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Electrical Injury

Electric Injuries

Electrical injury is a potentially life-threatening form of trauma. Depending on the cause (low vs. high-voltage current), the clinical presentation ranges from mild and clinically inapparent injury to ventricular fibrillation, respiratory arrest, and significant neuronal, cutaneous, and/or vascular injury. Both short-term and long-term sequelae can ensue, primarily neurologic and psychiatric in nature, illustrating the importance of an early diagnosis.


Presentation

Electrical injury is responsible for about 20,000 emergency visits every year in North America, making it one of the most common causes of work-related injuries encountered in clinical practice [1]. Several factors determine the extent of injury, but the most important classification divides electrical injury into those caused by low currents (< 1000 volts, principally seen due to contact with household items) and high-current (> 1000 volts, predominantly in the occupational setting, or lightning strikes) [1] [2] [3] [4]. Paradoxically, injuries caused by low currents are responsible for a more severe clinical presentation, as the electricity travels at a much slower rate through the body compared to high-current injuries, during which the contact with the source is minimal [2] [5]. As the current passes, it damages several tissues in the body, including the skin, the musculoskeletal system, the nervous system, and might interfere with the cardiac pacing activity [1] [2] [6] [7]. Extensive skin burns at the site where the current entered (and exited) the body are the principal manifestation of electrical injury, followed by signs such as pain, paresthesia, weakness, or even muscle tetany, whereas fatigue is a frequent complaint [1] [7]. Compartment syndrome (as a result of venous thrombosis) can also occur and is more frequent in high-voltage injuries [5]. More severe damage to the CNS may cause seizures, quadriplegia, paralysis, coma, and loss of consciousness [5]. Electrical injuries are life-threatening in the presence of cardiac arrhythmia (mainly ventricular fibrillation) or respiratory arrest, and studies estimate that the overall mortality rate is 20-30% [3] [5]. One of the reasons why low currents are more dangerous for humans is its transmission through tissues with lower resistance - blood vessels and the central nervous system [4]. Hence, if patients survive the attack, both short-term and long-term sequelae, primarily neurological (paresthesia, numbness, persistent pain), but also psychological (anxiety, depression, insomnia, flashbacks, nightmares), ophthalmological, and auditory, are more common in low-current vs. high-current injuries [1] [5] [8].

Intravenous Administration
  • We present the case of a patient who developed acute atrial fibrillation in association with low-voltage electrical injury, which resolved after the intravenous administration of digoxin.[ncbi.nlm.nih.gov]
Reiter's Syndrome
  • Bony ankylosis has been described following trauma, paralysis, psoriasis, Reiter's syndrome, ankylosing spondylitis, juvenile chronic arthritis and rheumatoid arthritis. Reports of bony ankylosis following thermal and electrical injury are limited.[ncbi.nlm.nih.gov]
Tachycardia
  • We report on two previously healthy patients who developed severe form of postural orthostatic tachycardia syndrome (POTS) following an electric injury.[ncbi.nlm.nih.gov]
  • Delayed arrhythmia sinus tachycardia and premature ventricular contractions are common in electrical injuries.[hopkinsmedicine.org]
  • VF is the usual cause of immediate death from electrocution; this occurs immediately. [ 9 ] Other arrhythmias have been reported: right bundle branch block and nonspecific ST and T-wave changes occur most commonly. [ 6 ] There may be supraventricular tachycardia[patient.info]
Left Ventricular Dysfunction
  • CONCLUSIONS: The long-term contractile performance of the myocardium is preserved when patient do not experience left ventricular dysfunction in the early stages after HVEI.[ncbi.nlm.nih.gov]
Ankylosis
  • Thirteen cases of burn-related joint ankylosis in four patients are presented. Patients with burns from thermal or electrical injury may develop bony ankylosis among other radiographic manifestations.[ncbi.nlm.nih.gov]
Distractibility
  • Surface electromyographic evaluation revealed constant tonic activity of multiple upper and lower arm muscles at rest, that was not distractible.[ncbi.nlm.nih.gov]
Psychiatric Manifestation
  • Among psychiatric manifestations, neurotic disorders like post-traumatic stress disorder, conversion and adjustment disorders have been appreciated many a times as a frequent accompaniment of these injuries.[ncbi.nlm.nih.gov]
Amnesia
  • Mutism and dense retrograde amnesia are found both in organic and dissociative contexts. Moreover, dissociative symptoms may be modulated by right prefrontal activity.[ncbi.nlm.nih.gov]
  • A 30-year-old lady developed amnesia and spastic paraparesis with loss of pin prick sensation below the second thoracic spinal segment following electrocution.[ncbi.nlm.nih.gov]
  • Examples include: loss of consciousness, amnesia, confusion, paresthesias, and weakness/paralysis. The limb clumsiness and aphasia affecting our patient fall into this category.[ajnr.org]
  • […] early and continued Asystole may spontaneously recover therefore management of apnoea and respiratory arrest is imperative Cardiac: VF likely secondary to hypoxia not lightning shock induced Neurologic: Immediate transient (LOC, confusion, anterograde amnesia[kidshealthwa.com]
  • Immediate cardiopulmonary resuscitation was initiated and on admission the patient was alert, although suffering from amnesia. The sensory and motor examinations were normal. X-ray of the skull and ECG showed no changes.[medbc.com]
Spastic Quadriplegia
  • However, spastic quadriplegia and severe mental retardation remained as sequela. On the 4th month of follow-up, no improvement was noted in his neurological examination.[ncbi.nlm.nih.gov]
Abnormal Involuntary Movement
  • We then reviewed the differential diagnosis of abnormal involuntary movements of the tongue as well as movement disorders related to electrocution.[ncbi.nlm.nih.gov]
Spinal Cord Syndrome
  • A non-progressive spinal cord syndrome is associated with more severe electrical injury. Overall, the evidence reviewed does not support a causal relationship between ALS and electric shock.[ncbi.nlm.nih.gov]
Dystonia
  • We describe a patient who developed right arm dystonia following an electrical injury. The patient's arm remained adducted, and flexed at the elbow and wrist, with all movement resulting in pain and tremor.[ncbi.nlm.nih.gov]

Workup

A properly obtained patient history is a pivotal step for identifying the source of signs and symptoms and further clarification of the source (high vs. low current) can be helpful in assessing the risk of complications. A thorough physical examination is equally important, during which physicians must evaluate the musculoskeletal, nervous, and vascular systems through appropriate examination. A complete neurological examination is particularly important, as it may reveal pathological changes long after the initial event [4]. A thorough laboratory and imaging workup is required to evaluate the status of the patient - laboratory studies (a complete blood count, serum electrolytes, urinalysis, creatine kinase levels, cardiac enzymes, etc.) and imaging procedures (plain radiography, ultrasonography, and echocardiography). Electrocardiogram (ECG) should be immediately performed to exclude cardiac arrhythmias, however some authors claim that conscious patients who suffer from minor symptoms after low-current injuries are not at risk for cardiac complications [7]. Furthermore, electrophysiological studies (nerve conduction testing, electromyography, etc.) are recommended for nerve damage [5].

Treatment

  • In electrical injuries, new treatment modalities and guidelines are needed for improving clinical outcome and the survival of damaged tissue.[ncbi.nlm.nih.gov]
  • We recommend this flap as the treatment of choice.[ncbi.nlm.nih.gov]
  • However, total cost of treatment did not differ significantly between the 2 groups (p 0.05).[ncbi.nlm.nih.gov]
  • 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.[ncbi.nlm.nih.gov]
  • Your doctor or hospital will evaluate the victim and determine whether or not there are injuries that need treatment.[legal-lookout.com]

Prognosis

  • For patients without prolonged unconsciousness or cardiac arrest, the prognosis for recovery is excellent. People who experience low-voltage injuries with cardiac or respiratory arrest may recover completely with immediate CPR on the scene.[hopkinsmedicine.org]
  • With regards to prognosis, research suggests that only 25-30% of electrical injury survivors are able to return to their previous employment and one third of individuals are unable to return to work at all as a result of their injury (depending on the[thebrainclinic.com]
  • Prognosis [ 1 ] Mortality : if the initial shock is survived, the chances of survival are excellent.[patient.info]
  • MR imaging. 4 Numerous conditions have been reported, including basal ganglia disorders, myelopathy, and motor system diseases. 4 Other coincidental, and perhaps treatable, conditions must be ruled out by imaging, because these injuries carry a poor prognosis[ajnr.org]

Etiology

  • The specific etiologic factor and pathogenesis of most dilated cardiomyopathies have yet to be described definitively. Hypotheses of the etiologic factor of idiopathic dilated cardiomyopathy (DCM) abound.[ncbi.nlm.nih.gov]
  • The high frequency of psychological problems is very well established and may be multifactorial in etiology.[cetri.org]
  • […] injuries present serious and common form of trauma with a unique etiology, pathophysiology and mechanism of injury.[degruyter.com]

Epidemiology

  • A review of the literature was undertaken to develop a better understanding of the epidemiology, mechanisms of injury and neuropathology associated with this type of injury.[ncbi.nlm.nih.gov]
  • The purpose of this study is to analyze epidemiological variables of electrical injuries and identify preventable measures through them.[ncbi.nlm.nih.gov]
  • A discussion of the epidemiology of high-voltage electrical injury in children and the clinical management of electrical-injury-induced cardiac complications is provided.[ncbi.nlm.nih.gov]
  • Rahman, Epidemiology of electrical injury: Findings from a community based national survey in Bangladesh, Injury, 43, 1, (113), (2012).[doi.org]
  • Epidemiology and identification of avoidable hazards. Am J Dis Child 1989 ; 143 : 59 –62 Taylor AJ, McGwin G Jr, Davis GC, et al. Occupational electrocutions in Jefferson County, Alabama.[ajnr.org]
Sex distribution
Age distribution

Pathophysiology

  • Further histologic examination of myocardial tissue after electrical injury may reveal clues regarding the pathophysiology behind electrically induced DCM.[ncbi.nlm.nih.gov]
  • However, imaging findings and pathophysiology of electrical injuries that result in significant neurological events remain largely unexplored.[ncbi.nlm.nih.gov]
  • The mechanisms of injury and pathophysiology to the spinal cord are poorly understood. Possible explanations for the delayed onset of neurologic complications are given.[ncbi.nlm.nih.gov]
  • Joule heating and cell membrane disruption are two mechanisms important in understanding the pathophysiology of electrical injury. The degree of tissue damage is often more extensive than initially perceived on clinical exam.[ncbi.nlm.nih.gov]
  • Neurophysiological study and MRI may help in understanding the pathophysiological basis of neurological sequelae following electrical injury.[ncbi.nlm.nih.gov]

Prevention

  • Prevention of Electrical Burns Three pronged electrical outlets that are grounded are one way to help prevent this type of serious injury. Another good source of prevention is to keep covers on all outlets that are not currently in use.[legal-lookout.com]
  • They can usually be prevented through simple safety measures. An effective prevention program would help address this problem.[ncbi.nlm.nih.gov]
  • The purpose of this study is to analyze epidemiological variables of electrical injuries and identify preventable measures through them.[ncbi.nlm.nih.gov]
  • A nationwide prevention program needs to be developed to address this problem. Copyright 2010 Elsevier Ltd. All rights reserved.[ncbi.nlm.nih.gov]
  • Even simple precautions can prevent possible morbidity and mortality. We think that the public level of knowledge and awareness should be increased.[ncbi.nlm.nih.gov]

References

Article

  1. Singerman J, Gomez M, Fish JS. Long-term sequelae of low-voltage electrical injury. J Burn Care Res. 2008;29(5):773-777.
  2. Wesner ML, Hickie J. Long-term sequelae of electrical injury. Can Fam Physician. 2013;59(9):935-939.
  3. Adukauskiene D, Vizgirdaite V, Mazeikiene S. Electrical injuries [Article in Lithuanian]. Medicina (Kaunas). 2007;43(3):259-266.
  4. Kim HM, Ko Y-A, Kim JS, Lim SH, Hong BY. Neurological Complication After Low-Voltage Electric Injury: A Case Report. Ann Rehabil Med. 2014;38(2):277-281.
  5. Primavesi R. A shocking episode: Care of electrical injuries. Can Fam Physician. 2009;55(7):707-709.
  6. Andrews C. Towards solving enigmas in electrical injury. Crit Care. 2012;16(2):117
  7. Bailey B, Gaudreault P, Thivierge RL. Cardiac monitoring of high‐risk patients after an electrical injury: a prospective multicentre study. Emerg Med J. 2007;24(5):348-352.
  8. Piotrowski A, Fillet AM, Perez P, et al. Outcome of occupational electrical injuries among French electric company workers: a retrospective report of 311 cases, 1996-2005. Burns. 2014;40(3):480-488.

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Last updated: 2019-06-28 11:44