sign in sign up
<<
Home , Electrical injury

Dr. Minoo Saeidi & ELECTRICAL INJURIES Assisstant professor of pediatrics DROWNING

 It is more common in children under 5 and 15 to 24 years old  Falling in to the swimming pool, open water, bathtub  Suicide, child abuse  Boys are four times susceptible than girls  Aspiration of small amount of water into the larynx, trigger breath holding and laryngospasm, after that aspiration of the larger volume of water or gastric content into the lung, destroying surfactant, pulmonary endothelial injuries, increased capillary permeability, impaired ventilation and oxygenation, , circulatory collapse DISORDERS ASSOCIATED WITH DROWNING PREHOSPITAL CARE

 Rapid after safe removal of the victim  Cervical spine injuries is rare (0.5%)  Use high flow oxygen  Warm the patient  Monitoring if possible  Establish IV access if possible  ED transfer is necessary if: Drowning amnesia for the event, Loss or depressed consciousness, Observed period of apnea, Who required a period of artificial ventilation EMERGENCY DEPARTMENT CARE

 Assess and secure the airway  Provide oxygen  Determine core temperature (warmed IV fluid, blanket, warmer)  Assist ventilation if needed  routine cervical immobilization and CT of brain is not necessary  GCS>13 and O2Sat >95% are low risk; observe them for 4 to 6 hours  Laboratory data and chest X ray are not valuable in deciding (don’t request)  When they should return; Fever, Pulmonary symptoms, Mental status changes EMERGENCY DEPARTMENT CARE

 GCS< 13; administer supplemental oxygen, ventilatory support  Intubate if: PaO2<80 with FIO2 40 to 60%  Request lab data, chest X ray  Monitoring PR, RR, T, BP, O2Sat  Don’t use prophylactic antibiotics for aspiration pneumonia  If the patient is normothermic on arrival and cardiac rhythm is asystole; discontinue prolonged CPR because of profound neurological CONTINUED MANAGEMENT

 Cardiac monitoring (infusion of Dopamine, echocardiography, CV line)  Neurologic monitoring (brain edema, neurologic deficit)  Monitor ICP (don’t improve outcome)  management  Avoid ventilator associated  Consider Aeromonas when treat pulmonary infections

POOR PROGNOSTIC FACTORS IN DROWNING

 Bystander CPR at the scene (20% die later in hospital)  CPR in emergency department  Prolonged CPR in ED (longer than 30 minutes)  Asystole at the scene  Coma for more than 72 hours  GCS 5 or less  Fix dilated pupils  Seizure  Longer submersion time (more than 15 minutes, especially more than 60 minutes) PREVENTION TIPS

 Parental vigilance during bathing  Never leave an infant in bath seats  Four sided pool fences  Use personal floatation devices  Education  Only swim in a lifeguarded area  Supervising in or near water

ELECTRICAL INJURY

 Low < 1000 V (household)  High voltage > 1000 V (occupational)   Household is AC ()  Electricity of batteries is DC ()  Alternating current can cause ventricular and tetany  Both of them can hurl the victim away, severe blunt injury  Better prognosis in children CURRENT FLOW IN THE BODY MECHANISM OF DAMAGE

 Direct tissue damage due to electric power  Tissue damage due to thermal energy  Mechanical injuries due to falling or muscle contraction /LOW VOLTAGE CLINICAL FEATURES

 Cardiac dysrhythmia (asystole, VF, QT prolongation, bradycardia)  Neurologic impairment (transient loss of consciousness, confusion, seizure, agitation, focal neurologic deficit, aphasia, quadriplegia, hemiplegia, visual disturbances, deep coma)  Spinal cord injury (compressive fracture of spine, direct injuries to spinal cord cells, vascular injury to the cord, late onset spinal cord injury, progressive demyelination, GBS like illness)  Peripheral nerve injury (Paresthesia even late onset)  Cutaneous involvement (entry and exit wounds, )  Orthopedic injuries (fracture, posterior shoulder dislocation) CLINICAL FEATURES

 Inhalation injury (pulmonary hemorrhage and edema)  Ocular injuries (, corneal scar, keratitis, retinal detachment, macular edema, uveitis, intraocular hemorrhage, optic nerve damage)  Auditory injuries (hemorrhage in the middle ear, TM, cochlea and vestibular system, late onset mastoiditis, early or late onset hearing loss)  Vascular damage (aneurysm, thrombosis)  Muscle damage (spasm, compartment syndrome)  Renal involvement (myoglobinuria, ATN)  Coagulation disorders (DIC)  GI injuries (ileus, intra abdominal hemorrhage, GI perforation)

PREHOSPITAL CARE TIPS

 Rescuer safety is very important  Stay at least 10 m from downed power line  Support structures may be electrically alive  Eliminate electrical source immediately  Don’t touch the victim until contact with the electrical source is eliminated  Consider neck immobilization  Do CPR as early as possible MANAGEMENT IN ED

 Consider ABC  Maintain cervical immobilization  Cardiac monitoring in symptomatic and high voltage electrical injuries  Treat like you do in advanced life support  Do careful vascular and neurologic exam  Fluid administration (maintain diuresis until CPK level is less than 5 times normal) DISCHARGE/ADMISSION

 Discharge to home: Voltage <600, Asymptomatic, Normal ECG on arrival, Normal complete examination  Observe for 6 hours: Voltage<600, Unwell, Any in ECG  Admit to the hospital: Voltage > 600 even there is no apparent injury, Beyond superfacial skin injury unrelated to the voltage, Any abnormal lab data or ECG unrelated to the voltage, Oral and lip burn in children because of scar separation and severe bleeding after 5 days, Child with unreliable parents

PREVENTION TIPS

 Put child-safety covers on all electrical outlets  Get rid of equipment and appliances with old or frayed cords and extension cords that look damaged  Position television and stereo equipment against walls so small hands don't have access to the back surfaces or cords  Don't run electrical wires under rugs or carpet  If an appliance appears faulty stop using it and have it checked at once REFERENCES

 Essentials of Nelson, Drowning, chapter 43  Tintinallis , Drowning, chapter 215  Tintinallis Emergency Medicine, Electrical and lightning injuries, chapter 218