Extracorporeal Life Support Use in Mixed Distributive-Obstructive Shock Following an Electrical Injury: A Case Report.

Electrical burn injuries can be catastrophic, threatening severe disability or mortality. We present a patient who suffered from electrical shock, requiring bilateral above-knee amputations, right trans-radial amputation, renal replacement therapy, and veno-arterial extracorporeal life support (VA ECLS) therapy. While there exist reports of cases that have demonstrated the potential use of ECLS in burn patients with cardiogenic shock or acute respiratory distress syndrome, this is a unique case of VA ECLS use for an electrical injury patient who developed mixed distributive-obstructive shock secondary to pulmonary embolism and sepsis. Given the wide variety of morbidities that can result from electrical burns, VA ECLS is a promising tool for those who require cardiopulmonary support refractory to traditional measures.

Physiotherapy Approach in Transradial Amputation Following the Sequelae of Electric Burn: A Case Report.

A considerable amount of mortality and morbidity has been attributed to burn injuries. Because of expanding industrial development, greater consumption of electricity, and electric appliances at home, the number of burns caused by electricity is expanding. When it pertains to addressing burn injuries, therapeutic pursuits are necessary. The 18-year-old female patient in this case reported a history of burns due to electrical shock to her left upper and lower limbs along with her right foot. She came to the hospital, and after necessary investigations and examination, she was suggested for below elbow amputation or transradial amputation with debridement of the wound over the left axilla, foot, and right foot. Following the surgical procedure, the patient had pain, reduced muscle strength, limited joint mobility, and edema. For further rehabilitation, community health physiotherapy was advised. Routine physiotherapy treatment was provided to the patient for fifteen days. We report that after surgery, the effects of physical therapy showed decreased pain intensity, enhanced range of motion (ROM) of the affected and peripheral joints, and improved strength in adjacent muscles.

Bilateral Posterior Fracture-Dislocation of the Shoulder after Electrical Shock Treated with Bilateral Hemiarthroplasty: A Case Report.

This is a case report of a bilateral posterior fracture-dislocation of the shoulder after electrical shock and presents the first such patient treated with bilateral shoulder hemiarthroplasty. At first presentation, the upper limbs of the patient were in a position of internal rotation, and passive and active external rotations were painful. Radiographs and computed tomography of both shoulders showed bilateral posterior fracture-dislocation. Defects over 50% of the head articular surfaces led to unstable and unsuccessful initial closed and open reductions. The patient was then treated with cemented hemiarthroplasties with very good functional results two years post-operatively. This case presentation underlines the critical value of systematic clinical and radiographic evaluation of severe bilateral shoulder fracture-dislocations, prior to the ultimate proper treatment with cemented humeral shoulder hemiarthroplasties, followed by appropriate rehabilitation programme, for successful patient outcomes.

Unspecified pain and other soft tissue disorders following electrical injuries: a register-based matched cohort study.

OBJECTIVE: This study investigates whether individuals who have sustained an electrical injury (EI) are diagnosed with unspecified pain or pain related to the musculoskeletal system in the years following the injury. METHODS: Individuals listed in Danish registers as having sustained EIs were matched for sex, age, and year of injury in a cohort study with individuals having experienced dislocations/sprains (match 1), eye injuries (match 2), and a sample of individuals with the same occupation without a history of electrical injuries (match 3). Outcomes were unspecified pain and unspecified soft tissue disorders. Conditional logistic regression and conditional Cox regression were applied. RESULTS: We identified 14,112 individuals who sustained EIs. A higher risk of both outcomes was observed for all three matches, and was highest at the 6- and 12-month follow-ups. The risk of both outcomes was considerably higher for match 3. CONCLUSIONS: This study confirms that exposure to EIs increases the risk of being diagnosed with unspecified pain or unspecified soft tissue disorders both at short and long terms. Our results also showed that the risk of unspecified pain as sequelae is related to the severity of the injury.

Bilateral Posterior Fracture-Dislocation of the Shoulder after Electrical Shock Treated with Bilateral Hemiarthroplasty: A Case Report

@#This is a case report of a bilateral posterior fracturedislocation of the shoulder after electrical shock and presents the first such patient treated with bilateral shoulder hemiarthroplasty. At first presentation, the upper limbs of the patient were in a position of internal rotation, and passive and active external rotations were painful. Radiographs and computed tomography of both shoulders showed bilateral posterior fracture-dislocation. Defects over 50% of the head articular surfaces led to unstable and unsuccessful initial closed and open reductions. The patient was then treated with cemented hemiarthroplasties with very good functional results two years post-operatively. This case presentation underlines the critical value of systematic clinical and radiographic evaluation of severe bilateral shoulder fracturedislocations, prior to the ultimate proper treatment with cemented humeral shoulder hemiarthroplasties, followed by appropriate rehabilitation programme, for successful patient outcomes.

A case of burn evisceration with full-thickness injury to abdominal wall, bowel, bladder, and three extremities.

BACKGROUND: Severe electrical burns are a rare cause of admission to major burn centers. Incidence of electrical injury causing full-thickness injury to viscera is an increasingly scarce, but severe presentation requiring rapid intervention. We report one of few cases of a patient with full-thickness electrical injury to the abdominal wall, bowel, and bladder. CASE REPORT: The patient, a 22-year-old male, was transferred to our institution from his local hospital after sustaining a suspected electrical burn. On arrival the patient was noted to have severe burn injuries to the lower abdominal wall with evisceration of multiple loops of burned small bowel as well as burns to the groin, left upper, and bilateral lower extremities. In the trauma bay, primary and secondary surveys were completed, and the patient was taken for CT imaging and then emergently to the operating room. On exploration, the patient had massive full-thickness burns to the lower abdominal wall, five full-thickness burns to small bowel, and intraperitoneal bladder rupture secondary to full-thickness burn. The patient underwent damage-control laparotomy including enterectomies, debridement of bladder coagulative necrosis, and layered closure of bladder injury followed by temporary abdominal closure with vacuum dressing. The patient also underwent right leg escharotomy and partial right foot fasciotomies. The patient was subsequently transferred to the nearest burn center for continued resuscitation and comprehensive burn care. CONCLUSION: Severe electrical burns can be associated with devastating visceral injuries in rare cases. Though uncommon, these injuries are associated with very high mortality rates. The authors assert that rapid evaluation and initial stabilization following ATLS guidelines, damage-control laparotomy, and goal-directed resuscitation in concert with transfer to a major burn center are essential in effecting a successful outcome in these challenging cases.

Injury of Corticospinal tract and Corticoreticular pathway caused by high-voltage electrical shock: a case report.

BACKGROUND: We imaged the corticospinal tract (CST) and corticoreticular pathway (CRP) using diffusion tensor tractography (DTT) to evaluate the cause of muscle weakness in a patient who was exposed to high-voltage electricity. CASE PRESENTATION: A 39-year-old man presented with quadriparesis after high-voltage electrical shock from power lines while working about 5.8 years ago. The electrical current entered through the left hand and exited through the occipital area of the head. The degree of weakness on bilateral upper and lower extremities was 3-4 on the Medical Research Council strength scale. Diffusion tensor imaging (DTI) was performed 5.8 years after onset. The CST and CRP were depicted by placing two regions of interest for each neural tract on the two-dimensional fractional anisotropy color map. DTT of the DTI scan showed that the bilateral CST and CRP were thinned compared to those of the healthy control subject. On the nerve conduction test, abnormal findings suggesting peripheral nerve lesion were not observed. Therefore, injury of bilateral CST and CRP seems to have contributed to our patient's weakness after the electrical shock. CONCLUSION: Depiction of neural tracts in the brain using DTT can assist in the accurate and detailed evaluation of the cause of neural deficit after electrical injury.

Simultaneous Cataract, Maculopathy and Optic Atrophy Secondary to High-Voltage Electrical Shock Injury.

A 32-year-old man presented to our clinic with complaint of vision loss in both eyes (oculus utro; OU). Past medical history revealed that he had been exposed to high-voltage electrical current that passed through the temporal region of the head 2 months ago. Slit-lamp examination demonstrated cortico-nuclear cataract and mature cataract in his right eye (oculus dexter; OD) and left eye (oculus sinister; OS), respectively. On fundus examination, a macular hole was observed in OD. Optic atrophy and foveal atrophy were observed in the left fundus examination after cataract surgery. Simultaneous cataract, maculopathy and optic atrophy may occur after high-voltage electrical current injury. Therefore, clinicians should perform detailed anterior and posterior segment examinations in such patients.

Electrical safety.

Since the purpose of clinical neurophysiology testing is to record the electrical activity of the nervous system, and often to electrically stimulate the peripheral or central nervous system (for evoked potentials, nerve conduction studies, etc.), these tests by their very nature demand an excellent electrical connection to the patient. This direct electrical connection by definition puts the patient at increased risk of electrical shock. When patients suffer from other nonneurological disorders that also require equipment to be attached to or inserted into their body, the additional and more direct electrical pathways to the heart make them even more vulnerable, especially when undergoing monitoring in the operating room or intensive care unit. Although we depend on the hospital's construction and utilities to follow appropriate regulations (the National Electrical Code in the United States) and on the vendors to sell only safe equipment (approved by the Food and Drug Administration in the United States), there may exist combinations of equipment and connections that put the patient at risk of injurious or fatal electrical shock. Regular testing and safe practices, informed by a scientific understanding of the risks, are the responsibilities of the healthcare providers in order to protect the patient from harm from electricity.

Perceived Electrical Injury: Misleading Symptomology Due to Multisensory Stimuli.

BACKGROUND: An electrical accident victim's recollection is often distorted by Bayesian inference in multisensory integration. For example, hearing the sound and seeing the bright flash of an electrical arc can create the false impression that someone had experienced an electrical shock. These subjects will often present to an emergency department seeking either treatment or reassurance. CASE REPORTS: We present seven cases in which the subjects were startled by an electrical shock (real or perceived) and injury was reported. Calculations of the current and path were used to allocate causality between the shock and a history of chronic disease or previous trauma. In all seven cases, our analysis suggests that no current was passed through the body. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Symptomology seen as corroborating may actually be confounding. Witness and survivor descriptions of electrical shocks are fraught with subjectivity and misunderstanding. Available current is usually irrelevant and overemphasized, such as stress on a 100-ampere welding source, which is orders of magnitude beyond lethal limits. History can also be biased for a number of reasons. Bayesian inference in multisensory perception can lead to a subject sincerely believing they had experienced an electrical shock. Determination of the current pathway and calculations of the amplitude and duration of the shock can be critical for understanding the limits and potential causation of electrical injury.

Padronização do tratamento cirúrgico do trauma elétrico na fase aguda / Standardization of surgical treatment of acute electrical trauma

INTRODUÇÃO: As queimaduras elétricas correspondem de 5 a 15% dos casos de acidentes com queimaduras. A maioria está associada a acidentes do trabalho, nos quais predominam as lesões com alta voltagem (acima de 1.000 Volts), em pacientes do sexo masculino. As taxas de mortalidade variam de 2 a 15%, nos mais diversos centros de queimados. O objetivo é revisar padronização das etapas cirúrgicas na fase aguda de desbridamento (primeiros 15 dias) pela comparação de dosagem de creatofosfoquinase, hidratação venosa e fotografias para a aplicação de uma rotina de etapas cirúrgicas. MÉTODOS: Trata-se de um estudo quantitativo, prospectivo, realizado em um hospital público da cidade de Fortaleza, CE, entre julho de 2013 a dezembro de 2015. A população foi composta por adultos jovens, entre 15 e 50 anos, de ambos os sexos, vítimas de queimaduras por choque elétrico, com lesão de terceiro grau, no mínimo muscular. RESULTADOS: Foram realizados 12 procedimentos cirúrgicos de amputações nos 15 pacientes do estudo (60%). Seis pacientes não sofreram amputação (40%). Um paciente sofreu três procedimentos de amputação no mesmo membro (pododáctilo, pé e coxa esquerdos) e outro, duas amputações em membros superiores distintos. CONCLUSÃO: O tratamento na fase aguda do choque elétrico deve incluir uma imediata e adequada reposição líquida venosa, associada com procedimentos cirúrgicos de desbridamentos e de amputações, o mais precoce possível, em etapas com intervalos de 48 a 72 horas.

INTRODUCTION: Electrical burns are responsible for 5% to 15% of cases of burn accidents. The majority is associated with workplace accidents, in which high-voltage injuries (>1,000 V) predominate in male patients. The mortality rates vary from 2% to 15% in different burn centers. The objective is to review the standardization of surgical steps in the acute phase of debridement (the first 15 days) by comparison of creatine phosphokinase levels, intravenous hydration, and photographs to implement routine surgical stages. METHODS: This was a quantitative, prospective study performed in a public hospital in the city of Fortaleza, Brazil, between July 2013 and December 2015. The population was composed of young adults between 15 and 50 years, of both sexes, who experienced electrical burns, with third-degree injuries and muscle involvement. RESULTS: Of the 15 patients in the study, 9 (60%) patients underwent 13 surgical amputation procedures and 6 (40%) patients did not undergo amputation. One patient underwent three amputation procedures in the same limb (toe, foot, and thigh) and another patient underwent two amputations in the upper limbs. CONCLUSION: Treatment in the acute phase of electrical shock must include immediate and adequate intravenous fluid replacement, along with surgical procedures of debridement and amputations, as early as possible, in steps with intervals of 48 to 72 hours.

Bilateral posterior shoulder dislocation after electrical shock: A case report.

INTRODUCTION: Posterior dislocation of the shoulder is a rare and commonly missed injury. Unilateral dislocations occur mostly due to trauma. Bilateral posterior shoulder dislocations are even more rare and result mainly from epileptic seizures. Electrical injury is a rare cause of posterior shoulder dislocation. Injury mechanism in electrical injury is similar to epileptic seizures, where the shoulder is forced to internal rotation, flexion and adduction. PRESENTATION OF CASE: This report presents a case of bilateral posterior shoulder dislocation after electrical shock. We were able to find a few individual case reports describing this condition. The case was acute and humeral head impression defects were minor. Our treatment in this case consisted of closed reduction under general anesthesia and applying of orthoses which kept the shoulders in abduction and external rotation. A rehabilitation program was begun after 3 weeks of immobilization. After 6 months of injury the patient has returned to work. 20 months postoperatively, at final follow-up, he was painless and capable of performing all of his daily activities. DISCUSSION: The amount of bilateral shoulder dislocations after electrical injury is not reported but is known to be very rare. The aim of this case presentation is to report an example for this rare entity, highlight the difficulties in diagnosis and review the treatment options. CONCLUSION: Physical examination and radiographic evaluation are important for quick and accurate diagnosis.

Visceral injury in electrical shock trauma: proposed guideline for the management of abdominal electrocution and literature review.

UNLABELLED: Victims of electrical burns account for approximately 5% of admissions to major burn centers. The first case of visceral injury caused by electrical burns was described in 1927 by Simonin, who reported perforation of the small intestine. Other rare cases were reported over the following years. The colon and small intestine were the organs most frequently affected. Less frequently involved organs were the heart, esophagus, stomach, pancreas, liver, gallbladder, lung, and kidney. We highlight the potential fatal visceral injuries after the electrical trauma. This study provides a review on this topic and proposes a management flowchart that should be adopted by the multidisciplinary team to treat these patients. CONCLUSION: Visceral injuries are rare in electrical burns victims, but it can be severe and are associated with high rates of morbidity and mortality, sometimes requiring a more interventional approach.

Mood and cognition after electrical injury: a follow-up study.

Individuals who have experienced an electrical injury have been reported to demonstrate both acute and delayed cognitive and psychiatric symptoms. The present study assessed 20 electrically injured patients who underwent neuropsychological evaluations twice following their injury. Time since injury, time between assessments, and longitudinal mood changes were evaluated for their potential impact on simple and complex attention outcomes. As an overall group, there was little change over time from low average to average baseline attention/concentration performance. However, results indicated that longitudinal increases in depressive symptoms were consistently associated with poorer performance on a measure of simple and complex attention. Loss of consciousness, litigation status, baseline injury status (acute vs. post-acute), and time between evaluations were not significant predictors of changes in cognitive performance. Implications for the treatment of comorbid psychiatric issues and for future research on victims of electrical trauma are discussed.

Lesões por choque elétrico e por raios / Injuries from electrical shock and lightning

JUSTIFICATIVA E OBJETIVOS: As lesões por choque elétrico e por raios representam pequena parcela das admissões nos serviços de urgência e emergência. No entanto, resultam em custo extremamente elevado para as vítimas e para a sociedade. Os índices de mortalidade são altos: cerca de 30% a 40% dos acidentes são fatais, com estimativas de aproximadamente 1.000 mortes por ano nos EUA. O objetivo deste estudo foi rever as definições, a fisiopatologia, as manifestações clínicas e as medidas terapêuticas ideais para a abordagem dos pacientes vítimas de choque elétrico e raios. CONTEÚDO: Artigos publicados entre 1969 e 2010 foram selecionados no banco de dados da Medline, através das palavras-chave: choque elétrico e lesões por raio. Adicionalmente, referências destes artigos, capítulos de livros e artigos históricos foram avaliados. CONCLUSÃO: As manifestações clínicas envolvidas variam de queimaduras superficiais a disfunção de múltiplos órgãos e morte. As complicações mais relatadas na literatura são: parada cardíaca ou respiratória, queimaduras, arritmias, traumatismos, ruptura de membrana timpânica e convulsões. O tratamento adequado minimiza as complicações da fase aguda e evita ou resolve algumas sequelas tardias como amputações, lesões neurológicas permanentes e o desenvolvimento de catarata.Os pacientes devem ser abordados de acordo com os protocolos do suporte de vida cardiológico avançado e do suporte avançado para o trauma. Reposição volêmica vigorosa, identificação e tratamento de síndrome compartimental, cuidados apropriados com queimaduras e profilaxia para tétano são as medidas mais importantes.

BACKGROUND AND OBJECTIVES: Injuries from electrical shock and lightning represent a small proportion of the number of admissions to emergency departments and emergency; however, result in an extremely high cost to society and to patients. Mortality rates are high, about 30% to 40% of accidents are fatal with an estimated 1,000 deaths per year in the U.S. The aim of this study was to review the concepts, the physiopathology, the clinical manifestations and therapeutic measures suitable for the treatment of victims of electric shockor lightning. CONTENTS: Articles published between 1969 and 2010 were selected in the MedLine database, using the keywords:electric shock, injury from lightning, electrical discharge. References of these articles, chapters of books and historical articleswere evaluated. CONCLUSION: The clinical manifestations range from superficial burns to multiple organ failure and death. The complications are commonly reported as cardiac arrest or respiratoryfailure, burns, arrhythmias, trauma, ruptured eardrum, and seizures. Proper treatment minimizes the initial effects and also prevents and resolves some late sequelae such as amputations, permanent neurological damage and the development of cataracts. Patients should be dealt with according to the protocols of advanced cardiac life support and advanced trauma life support. Vigorous fluid replacement, identification and treatment of compartment syndrome, appropriate care with burns and tetanus prophylaxis are the most important.

The effects of electrical shock on the expressions of aquaporin subunits in the rat spinal cords.

We analyzed aquaporin (AQP) expression in the rat spinal cord following an electrical shock (ES) to elucidate the roles of AQP in spinal cord injury (SCI) induced by an electrical burn. In control animals, AQP1 immunoreactivity was observed in the small diameter dorsal horn fibers of laminae I and II and in astrocytes and neurons in the spinal cord. Both AQP4 and AQP9 immunoreactivity were detected in astrocytes. One week after the ES, AQP1 immunoreactivity in dorsal horn fibers was downregulated to 83, 61, and 33% of control levels following a 1-, 4-, or 6-second ES, respectively. However, AQP1 immunoreactivity in ventral horn neurons increased to 1.3-, 1.5-, and 2.4-fold of control levels following a 1-, 4-, or 6-second ES, respectively. AQP4 immunoreactivity was upregulated after an ES in laminae I and II astrocytes in a stimulus-intensity independent manner. Unlike AQP1 and AQP4, AQP9 immunoreactivity was unaffected by the ES. These findings indicate that altered AQP immunoreactivity may be involved in SCI following an ES.

The effects of electrical shock on the expressions of aquaporin subunits in the rat spinal cords / 대한해부학회지

We analyzed aquaporin (AQP) expression in the rat spinal cord following an electrical shock (ES) to elucidate the roles of AQP in spinal cord injury (SCI) induced by an electrical burn. In control animals, AQP1 immunoreactivity was observed in the small diameter dorsal horn fibers of laminae I and II and in astrocytes and neurons in the spinal cord. Both AQP4 and AQP9 immunoreactivity were detected in astrocytes. One week after the ES, AQP1 immunoreactivity in dorsal horn fibers was downregulated to 83, 61, and 33% of control levels following a 1-, 4-, or 6-second ES, respectively. However, AQP1 immunoreactivity in ventral horn neurons increased to 1.3-, 1.5-, and 2.4-fold of control levels following a 1-, 4-, or 6-second ES, respectively. AQP4 immunoreactivity was upregulated after an ES in laminae I and II astrocytes in a stimulus-intensity independent manner. Unlike AQP1 and AQP4, AQP9 immunoreactivity was unaffected by the ES. These findings indicate that altered AQP immunoreactivity may be involved in SCI following an ES.

Transient Quadriplegia after Low-Voltage Electric Shock

Neurologic disorders from electrical injury may be classified as cerebral syndroms, spinal syndroms, peripheral nerve syndromes. Neurological complication involving either cerebral complication (loss of consciousness, seizures, decreased memory, headache) or peripheral complaints (sensorimotor loss, paraesthesias, paralysis, paresis, dysthesias) are described in the current literatures. However, the exact site of neurological damage causing paralysis after electrical trauma ramains to be clarified. Although transient tetraplegia has been previously reported following high-voltage electrical injury, the following case report describes an unusual presentation of transient acute tetraplegia following a low-voltage electrical injury.