Electrical Injury Anne Lambert Wagner, MD, FACS Burn & - - PowerPoint PPT Presentation
Electrical Injury Anne Lambert Wagner, MD, FACS Burn & Frostbite Center Medical Director Associate Professor of Surgery University of Colorado Hospital Aurora, CO Objectives Discuss differences between electrical injuries
Anne Lambert Wagner, MD, FACS
Burn & Frostbite Center Medical Director Associate Professor of Surgery
University of Colorado Hospital
Aurora, CO
between electrical injuries
– g
Renamed in 2018 Burn & Frostbite Center at UCHealth
care trained and boarded surgeons
1998
an ABA verified burn center
>40 k
Only ABA Verified Burn Center in Colorado Since 1998 1998
Community Education and Prevention and Advocacy
Electrical Company Injury Prevention
Frostbite Prevention for the Homeless
SOAR (Survivors Offering Assistance in Recovery)
It Happens in Seconds Training for Firefighters
ABLS (Advanced Burn Life Support)
Community Education and Prevention and Advocacy
Electrical Company Injury Prevention
Frostbite Prevention for the Homeless
SOAR (Survivors Offering Assistance in Recovery)
It Happens in Seconds Training for Firefighters
ABLS (Advanced Burn Life Support) Rwanda Burn Scholarship 1 Resident & 1Attending
Community Education and Prevention and Advocacy
Electrical Company Injury Prevention
Frostbite Prevention for the Homeless
SOAR (Survivors Offering Assistance in Recovery)
It Happens in Seconds Training for Firefighters
ABLS (Advanced Burn Life Support) Rwanda Burn Scholarship 1 Resident & 1Attending
– 1.25 million, 80% minor – Approximately 450,000 seeking treat – 45,000 hospital admissions
– 44% fire/flame, – 33% scald – 9% contact
– 4% electrical
– 3% chemical
– Higher morbidity – Longer hospital LOS – Consume far more resources
– 3rd most common injury causing death – Greatest length of stay (7.8 days)
– <2 years age – Account for 65% hospital admissions
deaths – 50% for 49% TBSA – 50% for > 90% TBSA
– Work-related – 3% work related deaths – 90% male
– 2:1 male:female – Most commonly around their home – Kids < 6 low voltage – Kids > 6 high voltage – 70 % occur at home with adult supervision.
– 13 yo male – Electrical arc burn – 59% TBSA – 30 foot fall resulting in
fractures
– ICU days: 73 – LOS: 85 days – – –
– ICU days: 73 – Vent days 27 – 15 total operative procedures – LOS: 85 days – Acute rehab – ICU days: 73 days – Vent days: 27
shocked or injured on the job
work day
– A worker suffers an electrically injury that requires time off the job for recovery
– Few people perform “electrical work” as part of their job.
were able to return to their previous
electrical – Operations – 3.3 vs 5.2 – Amputations – 1.5% vs 19.7% – Escharotomy/fasciotomy – 21% vs 47 % – LOS 32 days vs 44 days – Mortality 11% vs 13.2%
tension were able to return to their previous occupation
has multiple distinct mechanisms – Direct action on cell proteins and cell membranes – Direct tissue injury from heat generation
– Voltage – Current – Type of current – Path of the flow – Duration of contact
injury
ignition
Power (J[Joules])=I2 (Current) x R(Resistance)
– Nerves->blood vessels->muscle->skin- >bones
– Body acts as a single uniform resistance – Injury is inversely proportional to the cross-sectional area of the involved body part
– Irreversible – Rationality for serial debridement's
– Follow current ATLS protocols
issues:
syndromes
myocardial damage
– both low & high voltages
– most common ECG abnormality
– Most common dysrhythmia
dysrhythmias will manifest quickly
– Enroute – ED
monitoring:
– Loss of consciousness – ECG abnormality – Documented dysrhythmia – CPR in the field – Other standard indications
length of time
– Generally 24-48 hours
muscle damage
a UO
– 1-2 cc/hour adults – 2 cc/hour peds
sustain traumatic injuries
clear cut and early
– Avoid prophylactic releases – Clear signs of a developing compartment syndrome
severity
– 7.5% develop DVT – 49% require amputations
world
fatalities/year.
are killed
lightning fatalities.
Peter Hawkes
pm
extremely varied
like branching
tips of the toes
membranes
destruction
initial injury
paralysis)
following a lightning strike, often associated with cold, mottled skin.
common
AB 38 y.o. male
CPR with resumption of a normal heart rhythm with a perceptible pulse
3% TBSA involving chest, left thigh, bilateral feet Discharged hospital day 4
contact
common
artery
frequently affected ocular tissue
surgical therapy
can range from
injuries
bone amputations
sclerosis
Sept 2008
– Neuro/psych complication rates at 81.6% & 71% – Neuro
memory problems, paresthesias & chronic pain
– Psych
& flashbacks
anne.wagner@ucdenver.edu