Search

Electrical Accidents Abstract: 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.

Cataract development is one of the most common complications of ocular electrical injury. Our patient reported an electrical injury of his face 13 years ago that affected both eyes. Since that time he noticed progressive visual impairment of both eyes. At the time of first presentation in 2014, slit lamp examination showed characteristic opacities within the anterior and posterior subcapsular area of the lens. Cataract surgery led to full recovery of visual acuity.

In a 50-year-old patient with arrhythmogenic right ventricular cardiomyopathy (ARVC) and implantable cardioverter defibrillator (ICD) two shock discharges occurred after several ineffective attempts with antitachycardia pacing. The analysis of the stored electrograms shows a peculiarity of shocks with low energy, a problem of ICD therapy in ARVC, and the impact of committed shocks as opposed to non-committed shocks.

In this article the case of a patient who received a total of 35 inappropriate defibrillator shocks due to insulation failure with externalized conductor of a Biotronik Linox® lead is described. The implanted defibrillator was immediately inactivated and the failed lead was extracted using a laser sheath system.

We describe for the first time the misinterpretation of a wearable cardioverter defibrillator in the arrhythmia recognition algorithm with subsequent fatal outcome of a multi-morbid patient with an ischemic cardiomyopathy and a highly reduced left ventricular pump function (30 %). The patient's death was preceded by a life-threatening shockable rhythm which was repeatedly documented, but ultimately not correctly recognized by the system and therefore not treated.

The frequency of electric arc accidents has been successfully reduced owing to preventive measures taken by the professional association. However, the risk of accidents has continued to exist in private setting. Three fatal electric arc accidents caused by high voltage are reported with reference to the autopsy findings.

History and Clinical Findings: A 25-year-old man working as varnisher near a power transmission line sustained a 110,000 V shock. Immediately cardiopulmonary resuscitation (CPR) of the pulseless and unconscious man by lay personnel was continued after 5 minutes by an emergency physician. Normal cardiac rhythm was established after 25 electrical defibrillating shocks and 25 minutes of CPR. He was then taken to hospital by helicopter. On admission the intubated and ventilated patient was precariously stable on high doses of catecholamines. His blood pressure was 100/60 mm Hg, the heart rate 110/min. There were current marks on both hands and the left foot; part of the right pectoral muscle was contracted bulge-like. Creatine kinase activity in serum was raised to 2070 U/l (MB fraction 174 U/l). The ECG showed significant ST-elevations in V2-V4., Treatment and Course: At first most attention was paid to stabilising cardiac function. The activity of serum creatine kinase rose to a maximum of 13,881 U/l during the first 6 hours. To prevent renal failure caused by the marked rhabdomyolysis large fluid volumes were administered while intracardiac pressures were monitored via a right-heart catheter and urinary alkalization obtained. The precordial leads of the ECG showed an evolution of changes as in an anteroseptal infarction, the latter confirmed echocardiographically by hypo- and akinesia of the anterior wall. The patient was successfully extubated after 32 hours and was symptom-free without cerebral impairment after 13 days. As subsequent coronary angiography was normal the previous signs of myocardial infarction were most likely caused by current-induced vasospasms., Conclusions: Immediate resuscitation measures after high-voltage shock can prevent physical and mental damage. The rare diagnosis of acute myocardial infarction requires careful consideration because the usual diagnostic criteria of enzyme abnormalities and symptoms cannot be used.

Five patient (one adult and four children) hit by lightning strokes were examined clinically and electroencephalographically. One child died immediately after the accident. For the four survivors, data are available which were collected during several years' examinations. It was possible to confirm the results of previous investigations which showed that pathologic EEG changes can be associated with a weak neuropsychiatric symptomatology following the gradual disappearance of the acute lightning-stroke syndrome and can be observed even in the case of freedom from complaints and symptoms. Finally, the authors also deal with the problems associated with the making of statements by medical experts.

Professional or spare time contacts with electrical appliances are, due to careless handling or technical inadequacies, potentially always associated with electrical injuries. The effects of the electric current on the body depends mainly on voltages: skin and muscle lesions predominate in high voltage injuries. Out of 23 patients, 19 with electrical injuries and 4 with lightning accidents, 18 showed normal ECGs at the time of hospital admission. There were no changes at follow-up. The remaining 5 patients had cardiac arrhythmias which disappeared after 1 1/2 to 36 hours using bedrest and symptomatic treatment only. Cardiac longterm monitoring is thus not required after electrical injuries.

Electrical damage of the ear can be caused by lightning or by electricity. A 41 year old woman hit by lightning causing burns and rupture of both tympanic membranes is reported and analysed.

A case is described in which the patient had been struck by lightning, with involvement of one eye and the visual pathways. Ophthalmological examination revealed a posterior capsule cataract in the right eye and peripheral constriction of the visual field of the left eye, although central vision in the left eye was not affected. The peak latency of the pattern reversal-evoked potentials in the left eye was longer and their amplitude lower. The skin ERG was normal. The CT scan revealed a thickening of the left optic nerve. The importance of electrophysiological and CT scan examination in the diagnosis and etiology of abnormalities caused in the eye by lightning is emphasized.

Neurologic abnormalities are frequent manifestation of an intoxication. beta-activity in EEG supports the diagnosis. Electrical injury is rarely seen in childhood. It may mimic the symptomatology of an intoxication. Exact data about the frequency of neurological symptoms and EEG changes after electrical injury are not available. The case of a young child with neurological symptoms and EEG changes after electrical injury is described.

The paper deals with a new aspect in patients with polytrauma using a method to distinguish between myocardial or skeletal muscle damage. The isoenzyme CKMB of kreatine kinase is found to be characteristic for myocardial damage when increasing to more than 10% of the whole enzyme activity. It should be mentioned that this elevation is also seen in other disorders. Therefore the correlation to ECG changes is important in considering the diagnosis.