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Objective: This study explored the relationship of neuropsychological complaints to accident- and injury-related characteristics, affective state, and work status in a group of electrical injury (EI) patients., Methods: Sixty-three EI patients and 22 electricians with no history of electrical shock completed the Neuropsychological Symptom Checklist and the Beck Depression Inventory as part of an extensive neuropsychological evaluation., Results: The EI group endorsed significantly more physical, cognitive, and emotional symptoms than did the controls. Symptom complaints were not related to injury parameters or litigation status. Only the time interval between injury and assessment accounted for differences in symptom presentation, with patients in the postacute stages of recovery showing the most cognitive and emotional complaints., Conclusion: The neuropsychological syndrome of electrical injury survival includes physical, cognitive, and emotional complaints. Considering that most electrically injured patients are treated within the acute medical setting, greater attention needs to be directed early in the course of treatment toward addressing neuropsychologic and psychiatric issues.

We report the case of a 19-year-old male who sustained an electrodynamic (16.67 Hz) high-voltage (15,000 V) railway overhead cable injury. He lost consciousness 30 minutes after contact and died secondary to brainstem herniation as a result of intracerebral swelling within 8 days. Repeated cranial computed tomography revealed a huge hemispheric mass bleeding accompanied by subarachnoidal hemorrhage. Additionally, necropsy showed an extensive thrombosis of the adjacent cerebral veins. The pathophysiological mechanism of this unusual injury is discussed.

The case of a patient with thoracic intervertebral disc prolapse, cord compression, and delayed paraplegia with recovery secondary to high-tension electrical current is presented. The unusual entry wound in the neck, makes this a rare event that to our knowledge has not been previously described in the literature. Magnetic resonance imaging allowed noninvasive and early diagnosis, and in the future probably will reveal the true incidence of cord compression in electrical injury victims.

A case of bilateral fractures of the femoral neck resulting from high-voltage electric injury is reported. Surgeons caring for patients with electrical injuries must be aware of the possibility of this injury as well as other skeletal injuries which may result from muscle contraction or falls related to electric shock. Without vigilance for these injuries, diagnosis may be delayed.

A patient with delayed neurologic injury secondary to high-tension current, with recovery, is presented. The mechanism of injury and pathophysiology are felt to be either vascular or direct damage to the spinal cord. This case demonstrates the need for frequent, repeated neurologic examinations of electrical injury victims. The cause of delay in onset of neurologic injury and the mechanism of recovery need further experimental study.

The development of cataracts, a well-known complication of electrical injury, remains poorly understood. We reviewed 113 patients suffering major electrical injuries and identified seven patients who suffered 13 cataracts, an incidence of 6.2%. Six of the seven patients were injured with high (greater than 1,000-v) voltage current, while one man was injured by a 440-v source. All patients suffered true 'entrance and exit' wounds, but only three such injuries involved the head or neck. Cataracts first presented as decreased visual acuity 1 to 12 months postinjury. Ten of the 13 cataracts progressed to a point where surgery was required, from 3 to 27 months postinjury. Surgical therapy resulted in excellent return of vision in every case, although one patient was lost to followup and developed a late retinal detachment. Electrical cataracts remain a serious potential complication of electrical injury. Awareness by burn team members is essential in providing optimal treatment to victims of electrical injury.

A 16-month-old girl suffered low-voltage electrocution from a hairdryer while playing in the bathtub. At exploratory laparotomy about 18 hours postinjury because of distention and persistent, unexplained acidosis, a 1.5-cm diameter necrotic lesion in the terminal ileum surrounded by multiple superficial serosal burns and a 1.5 x 1.0 cm eschar in the mid-transverse colon were found. The lesion in the small intestine was resected with wide margins and the colon lesion exteriorized. The child ultimately expired 12 hours after surgery from recurrent cardiac arrest. Abdominal visceral injury associated with major electrical injury is reviewed. Although the colon is probably the most frequently injured, the esophagus, pancreas, gallbladder, and small intestine have also been reported as directly injured by electric current. The importance of meticulous examination of the abdominal contents at laparotomy is stressed. Lesions of the small intestine should be resected with wide margins when possible and lesions of the colon resected with a colostomy of the injured segment exteriorized.

Because of basic differences in pathophysiology, patients with electrical injury require therapeutic measures quite separate and distinct from patients with flame burns. Fluid requirements are much greater for the electrical-injured patient due to the depth of the injury and frequent occurrence of pigment in the urine. Fasciotomy with surgical exploration for determination of tissue viability is usually required in areas of obvious or questionable viability in patients with electrical injury. Sulfamylon is preferred for topical antibacterial therapy in electrical injury, because of its excellent penetration into deeper tissues. With this regimen of conservative surgical debridement of necrotic tissue, in many patients we have been able to salvage limbs and, in particular, preserve function.

The natural history of electrical injury, exclusive of electrical flash burns, was determined in 64 patients. These patients sustained relatively small burns (x=11%); only nine patients (14%) had burns greater than 25%. Forty-six patients suffered 114 major complications. EKG abnormalities occurred in 36%, including major cardiac arrhythmias in ten patients. One-fourth of the patients developed neurologic sequelae (CNS-8, peripheral-8). Electrical vascular injury with subsequent arterial occlusion was responsible for many of the major amputations. Nineteen patients required 32 amputations (digits-17, hand-1, foot-2, leg-3, arm-9). Early patient referral and vigorous fluid resuscitation minimized renal failure (1.5%) and mortality (3.1%). Early fasciotomy and vigorous debridement appeared to decrease wound sepsis (8%), but apparently had little if any effect on major limb salvage. The unsolved problems of electrical injury, namely neurological and vascular sequelae, are major contributors to the high morbidity of electrical injury.

This report presents a patient with bilateral scapular fractures resulting from an accidental electric shock (440 volt, 60 cps current). This appears to be a previously unreported injury. A postulated mechanism of injury is discussed.