Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries...
Transcript of Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries...
![Page 1: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/1.jpg)
Project: Ghana Emergency Medicine Collaborative
Document Title: Electrical and Lightening Injuries
Author(s): Rashmi Kothari, M.D.
License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/
We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly shareable version. The citation key on the following slide provides information about how you may share and adapt this material.
Copyright holders of content included in this material should contact [email protected] with any questions, corrections, or clarification regarding the use of content.
For more information about how to cite these materials visit http://open.umich.edu/privacy-and-terms-use.
Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition.
Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.
1
![Page 2: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/2.jpg)
Attribution Key
for more information see: http://open.umich.edu/wiki/AttributionPolicy
Use + Share + Adapt
Make Your Own Assessment
Creative Commons – Attribution License
Creative Commons – Attribution Share Alike License
Creative Commons – Attribution Noncommercial License
Creative Commons – Attribution Noncommercial Share Alike License
GNU – Free Documentation License
Creative Commons – Zero Waiver
Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (17 USC § 102(b)) *laws in your jurisdiction may differ
Public Domain – Expired: Works that are no longer protected due to an expired copyright term.
Public Domain – Government: Works that are produced by the U.S. Government. (17 USC § 105)
Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain.
Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (17 USC § 107) *laws in your jurisdiction may differ
Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair.
To use this content you should do your own independent analysis to determine whether or not your use will be Fair.
{ Content the copyright holder, author, or law permits you to use, share and adapt. }
{ Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. }
{ Content Open.Michigan has used under a Fair Use determination. }
2
![Page 3: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/3.jpg)
3
ELECTRICAL &
LIGHTENING INJURIES
Rashmi U. Kothari MDAssociate Professor
KCMS/MSU
BotMultichillT, Wikimedia Commons
Maksim, Wikimedia Commona
![Page 4: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/4.jpg)
4
Goals Electrical Injuries
Low VoltageHigh Voltage
Lightening Injuries
Pathophysiology
Complications Management
![Page 5: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/5.jpg)
5
Importance Electrical burns:
1000 deaths annually 4-6.5% of all burn admissions Almost all involve litigation (negligence,
product liability, workmen’s compensation)
Lightening Injuries: 50-300 deaths annually 4-5 X as many lightening strikes 2nd leading cause of weather related deaths
![Page 6: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/6.jpg)
6
Vocabulary
Voltage: electrical pressure in a circuit
Resistance: tissues resistance to flow of electrons
Current: amount of energy in a circuit
Current = Voltage/Resistance
![Page 7: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/7.jpg)
7
Pathophysiology
Current Strength (I)= Voltage/Resistance
Thermal Power (J)=(I)2 X Resistance X duration
Severity =(Voltage) 2 X durationResistance
![Page 8: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/8.jpg)
8
Factors Affecting Injury
Current (Amperage) Type of current Resistance Duration of contact Voltage Pathway of current
![Page 9: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/9.jpg)
9
Current*(amount of energy in
circuit)Physical Effect Milliamperes
(mA)Tingling 1-4
Let go current
Children 4
Women 7
Men 9
Freezing to circuit 10-20
Thoracic muscle tetany 20-50
Ventricular fibrillation 60-120*at 50-60 Hz (frequency of household AC current)
![Page 10: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/10.jpg)
10
Why does AC vs DC current matter?
Which is more dangerous?AC 3X more dangerous than
DC
How do their mechanisms of injuries differ?AC causes tetanyDC throws you away
![Page 11: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/11.jpg)
11
Alternating Current
Source:Power linesHousehold current
Clinical Presentation3X more dangerous than
DCContinuous tetanyV-fibContact wounds
![Page 12: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/12.jpg)
12
Direct Current Source:
Power generating stationsLong distance transmission linesSubmarine cable connectionsPortable generators
Clinical PresentationSingle contractionAssociated blunt traumaArrhythmias cardiac phase dependentEntrance/Exit wounds
![Page 13: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/13.jpg)
13
Resistance
Amount tissue resists flow of electrons
resistance the greater potential to convert electric energy to heat energy
Tissue resistance changes with charring
![Page 14: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/14.jpg)
14
Resistance of Body TissuesLeastNervesBlood
Mucous membranes
IntermediateDry skin
MostTendon
FatBone
![Page 15: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/15.jpg)
15
Skin Resistance
Tissue Resistance (W/cm2)
Calloused hands 1-2 millionSoles of feet 100-200KOther skin 10-40KSweaty skin 2500Bathtub 1200-1500Mucous Membranes 100
![Page 16: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/16.jpg)
16
Injury=Voltage2 x Duration Resistance
ResistanceDry hands vs. Wet hands 2,000,000 W/cm2 1,200
W/cm2
![Page 17: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/17.jpg)
17
2 case scenarios Child puts key in socket
110V AC current Dry skin (10-40K W/cm2 ) current = 2.75-11 mA
Child in tub, key in socket 110V AC current Wet skin (1,200-1,500 W/cm2 ) current =73-92 mA
Injury=(V)2 X t
R
Chris Phan, Flickr
![Page 18: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/18.jpg)
18
Current*Physical Effect Milliamperes
(mA)Tingling 1-4
Let go current
Children 4
Women 7
Men 9
Freezing to circuit 10-20
Thoracic muscle tentany 20-50
Ventricular fibrillation 60-120
*at 50-60 Hz (frequency of household AC current)
2.75-11
73-92
![Page 19: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/19.jpg)
19
Duration of Contact
duration destruction
AC increases duration due to grip strength
![Page 20: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/20.jpg)
20
Voltage Difference in electrical potential
between two points Low Voltage <500-1000 V
24 V=Long distance communication lines
65 V Telephone lines 110-220 V Household current
High Voltage >500-1000 VTransformers, Power lines
![Page 21: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/21.jpg)
21
Current Pathway
Determines tissue at riskThorax: V-fib, myocardial damageHead: resp. arrest, seizure,
paralysisEye: cataracts
Anetode, Wikimedia Commons
![Page 22: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/22.jpg)
22
Factors Affecting Injury
Current (Amperage) Type of current Resistance Duration of contact Voltage Pathway of current
![Page 23: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/23.jpg)
23
Low Voltage Injuries
Usually minor:TinglingLocal contact burns
Exception:Lower resistance (moisture)Ocular involvement Oral injuriesAppliance capacitor (microwave, monitor,
TV)Pregnancy
Source Undetermined
![Page 24: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/24.jpg)
24
Oral Low Voltage Injuries
Child bites electrical cord Arc burn
Electricity jumps from high to low potential region
High temperaturesDelayed bleeding
Cosmetic & Dental deformitySource Undetermined
![Page 25: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/25.jpg)
25
40 y.o. touches an extension cord & feels shock & tingling
Evaluate for any burns Cardiaorespiratory complaints
ECG/monitorIsoenzymes
Consider ocular involvement Ophthalmology referral
Short ED observation Discharge home
![Page 26: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/26.jpg)
26
High Voltage Injury Devastating burns Electrical injuries Blunt trauma Renal
complications
Xy01, Wikimedia Commons
Source Undetermined
![Page 27: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/27.jpg)
27
Electrical Burns
Direct contactElectrothermal heating
Indirect contactArcFlameFlash
![Page 28: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/28.jpg)
28
Electrothermal Burns
Heating of tissue secondary to currentLow voltage injuries with local
burnsHigh voltage
Damage anywhere along current path
Prolonged exposure due to inability to release 7mike5000,
Wikimedia Commons
Source Undetermined
![Page 29: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/29.jpg)
29
Arc Burns
Spark between unconnected objects
Most destructive indirect burn Temperatures of 2,500° C
Oral cord burnsLightening strikes
Achgro, Wikimedia Commons
Source: Brown Medical School
![Page 30: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/30.jpg)
30
Flame Burns
Occur when external objects catch on fire and cause the burn.
Most commonly, clothes
![Page 31: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/31.jpg)
31
Flash Burns Current flashes over the body,
rather than going through the tissues
Seen primarily in lightening injuries.
Source Undetermined
![Page 32: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/32.jpg)
32
Electrical Injuries by Body Site
Head Cardiac Skin Extremities Neurological
7mike5000, Wikimedia Commons
![Page 33: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/33.jpg)
33
Head Strikes
Common point of contact Burns Blunt trauma Cataracts
Days, weeks, monthsComplete eye examOutpatient Ophthalmology
Batholith, Wikimedia CommonsEyeMD,
Wikimedia Commons
Source Undetermined
![Page 34: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/34.jpg)
34
Cardiovascular
ArrhythmiasV-Fib or AsystoleSinus Tach/ A-fib/BBB
ECG changesST elevationProlonged QT
AMIRareElevation of CPK & CPK MB%
![Page 35: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/35.jpg)
35
Skin
Common contact sitesHead/hands/heels
Internal flow of currentDeep muscle injuryCan’t estimate damage from surface burn
Guyprocter, Wikimedia Commons
Magnus Manske, Wikimedia Commons
![Page 36: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/36.jpg)
36
Extremities Damage distant to skin burns Arterial injury
High flow delayed injury Venous injury
Slow flow acute thrombosis & edema
Severe muscle necrosisFasciotomyRhabdomyolysis
Kissing burns Source Undetermined
![Page 37: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/37.jpg)
37
Nervous System
Transient loss of consciousness Concussive type symptoms
Difficulty concentratingDizzinessFlat affect
Spinal InjuriesFractures/ligamentous injuries
Source Undetermined
![Page 38: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/38.jpg)
38
Neurologic Injuries Immediate
Weakness/parasthesias within hoursLower extremity >upper extremityGood prognosis
DelayedDays to yearsAscending
paralysis/ALS/Transverse myelitisMotor>sensoryPoor prognosis
![Page 39: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/39.jpg)
39
Lightening Injuries
Current impulse High voltage/Short
durationVery minimal skin damageFlash over
Maksim, Wikimedia Commons
![Page 40: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/40.jpg)
40
Mechanism of Lightening Injuries
Direct strikeOrifice entry
ContactSide flash, “splash”Ground current or step
voltageBlunt trauma
Ambika Kilaparthi, Flickr
![Page 41: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/41.jpg)
41
Orifice Entry
Enters eyes, ears, mouth High incidence of:
cataracts/uveitis/detached retina/optic atrophy
ruptured TM/hearing loss, tinnitus, vertigo
![Page 42: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/42.jpg)
42
Splash Injury
object person ground
![Page 43: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/43.jpg)
43
Step Voltage
Source Undetermined
![Page 44: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/44.jpg)
44
Blunt Trauma
Thrown 2° to massive contraction of current passing through body
Air superheats then quickly cools explosive force
![Page 45: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/45.jpg)
45
Lightening Injuries
CardiovascularCardiac arrest 2° electrical shock or
vascular spasmRespiratory arrest > Cardiac arrest
Skin<5% deep burnsLinear lesionsPunctate lesionsFeatheringThermal
![Page 46: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/46.jpg)
46
Skin LesionsSource Undetermined
Source Undetermined
Source Undetermined
![Page 47: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/47.jpg)
47
Extremities
ExtremitiesTransient vasospasmCold, blue, mottled,
pulselessResolves within hours
![Page 48: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/48.jpg)
48
Nervous System
CommonLOC, confusion, antegrade
amnesiaParesthesias
Less commonICH, seizure, paraplegiaDelayed muscle atrophy
![Page 49: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/49.jpg)
49
Nervous System
Keraunoparalysis2/3 of patientsExtremities mottled, cold, blueLegs>armsTransient (clears w/in hours)Vascular spasm & sympathetic
instability
![Page 50: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/50.jpg)
50
3 y.o. bites electrical cordpresents with oral burn
Evaluate for other injuries Other burns Ocular involvement
Admission Pain or poor oral intake Poor compliance or follow-up
Discharge home Educate parents regarding bleeding Burns follow-up Dental referral ±Plastics referral ±Ophthalmology referral
![Page 51: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/51.jpg)
51
37 yo touched high voltage power line
ABC Fluids & foley
Urine output 0.5-1.0 cc/kg/hrHeme in urine 1-1.5 cc/kg/hr
Cardiac monitor/ECG Trauma Evaluation Labs
CBC & CMPSerum Myoglobin, U/A
![Page 52: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/52.jpg)
52
Ancillary Tests
Trans-abdominal currentHepatic, lipase, PT/PTT
Altered MSCT head
Cardio-respiratory complaintsTroponin, CPK with IsoenzymesPoor correlation: CPK MB, Angio,
echo, thallium studies with AMI
![Page 53: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/53.jpg)
53
Admission Criteria for ECG Monitoring
Status post arrest Concomitant severe injuries Loss of consciousness Suspicion of conductive
injury Abnormal ECG or
dysrhythmia History of CAD Significant CAD risk factors Chest pain
![Page 54: Project: Ghana Emergency Medicine Collaborative Document Title: Electrical and Lightening Injuries Author(s): Rashmi Kothari, M.D. License: Unless otherwise.](https://reader035.fdocuments.in/reader035/viewer/2022081519/56649e015503460f94aebe4b/html5/thumbnails/54.jpg)
54
Consultants Inhospital
TraumaBurns/Plastics
OutpatientOphthalmologyNeurology