Successful management of pulmonary edema secondary to accidental electrocution in a young dog.

BACKGROUND: Human records describe pulmonary edema as a life-threatening complication of electric shock. Successful management requires prompt recognition and intensive care. However, in companion animals, electrocutions are rarely reported, even though domestic environments are full of electrical devices and there is always the possibility of accidental injury. Therefore, it is important for veterinarians to know more about this condition in order to achieve successful patient outcomes. CASE PRESENTATION: A 3-month-old male Labrador Retriever was presented with a history of transient loss of consciousness after chewing on a household electrical cord. On admission, the puppy showed an orthopneic position with moderate respiratory distress. Supplemental oxygen via nasal catheter was provided, but the patient showed marked worsening of respiratory status. Point-of-care ultrasound exams suggested neurogenic pulmonary edema due to electrical shock close to the central nervous system and increased B-lines without evidence of cardiac abnormalities. Mechanical ventilation of the patient was initiated using volume-controlled mode with a tidal volume of 9 to 15 ml/kg until reaching an end-tidal carbon dioxide ≤ 40 mm Hg, followed by a stepwise lung-recruitment maneuver in pressure-controlled mode with increases of the peak inspiratory pressure (15 to 20 cm H2O) and positive end-expiratory pressure (3 to 10 cm H2O) for 30 min, and return to volume-controlled mode with a tidal volume of 15 ml/kg until reaching a peripheral oxygen saturation ≥ 96%. Weaning from the ventilator was achieved in six hours, and the patient was discharged two days after admission without neurological or respiratory deficits. CONCLUSIONS: We present a rather unusual case of a neurogenic pulmonary edema subsequent to accidental electrocution in a dog. Timely diagnosis by ultrasound and mechanical ventilation settings are described. Our case highlights that pulmonary edema should be considered a potentially life-threatening complication of electrical shock in small animal emergency and critical care medicine.

Bilateral maculopathy following electrical burn: case report / Maculopatia bilateral após queimadura elétrica: relato de caso

CONTEXT: Electrical burns are an important etiology in dealing with patients suffering from burns. In situations of extensive deep lesions of multiple organs and systems affecting young and economically active people, there is a need for expensive multidisciplinary treatment, with a high socioeconomic cost for the community. Among the permanent injuries that explain this high cost, eye injuries stand out, since they are widely disabling. Although rare, lesions of the posterior segment of the eye are associated with higher incidence of major sequelae, and thus deserve special attention for dissemination and discussion of the few cases observed. CASE REPORT: The authors report the case of a patient who suffered high-voltage electrical burns and presented bilateral maculopathy, which evolved with a need for a surgical approach to repair retinal detachment and permanent low visual acuity. CONCLUSION: This report highlights the rarity of the etiology of maculopathy and the need for campaigns for prevention not only of burns in general, but also especially of electrical burns. .

CONTEXTO: As queimaduras elétricas representam etiologia importante na abordagem de pacientes vítimas de queimaduras. Lesões extensas e profundas de múltiplos órgãos e sistemas e o acometimento de população jovem economicamente ativa apontam para a necessidade de tratamento multidisciplinar dispendioso, com alto custo socioeconômico para as comunidades. Dentre as lesões permanentes que justificam esse alto custo, as oculares têm local de destaque, porque são amplamente incapacitantes. Embora raras, as lesões do segmento posterior do olho estão associadas a maior incidência de sequelas importantes, merecendo atenção especial para divulgação e discussão dos poucos casos observados. RELATO DE CASO: Os autores relatam o caso de paciente vítima de queimadura elétrica com fio de alta voltagem que apresentou maculopatia bilateral, evoluindo com necessidade de abordagem cirúrgica para correção de descolamento de retina e baixa acuidade visual permanente. CONCLUSÃO: Este relato destaca a raridade da etiologia da maculopatia e a necessidade de campanhas de prevenção não só das queimaduras em geral, mas especialmente das queimaduras elétricas. .

Bilateral maculopathy following electrical burn: case report.

CONTEXT: Electrical burns are an important etiology in dealing with patients suffering from burns. In situations of extensive deep lesions of multiple organs and systems affecting young and economically active people, there is a need for expensive multidisciplinary treatment, with a high socioeconomic cost for the community. Among the permanent injuries that explain this high cost, eye injuries stand out, since they are widely disabling. Although rare, lesions of the posterior segment of the eye are associated with higher incidence of major sequelae, and thus deserve special attention for dissemination and discussion of the few cases observed. CASE REPORT: The authors report the case of a patient who suffered high-voltage electrical burns and presented bilateral maculopathy, which evolved with a need for a surgical approach to repair retinal detachment and permanent low visual acuity. CONCLUSION: This report highlights the rarity of the etiology of maculopathy and the need for campaigns for prevention not only of burns in general, but also especially of electrical burns.

Ritmo nodal secundario a descarga eléctrica de alto voltaje: Report of one case / Transient high frequency nodal rhythm after a high voltage electric shock

Electrical shock can cause a direct myocardial damage and different types of arrhythmias, which are uncommon and occur more often when there is a high voltage exposure. We report a 19-year-old male that received a high voltage shock, falling thereafter from an altitude of four meters. On admission to the emergency room, he had second and third degree burns in the right hand and the left thigh. The electrocardiogram showed a nodal rhythm of 72 beats per minute. After four hours of monitoring, sinus rhythm returned spontaneously.

[Transient high frequency nodal rhythm after a high voltage electric shock. Report of one case]. / Ritmo nodal secundario a descarga eléctrica de alto voltaje.

Electrical shock can cause a direct myocardial damage and different types of arrhythmias, which are uncommon and occur more often when there is a high voltage exposure. We report a 19-year-old male that received a high voltage shock, falling thereafter from an altitude of four meters. On admission to the emergency room, he had second and third degree burns in the right hand and the left thigh. The electrocardiogram showed a nodal rhythm of 72 beats per minute. After four hours of monitoring, sinus rhythm returned spontaneously.

[Atypical behavior of QTc and ST-T intervals in a patient with the Brugada syndrome]. / Comportamiento atípico del QTc y del ST-T en un caso con síndrome de Brugada.

We present a 56-year-old man who was admitted to an emergency service after receiving an electric shock. The ECG showed a J point and ST segment elevation of up to 5 mm in leads V1 to V3, which normalized in 24 hours. The ajmaline test caused elevation of the J point and of the ST segment up to 12 mm in leads V1 to V3, QTc lengthening, and QTc and T wave alternans. These results denoted alterations in the duration of myocardial action potentials, a common finding in patients with Brugada syndrome and long QT syndrome.

Tongue tremor in a patient with coma after electrical injury.

We report on the case of a patient with transient tongue tremor and coma after electrical injury, probably due to a reversible brainstem dysfunction. We then reviewed the differential diagnosis of abnormal involuntary movements of the tongue as well as movement disorders related to electrocution.

Trauma eléctrico: fisiopatología y resucitación / Electric trauma: physiopathology and resuscitation

La atención del paciente que sufre una injuria eléctrica es generalmente poco conocida por el médico general, probablemente debido a su relativa poco frecuencia, excepto en centros especializados a tal fin o en instituciones en que este fenómeno traumático es más frecuente (ej.: trabajadores de red de distribución eléctrica). Se describe la epidemiología del trauma eléctrico, su atención inicial y forma de presentación en el terreno, como también los tipos de lesiones que pueden aparecer luego de la injuria, por lo general de manifestación tardía con posibles secuelas severas a largo plazo. El seguimiento atento de estos pacientes a corto y mediano plazo es la clave para prevenir daños mayores.

Trauma eléctrico: fisiopatología y resucitación / Electric trauma: physiopathology and resuscitation

La atención del paciente que sufre una injuria eléctrica es generalmente poco conocida por el médico general, probablemente debido a su relativa poco frecuencia, excepto en centros especializados a tal fin o en instituciones en que este fenómeno traumático es más frecuente (ej.: trabajadores de red de distribución eléctrica). Se describe la epidemiología del trauma eléctrico, su atención inicial y forma de presentación en el terreno, como también los tipos de lesiones que pueden aparecer luego de la injuria, por lo general de manifestación tardía con posibles secuelas severas a largo plazo. El seguimiento atento de estos pacientes a corto y mediano plazo es la clave para prevenir daños mayores.(AU)

Comprometimento pulmonar em trauma eletrico: relato de caso / Pulmonary lesion in eletric injury: case report

Trauma eletricos severos constituem cerca de 5 por cento das admissoes em Unidades de Queimados. O acometimento visceral pela corrente eletrica apresenta grande morbidade e mortalidade. A presenca de lesoes viscerais sem continuidade com lesao de partes moles e pouco referida, porem de extrema gravidade, principalmente pela dificuldade diagnostica que apresenta. Lesoes cardiacas tem sido mais frequentemente relatadas, ocorrendo em 10 a 25 por cento dos pacientes, consistinto basicamente em arritmias e disturbios de conducao, consequentes a espasmos coronarios ou lesao muscular difusa pela corrente...

Injuria miocárdica asociada a corriente eléctrica domiciliaria / Myocardial injury caused by domiciliary electric current

La injuria eléctrica del miocardio ha sido descrita en diversas instancias. La injuria eléctrica por rayos y de alto voltaje, son sabidas causas de arritmias severas, isquemia miocárdica transitoria, así como cambios electrocardiográficos y enzimáticos simulando un infarto de miocardio. La corriente eléctrica alterna de bajo voltaje (110 a 380V) usada en el equipamiento eléctrico domiciliario, ha sido reportada como causante de muerte súbita, usualmente como resultado de fibrilación ventricular. La naturaleza de la injuria eléctrica miocárdica es una intriga. La rareza del evento y la escasez de datos experimentales relevantes, hacen la tarea de revelar los mecanismos patogénicos de la injuria miocárdica eléctrica muy dificultosa. Describiremos los hallazgos electrocardiográficos inusuales, así como el curso clínico de un paciente que presentó un infarto de miocardio luego de una injuria eléctrica de bajo voltaje. Realizamos una profunda revisión bibliográfica sobre la injuria eléctrica de bajo voltaje causando infarto de miocardio. En conclusión, la similitud de la injuria miocárdica con la injuria de repercusión, así como la ausencia de trombos coronarios o ateroesclerosis significativa en la autopsia, hacen el espasmo coronario como probable causa de necrosis miocárdica en la electrocución

Injuria miocárdica asociada a corriente eléctrica domiciliaria / Myocardial injury caused by domiciliary electric current

La injuria eléctrica del miocardio ha sido descrita en diversas instancias. La injuria eléctrica por rayos y de alto voltaje, son sabidas causas de arritmias severas, isquemia miocárdica transitoria, así como cambios electrocardiográficos y enzimáticos simulando un infarto de miocardio. La corriente eléctrica alterna de bajo voltaje (110 a 380V) usada en el equipamiento eléctrico domiciliario, ha sido reportada como causante de muerte súbita, usualmente como resultado de fibrilación ventricular. La naturaleza de la injuria eléctrica miocárdica es una intriga. La rareza del evento y la escasez de datos experimentales relevantes, hacen la tarea de revelar los mecanismos patogénicos de la injuria miocárdica eléctrica muy dificultosa. Describiremos los hallazgos electrocardiográficos inusuales, así como el curso clínico de un paciente que presentó un infarto de miocardio luego de una injuria eléctrica de bajo voltaje. Realizamos una profunda revisión bibliográfica sobre la injuria eléctrica de bajo voltaje causando infarto de miocardio. En conclusión, la similitud de la injuria miocárdica con la injuria de repercusión, así como la ausencia de trombos coronarios o ateroesclerosis significativa en la autopsia, hacen el espasmo coronario como probable causa de necrosis miocárdica en la electrocución (AU)

Catarata eletrica por raio: apresentacao de dois casos / Electrical cataract by lightning: two cases report

No presente trabalho os autores apresentam dois casos de catarata eletrica provocada por raio, discutem a sua evolucao, etiopatogenia e tratamento. Constataram que no primeiro paciente houve boa recuperacao da acuidade visual em ambos os olhos apos facectomia extracapsular e o outro paciente apresentou amaurose bilateral por atrofia optica primaria total. A raridade dos casos e tambem enfatizada pelos autores, baseando-se na escassa literatura existente sobre esta patologia ocular.

[Acute cardiorespiratory insufficiency due to electric injury: invasive hemodynamic study]. / Insuficiência cardiorrespiratória aguda por choque elétrico: estudo hemodinâmico invasivo.

Case report on right branch block, acute pulmonary oedema and enteritis caused by electric shock in a boy. The invasive hemodynamic study showed primary pulmonary hypertension, cardiogenic shock, and acute respiratory failure. The outcome was good, with total and progressive recovery of all lesions. The literature review revealed the rarity of pulmonary oedema and enteritis after an electric shock. The invasive haemodynamic data suggest physiopathological explanations for findings in the case and indicate therapeutic measures for similar situations.

Visceral complications of electrical burn injury. A report of two cases and review of the literature.

Two patients with high voltage electrical injury involving the trunk are presented. Both injuries were complicated by visceral damage; and one patient died from sepsis secondary to bowel perforation. The rarity of this complication is examined in light of the pathophysiology of electrical injury; and its management is discussed with reference to previously published reports on this condition.

Visceral complications of electrical burn injury: a report of two cases and review of the literature

Two patients with high voltage electrical injury involving the trunk are presented. Both injuries were complicated by visceral damage; and one patient died from sepsis secondary to bowel perforation. The rarity of this complication is examined in light of the pathophysiology of electrical injury; and its management is discussed with reference to previously published reports on this condition. (AM)

Visceral complications of electrical burn injury: a report of two cases and review o the literature

Two patients with high voltage electrical injury involving the trunk are presented. Both injuries were complicated by visceral damage; and one patient died from sepsis secondary to bowel perforations. The rarity of this complications is examined in light of the pathophysiology of electrical injury, and its management is discussed wiht reference to previously published reports on this conditions

Electrical injury and cataracts: an unusual case

A 24 year-old male Jamaican building worker developed cataracts four months after electrical injury from a high tension cable. His visual acuity fell to perception of hand movements at 1 metre. Extracapsular cataract extraction and intraocular lens implantation restored his visual acuity to 20/25 (6/7.5). Mechanisms for this unusual complication of electrical injury are discussed (AU)