[Serum creatine phosphokinase as a predictor of upper limb amputation in electrical trauma]. / Soderzhanie kreatinfosfokinazy v plazme krovi kak prediktor amputatsii verkhnei konechnosti pri elektrotravme.

OBJECTIVE: To study the relationship between serum creatine phosphokinase and outcomes of injury in victims with electrical burns. MATERIAL AND METHODS: Among 40 patients with electrical injury, 7 (18%) ones underwent upper limb amputation. There were 37 (92.5%) men and 3 (7.5%) women aged 37 (28; 47) years. We analyzed total serum creatine phosphokinase and MB fraction on the first day in patients with and without amputations. RESULTS: Total serum creatine phosphokinase exceeded the upper reference value in 11 out of 33 patients without amputation and in all 7 patients with limb amputation (p=0.001). Patients with limb amputation had significantly higher total serum creatine phosphokinase and MB fraction (p<0.001 and p=0.030, respectively). Logistic regression equation showed that high total serum creatine phosphokinase significantly influenced amputation rate (p<0.001), as evidenced by odds ratio (42.7, 95% CI 3.5-514.8). ROC analysis revealed the cut-off value of total serum creatine phosphokinase (950 IU/L). Sensitivity was 100% (63; 100), specificity - 94% (86; 94), positive predictive value - 78% (49; 78), negative predictive value - 100% (92; 100). CONCLUSION: Total serum creatine phosphokinase depends only on severity of electrical and flame burns. Serum creatine phosphokinase is a predictor of upper limb amputation in patients with electrical injury. Total serum creatine phosphokinase ≥ 950 IU/L is significant for upper limb amputation (in CK-MB fraction within the reference values).

Just another railway fatality.

We report on a 56-year-old male who was found dead on railroad tracks, equipped with overhead high-voltage power lines (15,000 V AC). Apparently, the body had been hit by a passing train and completely severed at the mid-abdominal level. Based on this apparently unequivocal finding, the police initially assumed a fatal railway accident or suicide. However, close examination of the deceased's clothes revealed heat damage to at least four overlying layers of clothing in different locations. The rubber soles of his heavy leather shoes showed small holes in blackened areas underneath the toes. Furthermore, both socks revealed tears and fabric defects with burnt rims, again most prominent in the area of the toes. Skin burns, consistent with electric burns, and blistering were detected on the deceased's hands and feet. A broken fishing rod was found in the proximity. On autopsy, multiple injuries caused by severe blunt force with subsequent skull fracture and brain laceration as well as multiple injuries to the spinal column and rib fractures were found and visceral organs displayed multiple lacerations. However, the lack of relevant hematomas argues that these injuries were inflicted postmortem. Histological examination confirmed the presence of electric burns from electrocution. Based on the results of the forensic-pathological examination and additional investigations carried out at the scene of death, we could demonstrate that this highly unusual death was caused by an electrocution after contact of the fishing rod with the high-voltage power line and not by overrunning by the train.

Sociodemographic and culture results of paediatric burns.

Paediatric burn wounds are challenging conditions to manage for both the doctors and patients and can cause several complications entailing a complicated treatment and recovery process. This study aims to evaluate sociodemographic conditions and antibiogram culture results of paediatric burn wounds. Our study retrospectively evaluated 419 paediatric patients with burns regarding age, gender, burn area and degree, total days spent in hospital, surgical history, final condition, additional disease history, previous attempts, and culture results with their antibiotic resistances, haemogram results, C-reactive protein results, sociocultural conditions, burned region of the body, and structure of the burn. The prominent observations were an increased rate of incidence in male patients and patients with low socioeconomic conditions, the highest incidence of burns from scalding and domestic accidents, and the highest incidence of third-degree burns. Furthermore, even though the most encountered burn types were extremity burns, the burn types with the highest culture growth ratio were the perineum burns. The dominant culture growth bacterial group was coagulase-negative staphylococcus, and the ratio of medication resistance was 67.8%. It is imperative to raise awareness regarding domestic accidents to prevent paediatric burn wounds. The mortality risk can be reduced by carefully monitoring multiple organ involvement and providing timely treatment. Moreover, appropriate wound care is warranted to avoid infection from skin flora.

[HIGH VOLTAGE ELECTRIC INJURY: MECHANISM OF INJURY, CLINICAL FEATURES AND INITIAL EVALUATION.]

INTRODUCTION: Electrical injury is an infrequent but potentially devastating form of multisystem injury associated with high morbidity and mortality. Despite significant improvement in injury prevention and implementation of safety protocols at work places, electrical injury accounts for more than 500 deaths per year in the United States with a mortality rate of 10-30%. Electrical injuries are traditionally divided into low-voltage electric power injuries (less than 1,000V) and high-voltage )more than 1,000V). In contrast with other types of trauma, high voltage injuries present some rather unique problems that require a high index of suspicion and awareness of all possible manifestations. Electrical injury should be viewed and managed as a multisystem injury, since there is virtually no organ that is protected against it. The most essential concept of successful management of patients who sustain high voltage injury is that there is no relationship between skin burn, vital organs involvement and severity of injuries. This review aims to provide a comprehensive overview of reported high voltage electrical injury manifestations in an attempt to gain a better understanding of the distribution of morbidity and clinical features of the injury. We tried to encompass most of the reported cases of high voltage electrical injuries in order to give the readers a general view of the spectrum of injuries that can be encountered in victims suffering high voltage current, aiming to increase the awareness of emergency care and trauma teams to this rare but dangerous and potentially fatal type of injury.

High-voltage electrical injury: Modified surgical technique for optimal defect closuring of extra-large cranial defect.

Electrical burns are group of traumatic injuries with a mortality rate of 3-15%. High-voltage induced extensive electric burns are rarely seen in the cranial area, compared to upper and lower limbs, but extremely difficult for treatment, due to the limited flexibility in this area. The spectrum of therapeutic interventions in electrical burns in general, evolving initial necrectomy, decompression, and aggressive debridement with early skin coverage is usually not enough in cases of extensive cranial defects. The performance of a suitable flap combined with skin graft in donor site, and further implantation of expander is challenging in this area. We present a case of a high-voltage induced extra-large cranial injury in a 38-year-old man, treated with modified single large rotation flap and a split skin-thickness graft technique, for optimal defect closuring with satisfied aesthetic result.

Wound management and outcome of 595 electrical burns in a major burn center.

BACKGROUND: Electrical burns are important causes of trauma worldwide. This study aims to analyze the clinical characteristics, wound management, and outcome of electric burns. METHODS: This retrospective study was performed at the Institute of Burn Research of the Third Military Medical University during 2013-2015. Data including the demographics, injury patterns, wound treatment, and outcomes were collected and analyzed. RESULTS: A total of 595 electrical burn patients (93.8% males) were included. The average age was 37.3 ± 14.6 y, and most patients (73.5%) were aged 19∼50 years. Most patients (67.2%) were injured in work-related circumstances. The mean total body surface area was 8.8 ± 11.8% and most wounds (63.5%) were full-thickness burns. Operation times of high-voltage burns and current burns were higher than those of low-voltage burns and arc burns, respectively. Of the 375 operated patients, 83.2% (n = 312) underwent skin autografting and 49.3% (n = 185) required skin flap coverage. Common types of skin flaps were adjacent (50.3%), random (42.2%), and pedicle (35.7%). Amputation was performed in 107 cases (18.0%) and concentrated on the hands (43.9%) and upper limbs (39.3%). The mean length of stay was 42.9 ± 46.3 d and only one death occurred (0.2%). Current burns and higher numbers of operations were major risk factors for amputation and length of stay, respectively. CONCLUSIONS: Electrical burns mainly affected adult males with occupational exposures in China. Skin autografts and various skin flaps were commonly used for electric burn wound management. More standardized and effective strategies of treatment and prevention are still needed to decrease amputation rates.

Electrocution of Raptors on Power Lines: A Review of Necropsy Methods and Findings.

Decades after the problem was first identified, power line electrocution continues to be a cause of avian mortality. Currently, several federal laws protect eagles and other migratory birds, meaning that utility companies may be liable for electrocution-related deaths. Veterinarians and veterinary pathologists called upon to diagnose and treat electrocuted birds should keep this in mind when conducting clinical and postmortem examinations. This review details necropsy findings and methods used to diagnose electrocution. A combination of gross, subgross, and radiographic examinations can aid in identification of subtle injury. Diagnosis is made based on the presence of skin and/or feather burns. Other necropsy findings may include skin lacerations, subcutaneous burns, bruising, limb avulsion, hemopericardium, and vascular rupture. At the US Fish and Wildlife Service's National Forensics Laboratory, from 2000 to 2015, 417 raptor deaths were determined to have been caused by electrocution. Bald eagles and golden eagles were the most commonly submitted species. In a retrospective review of 377 cases, for which whole bodies were submitted, 18% of the electrocuted birds had only a single, small (less than 3 cm in diameter) external burn. Small, isolated burns tended to occur on the undersides of the wings at and distal to the elbow and on the lower legs and feet. These areas should be most carefully examined in cases where electrocution injury is not immediately apparent.

Electrical Injuries in Animals: Causes, Pathogenesis, and Morphological Findings.

Electrical injuries in animals occur most often accidentally. They comprise contact to various forms of currents, including alternating, rotary, or direct currents. Depending on various parameters of the current (including the type of circuit, voltage, current and duration of exposure) and conditions of the animal (such as wet or dry hair coat and pathway of current through the body), lesions may be absent or may include early or localized development of rigor mortis, signs of acute circulatory failure, or severe thermoelectrical burns. Such burns may present as external current marks, singed hair or feathers, metallization of the skin, or occasionally internal electroporation injury resulting in muscle necrosis, hemolysis, vascular damage with thrombosis, injury to brain and spinal cord, or skeletal fractures. Furthermore, lightning strikes occur regularly in grazing animals, which have greater risk of death from step potentials (ground current) in addition to direct strike and contact injury. Such cases may have no lesions, external signs of linear or punctate burns, keraunographic markings, or exit burns on the soles of the hooves or the coronary bands. Besides detailed information about the circumstances at the location where the animal was found, electrical injuries in animals require a thorough morphological workup, including additional investigations in conjunction with certain knowledge about the possible lesion spectrum.

Skin Burn Related to Coblation-Assisted Turbinoplasty.

Coblation-assisted turbinoplasty is an effective and safe method to manage nasal obstruction. The common complications of the procedure are pain, bleeding, and crust formation. Since coblation does not generate high heat, direct burn injuries by coblation have been rarely reported. Nevertheless, the authors experienced a skin burn injury in a patient, which is the first patient related to coblation-assisted turbinoplasty. Therefore, surgeons need to be careful and prepared for an inadvertent heat injury at the site that touches the coblation device. Here the authors present a patient along with suggestions to prevent the aforesaid accident.

An unusual electrical burn caused by alkaline batteries.

Electrical burns caused by low-voltage batteries are rarely reported. We recently encountered a male patient who suffered from a superficial second-degree burn over his left elbow and back. The total body surface area of the burn was estimated to be 6%. After interviewing the patient, the cause was suspected to be related to the explosion of a music player on the left-side of his waist, carried on his belt while he was painting a bathroom wall. Elevated creatine kinase levels and hematuria indicated rhabdomyolysis and suggested an electrical burn. Initial treatment was done in the burn intensive care unit with fluid challenge and wound care. The creatine kinase level decreased gradually and the hematuria was gone after 4 days in the intensive care unit. He was then transferred to the general ward for further wound management and discharged from our burn center after a total of 11 days without surgical intervention.

[A case of the fatal injury by technical electricity from a mobile device (cell phone) connected to the circuit].

The authors report a case of the fatal injury by technical electricity from a mobile device (cell phone) attached to the circuit in a moist environment as a result of the unsafe handling of the gadget (when taking the bath).

Acute ischaemic stroke and acute myocardial infarction occurring together in domestic low-voltage (220-240V) electrical injury: a rare complication.

BACKGROUND: Myocardial Infarction and Ischaemic stroke are potential outcome after an electric shock though it is seen relatively rarely. CASE REPORT: Here, we report a man with myocardial infarction as well as Ischaemic stroke occurring together who suffered a domestic low- voltage (220-240V) electrical injury. Myocardial infarction was evident by cardiac enzymes, electrocardiography and echocardiography while Ischemic stroke was evident on CT scan head: Patient was treated on line of acute ischaemic stroke and myocardial infarction. Patient was discharged in satisfactory condition. CONCLUSION: Electric Injury due to low voltage AC may cause ischaemic stroke as well as myocardial Infarction altogether. Vasospasm caused by electrical injury, direct thermal injury may be the cause of concurrent phenomenon.

Skin burns associated with radiofrequency catheter ablation of cardiac arrhythmias.

Skin burns are a rare complication associated with radiofrequency catheter ablation of cardiac arrhythmias. Burns related to the indifferent electrode patch may be severe and result in significant comorbidity. We describe our experience of skin burns and discuss potential predisposing and possible causative factors.

Peripheral neuropathy after burn injury.

OBJECTIVES: Peripheral neuropathy is a well-documented disabling sequela of major burn injury. These lesions are associated with both thermal and electrical injuries that may be frequently undiagnosed or overlooked in clinical settings. The purpose of this study was to evaluate the prevalence of burn-related neuropathy in our database and to investigate the clinical correlates for both mononeuropathy and generalized peripheral polyneuropathy. PATIENTS AND METHODS: Out of 648 burn patients, admitted to our clinic forty-seven burn patients with the diagnosis of peripheral neuropathy were evaluated retrospectively. The demographic and clinical data collected were gender, age, degree, site and percent surface area of burn, type of burn, and the results of electrodiagnostic examination, including electromyography and nerve conduction assessments and associated pathology if existed. RESULTS: Peripheral neuropathy is the most frequent disabling neuromuscular complication of burn, that may be undiagnosed or overlooked. In current study, peripheral neuropathy associated with burn all of our patients were identified by electrodiagnostic study. After treatment in Burn Unit, clinical and electrodiagnostic studies were applied. Motor and sensory distal latencies were prolonged and sensory nerve action potentials reduced in amplitude. CONCLUSIONS: The findings of our study have shown that polyneuropathies and axonal neuropathy were more frequent than mononeuropathy and demyelination.  

Pediatric electrical burn injuries: experience of a large tertiary care hospital and a review of electrical injury.

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.

[Preclinical treatment of severe burn trauma due to an electric arc on an overhead railway cable]. / Präklinische Versorgung einer lichtbogenbedingten schweren Verbrennung an einer Bahnoberleitung.

Severe burns due to electrical accidents occur rarely in Germany but represent a challenge for emergency physicians and their team. Apart from extensive burns cardiac arrhythmia, neurological damage caused by electric current and osseous injury corresponding to the trauma mechanism are also common. It is important to perform a survey of the pattern of injuries and treat acute life-threatening conditions immediately in the field. Furthermore, specific conditions related to burns must be considered, e.g. fluid resuscitation, thermal management and analgesia. In addition, a correct strategy for further medical care in an appropriate hospital is essential. Exemplified by this case guidelines for the treatment of severe burns and typical pitfalls are presented.

[Lightning strikes and lightning injuries in prehospital emergency medicine. Relevance, results, and practical implications]. / Blitzschlag und Blitzunfälle in der präklinischen Notfallmedizin. Relevanz, Folgen und praktische Implikationen.

Up to 32.2% of patients in a burn center suffer from electrical injuries. Of these patients, 2-4% present with lightning injuries. In Germany, approximately 50 people per year are injured by a lightning strike and 3-7 fatally. Typically, people involved in outdoor activities are endangered and affected. A lightning strike usually produces significantly higher energy doses as compared to those in common electrical injuries. Therefore, injury patterns vary significantly. Especially in high voltage injuries and lightning injuries, internal injuries are of special importance. Mortality ranges between 10 and 30% after a lightning strike. Emergency medical treatment is similar to common electrical injuries. Patients with lightning injuries should be transported to a regional or supraregional trauma center. In 15% of all cases multiple people may be injured. Therefore, it is of outstanding importance to create emergency plans and evacuation plans in good time for mass gatherings endangered by possible lightning.

[Mechanism and prevention and treatment strategy of progressive injury in high-voltage electric burns].

High-voltage electric burn is one of burns that can cause severe damages to tissue and organs. Clinically, progressive injury in high-voltage electric burns is a key pathological change that affects the level of amputation and the success rate of treatment. At present, the exact definition and mechanism of progressive injury in high-voltage electric burns have not been elucidated, and the clinical treatment is mainly symptomatic treatment. Relevant research data on the mechanism and treatment of progressive injury in high-voltage electric burns are lacking. This paper analyzes and summarizes the mechanism, diagnosis, treatment, and common outcome of progressive injury in high-voltage electric burns, and provides a reference for the mechanism research, clinical diagnosis and treatment of progressive injury in high-voltage electric burns.