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Anesthesiology Feb 2015Care of burn-injured patients requires knowledge of the pathophysiologic changes affecting virtually all organs from the onset of injury until wounds are healed. Massive... (Review)
Review
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 -
Clinical Neurophysiology : Official... Sep 2017Low intensity transcranial electrical stimulation (TES) in humans, encompassing transcranial direct current (tDCS), transcutaneous spinal Direct Current Stimulation... (Review)
Review
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 -
BMJ (Clinical Research Ed.) Jun 2004
Review
Topics: Burns; Burns, Chemical; Burns, Electric; Child; Child Abuse; Cytokines; Humans
PubMed: 15191982
DOI: 10.1136/bmj.328.7453.1427 -
Praxis Jun 2023Electrical 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...
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 -
Clinics in Plastic Surgery Jul 2017This article reviews the unique challenges presented by chemical, electrical, and radiation injuries. The authors discuss pathophysiology and diagnosis of these injuries... (Review)
Review
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 -
Journal of the Royal Society of Medicine Oct 1992
Topics: Electric Injuries; Female; Humans; Male; Sex Factors
PubMed: 1433031
DOI: 10.1177/014107689208501001 -
Neurologia I Neurochirurgia Polska 2021Electrical injury can affect any system and organ. Central nervous system (CNS) complications are especially well recognised, causing an increased risk of morbidity,... (Review)
Review
Electrical injury can affect any system and organ. Central nervous system (CNS) complications are especially well recognised, causing an increased risk of morbidity, while peripheral nervous system (PNS) complications, neurourological and cognitive and psychological abnormalities are less predictable after electrical injuries. PubMed was searched for English language clinical observational, retrospective, review and case studies published in the last 30 years using the key words: electrical injury, electrocution, complications, sequelae, neurological, cognitive, psychological, urological, neuropsychological, neurourological, neurogenic, and bladder. In this review, the broad spectrum of neurological, cognitive, psychological and neurourological consequences of electrical trauma are discussed, and clinical features characteristic of an underlying neurological, psychological or neurourological disorder are identified. The latest information about the most recently discovered forms of nervous system disorders secondary to electrical trauma, such as the presentation of neurological sequelae years after electrocution, in other words long-term sequelae, are presented. Unexpected central nervous system or muscular complications such as hydrocephalus, brain venous thrombosis, and amyotrophic lateral sclerosis are described. Common and uncommon neuropsychological syndromes after electrical trauma are defined. Neurourological sequelae secondary to spinal cord or brain trauma or as independent consequences of electrical shock are also highlighted.
Topics: Central Nervous System Diseases; Electric Injuries; Humans; Retrospective Studies; Spinal Cord Injuries
PubMed: 33026644
DOI: 10.5603/JNNS.a2020.0076 -
PloS One 2022Electric shocks may have neurological consequences for the victims. Although the literature on the neurological consequences of electric shocks is limited by...
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 -
Acta Ophthalmologica Feb 2023Over 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... (Review)
Review
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 -
Canadian Family Physician Medecin de... Sep 2013To summarize the current evidence-based knowledge about the long-term sequelae of injuries from electrical current. (Review)
Review
OBJECTIVE
To summarize the current evidence-based knowledge about the long-term sequelae of injuries from electrical current.
QUALITY OF EVIDENCE
MEDLINE was searched for English-language articles published in the past 20 years using the following search terms: electrical, injuries, wound, trauma, accident, sequelae, long-term, follow-up, and aftereffects. For obvious reasons, it is unethical to randomly study electrical injury in controlled clinical trials. By necessity, this topic is addressed in less-rigorous observational and retrospective work and case studies. Therefore, the strength of the literature pertaining to the long-term sequelae of electrical injury is impaired by the necessity of retrospective methods and case studies that typically describe small cohorts.
MAIN MESSAGE
There are 2 possible consequences of electrical injury: the person either survives or dies. For those who survive electrical injury, the immediate consequences are usually obvious and often require extensive medical intervention. The long-term sequelae of the electrical injury might be more subtle, pervasive, and less well defined, but can include neurologic, psychological, and physical symptoms. In the field of compensation medicine, determining causation and attributing outcome to an injury that might not result in objective clinical findings becomes a considerable challenge.
CONCLUSION
The appearance of these consequences of electrical injury might be substantially delayed, with onset 1 to 5 or more years after the electrical injury. This poses a problem for patients and health care workers, making it hard to ascribe symptoms to a remote injury when they might not arise until well after the incident event.
Topics: Electric Injuries; Humans; Mental Disorders; Pain
PubMed: 24029506
DOI: No ID Found