Children, Toronto, Ontario, Canada. Data regarding type of electrocution and associated burns were collected. Of the 36 patients identified, 31 (86%) were shocked by electrical current, and 5 (14%) by lightning. Most burns associated with current were first degree (58%). The upper limbs, most frequently the wrist and arm (n = 23), were injured in 26 patients, and the lower limb in 2 patients, whereas 3 patients suffered multiple sites of injury. Twenty-eight patients were treated conservatively with dressings and minor surgical interventions such as debridement and primary repair. The remainder required excision and/or grafting. Fasciotomy and/or escharotomy were performed in 2 patients, and no one required amputation. Burns associated with electrical injuries remain a worldwide problem, responsible for considerable morbidity and mortality. They can usually be prevented through simple safety measures. An effective prevention program would help address this problem.
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Abstract
AIM The objective of this study was to analyze the epidemiology, presentation, management, and complications of electrical burn injuries in urban children. METHODS Data from records and clinical data were collected retrospectively and prospectively during 2008 to 2010. RESULTS Of 41 children enrolled, the mean age of children enrolled was 8.1 ± 4.5 years. Low-voltage injury was seen in 28 (68.2%), and 13 (31.8%) had high-voltage injuries. Low-voltage injuries were most commonly (52.45%) secondary to direct contact with live wire, whereas high-voltage injuries in 70% were due to direct contact with broken wires lying in fields/rooftops. Fourteen children of the 41 enrolled had associated injuries. Low-voltage injuries were associated with minor burns, seizures, tibial fracture, eyelid burn, scalp hematoma, and speech and visual impairment, whereas high-voltage injuries were associated with cardiac arrest, extradural hematoma, visceral burns, pulmonary hemorrhage and hypoxic encephalopathy, and postelectrocution acute respiratory distress syndrome. Surgical interventions done included split-thickness skin grafting, fasciotomy, and amputation procedures. The mean duration of hospital stay of all the children enrolled was 9.02 days with 35 children discharged, 71.4% of them having low-voltage injuries. Four children died, 75% of them having high-voltage injury, whereas 2 children left without medical advice, both having low-voltage injuries. CONCLUSIONS Children are a major group susceptible to electrical injuries in our country. Most of the mechanisms leading to them are easily preventable, but occur because of lack or awareness among the children and their guardians. Burn prevention program should be implemented incorporating these epidemiological data.
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