Review

Authors: Edward A Bittner, Erik Shank, Lee Woodson...

Care of burn-injured patients requires knowledge of the pathophysiologic changes affecting virtually all organs from the onset of injury until wounds are healed. Massive airway and/or lung edema can occur rapidly and unpredictably after burn and/or inhalation injury. Hemodynamics in the early phase of severe burn injury is characterized by a reduction in cardiac output and increased systemic and pulmonary vascular resistance. Approximately 2 to 5 days after major burn injury, a hyperdynamic and hypermetabolic state develops. Electrical burns result in morbidity much higher than expected based on burn size alone. Formulae for fluid resuscitation should serve only as guideline; fluids should be titrated to physiologic endpoints. Burn injury is associated basal and procedural pain requiring higher than normal opioid and sedative doses. Operating room concerns for the burn-injured patient include airway abnormalities, impaired lung function, vascular access, deceptively large and rapid blood loss, hypothermia, and altered pharmacology.

Topics: Anesthesia; Burns; Burns, Electric; Burns, Inhalation; Humans; Pain Management; Perioperative Care

PubMed: 25485468
DOI: 10.1097/ALN.0000000000000559

Review

Authors: A Antal, I Alekseichuk, M Bikson...

Low intensity transcranial electrical stimulation (TES) in humans, encompassing transcranial direct current (tDCS), transcutaneous spinal Direct Current Stimulation (tsDCS), transcranial alternating current (tACS), and transcranial random noise (tRNS) stimulation or their combinations, appears to be safe. No serious adverse events (SAEs) have been reported so far in over 18,000 sessions administered to healthy subjects, neurological and psychiatric patients, as summarized here. Moderate adverse events (AEs), as defined by the necessity to intervene, are rare, and include skin burns with tDCS due to suboptimal electrode-skin contact. Very rarely mania or hypomania was induced in patients with depression (11 documented cases), yet a causal relationship is difficult to prove because of the low incidence rate and limited numbers of subjects in controlled trials. Mild AEs (MAEs) include headache and fatigue following stimulation as well as prickling and burning sensations occurring during tDCS at peak-to-baseline intensities of 1-2mA and during tACS at higher peak-to-peak intensities above 2mA. The prevalence of published AEs is different in studies specifically assessing AEs vs. those not assessing them, being higher in the former. AEs are frequently reported by individuals receiving placebo stimulation. The profile of AEs in terms of frequency, magnitude and type is comparable in healthy and clinical populations, and this is also the case for more vulnerable populations, such as children, elderly persons, or pregnant women. Combined interventions (e.g., co-application of drugs, electrophysiological measurements, neuroimaging) were not associated with further safety issues. Safety is established for low-intensity 'conventional' TES defined as <4mA, up to 60min duration per day. Animal studies and modeling evidence indicate that brain injury could occur at predicted current densities in the brain of 6.3-13A/m that are over an order of magnitude above those produced by tDCS in humans. Using AC stimulation fewer AEs were reported compared to DC. In specific paradigms with amplitudes of up to 10mA, frequencies in the kHz range appear to be safe. In this paper we provide structured interviews and recommend their use in future controlled studies, in particular when trying to extend the parameters applied. We also discuss recent regulatory issues, reporting practices and ethical issues. These recommendations achieved consensus in a meeting, which took place in Göttingen, Germany, on September 6-7, 2016 and were refined thereafter by email correspondence.

Topics: Animals; Brain; Burns, Electric; Humans; Practice Guidelines as Topic; Transcranial Direct Current Stimulation

PubMed: 28709880
DOI: 10.1016/j.clinph.2017.06.001

Review

Authors: Anette Kaergaard, Kent J Nielsen, Ole Carstensen...

PURPOSE

Over the years, many cases of electric cataract related to severe electrical injuries have been reported. Most have been cases where the entrance or exit point of the current was on the skull or near the eyes. Still, cases of cataract have been reported where an electric current has passed through the body between two contact points remote from the eyes. This study investigates whether persons exposed to an electric current develop cataracts in the subsequent years.

METHODS

We identified 14 112 persons who had received electrical injuries in two Danish registries. We matched these with patients partly with dislocation/sprain injuries and partly with persons from the workforce from the same occupation using year of accident, sex and age as matching variables in a prospective, matched-cohort design. We identified cataract as outcome (DH25, DH26 and DH28) in the Danish National Patient Registry. The associations were analysed using conditional Cox and logistic regression.

RESULTS

We did not identify an increased risk of cataract following electrical injury compared to matched controls.

CONCLUSION

A review of the literature clearly substantiates the occurrence of electric cataract as a consequence of electric current coming in contact with a point on the skull or near the eye. However, our results indicate that electric cataract is not a delayed-onset effect of electrical injury, in general, and do not suggest a need for cataract screening in all cases of electrical injury.

Topics: Humans; Cataract Extraction; Cohort Studies; Prospective Studies; Cataract; Electric Injuries

PubMed: 35894089
DOI: 10.1111/aos.15220

Authors: David Hörburger, Elke Schmidt, Samuel Henz...

Electrical Accidents When persons seek medical help after an electrical injury, physicians have to inquire on the type (AC/DC) and strength of current (>1000V is considered "high voltage") as well as the exact circumstances (loss of consciousness, falls) of the accident. In the advent of high-voltage accidents, loss of consciousness, arrhythmias, abnormal ECG or elevated troponin levels, in-hospital rhythm monitoring is warranted. In all other cases, the type of extra cardiac injury primarily directs the management. Superficial skin marks may disguise more extensive thermal injuries of inner organs.

Topics: Humans; Electric Injuries; Accidents; Arrhythmias, Cardiac; Troponin; Unconsciousness

PubMed: 37282521
DOI: 10.1024/1661-8157/a004046

Authors: R A Cox

Topics: Electric Injuries; Female; Humans; Male; Sex Factors

PubMed: 1433031
DOI: 10.1177/014107689208501001

Authors: Kent J Nielsen, Ole Carstensen, Anette Kærgaard...

INTRODUCTION

Electric shocks may have neurological consequences for the victims. Although the literature on the neurological consequences of electric shocks is limited by retrospective designs, case studies and studies of selected patient groups, previous research provides some evidence of a link between electric shocks, and diseases and symptoms of the central nervous system (CNS)(e.g. epilepsy, migraine and vertigo) and the peripheral nervous system (PNS)(e.g. loss of sensation, neuropathy and muscle weakness). This study aims to employ a register-based, matched cohort study, to investigate whether individuals demonstrate a greater risk of neurological diseases and symptoms of the CNS or PNS in the years following an electrical injury.

MATERIALS AND METHODS

We identified 14,112 electrical injuries over a period of 19 years in two Danish registries, and matched these with three different groups of persons in a prospective matched cohort study: (1) patients with dislocation/sprain injuries, (2) patients with eye injuries and (3) persons employed in the same occupation. Year of injury, sex and age were used as matching variables. The outcomes we identified comprised neurological disorders and central or peripheral nervous system symptoms that covered a range of diagnoses in the Danish National Patient Register. The associations were analysed using conditional logistic regression for a range of time periods (six months to five years) and conditional Cox regression for analyses of the complete follow-up period (up to 20 years).

RESULTS

For victims of electric shock, the CNS sequelae we identified included an increased risk of epilepsy, convulsions, abnormal involuntary movements, headache, migraine and vertigo. We also identified an uncertain, increased risk of spinal muscular atrophy and dystonia, whereas we identified no increased risk of Parkinson's disease, essential tremor, multiple sclerosis or other degenerative diseases of the nervous system. For victims of electric shock, the PNS sequelae we identified included an increased risk of disturbances of skin sensation, mononeuropathy in the arm or leg and nerve root and plexus disorders. We also identified an uncertain, increased risk of facial nerve disorders, other mononeuropathy, and polyneuropathy.

CONCLUSION

Our results confirm that electrical injuries increase the risk of several neurological diseases and symptoms of the CNS or PNS in the years following the injury. Most often the diseases and symptoms are diagnosed within the first six months of the injury, but delayed onset of up to 5 years cannot be ruled out for some symptoms and diagnoses. Some of the conditions were rare in our population, which limited our ability to identify associations, and this warrants cautious interpretation. Therefore, further studies are needed to confirm our findings, as are studies that examine the mechanisms underlying these associations.

Topics: Cohort Studies; Electric Injuries; Humans; Nervous System Diseases; Prospective Studies; Retrospective Studies; Vertigo

PubMed: 35235596
DOI: 10.1371/journal.pone.0264857

Review

Authors: Shehan Hettiaratchy, Peter Dziewulski

Topics: Burns; Burns, Chemical; Burns, Electric; Child; Child Abuse; Cytokines; Humans

PubMed: 15191982
DOI: 10.1136/bmj.328.7453.1427

Review

Authors: Kumar Abhinav, Ammar Al-Chalabi, Tibor Hortobagyi...

Electrical injury may act as a potential precipitating or risk factor for amyotrophic lateral sclerosis (ALS). A systematic review of the literature was undertaken to assess the relationship between electrical injury and the development of ALS. Information for the review was obtained using five medical databases, and from manual searching of individual papers. Patients presenting with a neurological syndrome after electrical injury, including lightning, were included and classified into four categories: ALS; progressive upper motor neurone (UMN) syndrome; progressive lower motor neurone (LMN) syndrome; and non-progressive syndrome. Linear regression and chi2 testing were used for analysis of the data. 96 individuals, comprising 44 with ALS, 1 with a progressive UMN syndrome, 7 with a progressive LMN syndrome and 44 with a non-progressive syndrome, were identified from 31 papers with publication dates between 1906 and 2002. The median interval between electrical injury and disease onset was 2.25 years for all progressive syndromes and just over 1 week for the non-progressive syndrome. The more severe the shock (excluding lightning), the more likely individuals were to have a non-progressive motor 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.

Topics: Amyotrophic Lateral Sclerosis; Electric Injuries; Humans; Motor Skills Disorders; Risk Factors; Syndrome; Time Factors

PubMed: 17098839
DOI: 10.1136/jnnp.2006.104414

Review

Authors: Jonathan Friedstat, David A Brown, Benjamin Levi...

This article reviews the unique challenges presented by chemical, electrical, and radiation injuries. The authors discuss pathophysiology and diagnosis of these injuries and provide recommendations for management.

Topics: Burns, Chemical; Burns, Electric; Humans; Radiation Injuries

PubMed: 28576255
DOI: 10.1016/j.cps.2017.02.021

Review

Authors: Martin Tondel, Anna Blomqvist, Kristina Jakobsson...

Immediate and delayed outcomes after electrical injury. A guide for clinicians In Sweden about 300 electrical injuries are recorded each year at the Swedish National Electrical Safety Board. Most of our knowledge of the health consequences of these arise from clinical case series. Severe electrical injuries have direct thermal effects and may result in ventricular fibrillation, skin burns, as well as muscular and nerve affection. Long-term consequences include pain, vascular symptoms, cognitive and neurological symptoms and signs. These sequelae may occur even though the initial symptoms were relatively modest. Mechanisms are better understood for the immediate symptoms, compared to long-term and delayed non-thermal medical consequences. Attention to and treatment of patients with electrical injury needs to be improved to minimize long-term consequences. Good medical care in the acute phase and early multidisciplinary follow-up of severe cases will likely reduce associated morbidity. Each electrical injury should result in an inquiry to identify the cause of the accident in order to suggest actions to prevent new incidents.

Topics: Aftercare; Electric Injuries; Emergency Treatment; Humans; Medical History Taking; Sweden; Time Factors

PubMed: 27922701
DOI: No ID Found