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Purpose: Symptoms described in previous studies indicate that electrical injury can cause longstanding injuries to the neurosensory nerves. The aim of the present case series was to objectively assess the profile of neurosensory dysfunction in electricians in relation to high voltage or low voltage electrical injury and the "no-let-go phenomenon"., Methods: Twenty-three Swedish male electricians exposed to electrical injury were studied by using a battery of clinical instruments, including quantitative sensory testing (QST). The clinical test followed a predetermined order of assessments: thermal perceptions thresholds, vibration perception thresholds, tactile gnosis (the Shape and Texture Identification test), manual dexterity (Purdue Pegboard Test), and grip strength. In addition, pain was studied by means of a questionnaire, and a colour chart was used for estimation of white fingers., Results: The main findings in the present case series were reduced thermal perceptions thresholds, where half of the group showed abnormal values for warm thermal perception and/or cold thermal perception. Also, the tactile gnosis and manual dexterity were reduced. High voltage injury was associated with more reduced sensibility compared to those with low voltage., Conclusion: Neurosensory injury can be objectively assessed after an electrical injury by using QST with thermal perception thresholds. The findings are consistent with injuries to small nerve fibres. In the clinical setting thermal perception threshold is therefore recommended, in addition to tests of tactile gnosis and manual dexterity (Purdue Pegboard)., (Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.)

Rational: There has been increased focus on hemostatic potential and function in the initial assessment of the patient with traumatic injuries, that not been extensively studied in patients with burns. We proposed to determine the hemostatic potential of patients with burns upon admission to the emergency department and contrasted their condition with that of healthy controls and patients with other traumatic injuries. In addition we assessed differences due to thermal versus electrical injury and evaluated the effect of burn size., Methods: This is a patient based prospective observational study conducted with delayed consented. Subjects at the highest level of trauma activation upon admission to the ED had a blood sample collected for research purposes and were subsequently consented. Hemostatic potential was measured by rapid thromelastography (r-TEG ® ), thrombin generation by calibrated automated thrombogram (CAT) and platelet function by Multiplate ® using five activators. Burn subjects were compared to subjects with other traumatic injuries and controls. Within the burn subjects additional analysis compared mechanism (thermal vs. electrical) and burn size. Values are medians (IQR)., Results: Two hundred and eighty two trauma patients (with burns n=40, 14%) and 27 controls were enrolled. Upon admission, compared to controls, subjects with burns or trauma were hyper-coagulable based on r-TEG and CAT, with increased rates of clot formation and thrombin generation. There were no differences in burns compared to other traumatic injuries. The presence of hyper-coagulation did not appear to be related to the type of burn or the percentage of total body surface area involved. Employing previous defined cut points for R-TEG driven therapeutic interventions burn patients had similar rates of hyper- and hypo-coagulation noted in patients with traumatic injuries., Conclusion: Upon admission patients with burns are in a hyper-coagulable state similar to that of other trauma patients. Employing demonstrated cut points of hemostatic potential in trauma patients associated with increased risk of poor outcomes demonstrated the incidence in burn patients to be similar, suggesting that these values could be used in the early assessment of the patient with burns to guide treatment interventions., (Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.)

Context: Electrical burns are an important etiology in dealing with patients suffering from burns. In situations of extensive deep lesions of multiple organs and systems affecting young and economically active people, there is a need for expensive multidisciplinary treatment, with a high socioeconomic cost for the community. Among the permanent injuries that explain this high cost, eye injuries stand out, since they are widely disabling. Although rare, lesions of the posterior segment of the eye are associated with higher incidence of major sequelae, and thus deserve special attention for dissemination and discussion of the few cases observed., Case Report: The authors report the case of a patient who suffered high-voltage electrical burns and presented bilateral maculopathy, which evolved with a need for a surgical approach to repair retinal detachment and permanent low visual acuity., Conclusion: This report highlights the rarity of the etiology of maculopathy and the need for campaigns for prevention not only of burns in general, but also especially of electrical burns.

Childhood electrical injuries are rare in the city of Hong Kong. We report the case of a 21-month boy with severe electrical injuries of both hands and explored underlying mechanism for the incident. Meticulous orthopedic repair and reconstruction ensures satisfactory cosmetic and functional outcomes. Our case concurs with the literature that young children may be predisposed to this mode of incident with their curious exploring hands. Despite regulations on electrical home safety standards, extension power boards can still pose a dangerous risk for severe morbidity in the household with young children. Prevention strategies often involve commonsense approach in home safety measures such as (1) use proper fuses in electrical boxes, (2) do not overload outlets, (3) use insulated and grounded electrical cords, (4) keep electrical cords away from a child's reach, and (5) cover electrical outlets so children will not stick items in the outlet., (Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.)

The objective of the present study was to develop the criteria for forensic-medical diagnostics of an electrical injury inflicted in the aqueous environment based on the characteristics of the electrical mark. The specific morphological features of the electrical injuries inflicted in the aqueous environment that were discovered in the materials available for the forensic medical expertise were analysed taking into consideration the results of the relevant research reported in the forensic medical literature. It was shown that an electrical injury inflicted in the aqueous environment results in the formation of an unusual mark in the form of blisters containing no watery liquid associated with electrogenic oedema in the surrounding tissues. Macroscopic and microscopic studies of the electrical mark failed to reveal the signs of grade III and IV grade thermal burning or thermally affected hair. It is concluded that the consistent characteristics of the electrical mark resulting from the injury inflicted by technical electricity in the aqueous environment include cell lengthening, blister formation inside the corneal layer, and the separation of epidermis from the skin proper.

Electrical injuries often result in extensive tissue damage where vascular damage may occur and result in thrombosis and spontaneous rupture of blood vessels. Rupture of the brachial, radial, ulnar, internal mammary, and obturator arteries has been reported in the literature. The authors present two cases of carotid artery rupture following high-voltage electrical injuries. The first case is a 21-year-old man who was climbing a fence near a high-voltage power line when a gold chain he was wearing around his neck caught on the power line, resulting in a 10% circumferential electrical injury to his neck. He presented with visible arterial bleeding from the large neck wound and was taken to the operating room, where a 1-cm laceration to the carotid artery was repaired with a vein patch. On the second postoperative day, the patch dislodged, and a spontaneous rupture of the common carotid artery occurred. The damaged artery was subsequently ligated. The patient recovered with no neurological sequelae. The second case is a 43-year-old man who suffered a high-voltage injury while working on an electrical panel, resulting in a 50% TBSA full-thickness burn to the face, scalp, trunk, and extremities. Four weeks after admission, a latissimus dorsi myocutaneous free flap was used for coverage of exposed outer table of the skull. Intraoperatively, the carotid artery spontaneously ruptured proximal to where the dissection was being carried out. The patient recovered with no neurological sequelae. High-voltage electrical injury results in significant damage to blood vessels via a number of mechanisms. Rupture of a major vessel is a rare, life-threatening sequelae of electrical injury.

Background: Electrical accidents are potentially fatal incidents with effect on the cardiovascular, nerve and musculoskeletal systems and on the skin (burns). The electrical engineering industry points out that the follow-up of injured persons from site of accident to hospital is quite random. This paper gives a review of the current literature and proposes guidelines for the follow-up of victims of electrical accidents., Material and Method: A search of the literature was conducted on Medline, Embase, Biosis, Healthline, the Cochrane Library, the ISI citation databases, and on several other search engines. The revised guidelines were developed in consultation with 23 medical and industry institutions., Results and Interpretation: Serious acute effects of electrical accidents include cardiac arrest, respiration failure, burns (also (internal burns) with necrosis of e.g. muscle tissue), injuries to the nerve system, and renal failure. Traumas caused by falls are also frequent. Possible chronic effects are mostly seen in the nerve system as encephalopathy and psychological sequelae or as spinal cord and peripheral nerve injury. Most importantly, long latent periods are possible for some chronic nerve injuries. This paper suggest guidelines for acute (on the spot) action and criteria for referral to hospital, observation in hospital and further follow-up.

The pathophysiology, types, and treatment of electrical and lightning injuries are discussed in detail. Cases of electrical injury almost always eventually involve litigation. Therefore, careful charting of history and physical findings may save the physician court time later. Care of lightning injuries is very different from that of high voltage injuries.

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.

Miscellaneous cardiac abnormalities can occur after electrical burns. The long term outcomes are still unknown. We studied 10 patients, 9 of whom suffered high-voltage electrocution, and one of whom was struck by lightning. Serial electrocardiograms (ECG) and serum MB creatine phosphokinase isoenzyme (MB-CPK) activities were obtained during their stay in hospital. ECG and thallium 201 cardiac scintigraphy at rest, as well as echocardiograms were obtained in all patients 4 to 48 months after discharge. In hospital, 9 patients showed one or more abnormal findings at physical examination (4 cases), ECG (8 cases), MB-CPK (1 case). At long term follow-up, 5 patients had one or more myocardial functions or conduction abnormalities, with or without symptoms. One patient had compensated heart failure. Nine patients were asymptomatic. Abnormal ECG findings persisted in 3 patients. Three cardiac scans showed evidence of regional myocardial hypoperfusion. Decreases in left ventricular indices measured by echocardiogram were found in 3 patients. We conclude that high-voltage electrocution is associated with a high incidence of cardiac abnormalities, which may persist. Long term evaluation, requiring cardiac T1 201 scintigraphy and echocardiogram, may be justified.

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.

A twenty year experience in the management of 182 patients with electrical injuries has been reviewed. Males predominate. The average age is thirty-six years. Bodily contact with high tension wires by linemen constituted the most common accidents. High voltage injuries were sustained by 67% of patients. Burns were sustained by 74% of our cases and of these, 71% involved the upper extremities. Complications developed in three fourths of patients, and one third of patients suffered some degree of permanent disability. Mortality (2.1%) was largely due to septicemia, pneumonia, and renal failure. The wide variety of injuries necessitates individualization in treatment. Prevention offers greatest hope in management.

Two patients with high voltage electrical injury involving the trunk are presented. Both injuries were complicated by visceral damage; and one patient died from sepsis secondary to bowel perforation. The rarity of this complication is examined in light of the pathophysiology of electrical injury; and its management is discussed with reference to previously published reports on this condition.