High-voltage Electrical Injury Research Articles

Burns Resulting from Electric Vehicle Manufacturing in Silicon Valley.

The development of electric vehicles (EVs) has introduced novel technologies and manufacturing processes that expose workers to new risks of burn injury. We identified six patients who were admitted to our burn center for injuries that occurred while working in EV manufacturing facilities. The burns fell into three categories: flash flame burns due to lithium-ion battery explosions, high-voltage electrical injuries, and burns caused by contact with molten metal. Recognizing these recurrent patterns of injury should inform future prevention efforts and prepare health systems to evaluate and treat patients burned in EV manufacturing.

The Silent Threat of Hypokalemia after High Voltage Electrical Injuries: A Case Study and Review of the Literature.

High-voltage electrical injuries, especially from lightning strikes, can cause life-threatening complications due to extreme temperature and voltage exposure. While burns and cardiac complications have been widely described, the documentation of metabolic imbalances, particularly hypokalemia, has not been as prevalent. This report focuses on a patient with profound transient hypokalemia following a lightning strike, alongside a review of three similar cases of transient hypokalemia from the literature. Our patient, a previously healthy young man, was struck by lightning and subsequently suffered transient hypokalemia with lower extremity sensory changes, which resolved after the normalization of serum potassium levels. While the exact underlying mechanisms of transient hypokalemia following high-voltage electrical injuries are unknown, we propose a multifactorial mechanism, which includes massive intracellular shifts of potassium due to elevated epinephrine levels and the prevention of potassium efflux through the electrical disruption of voltage-gated potassium channels. Our report underscores the importance of recognizing hypokalemia in patients with high-voltage electrical injuries and contributes to the understanding of the complex mechanisms involved. Further research is necessary to understand the connection between cellular changes induced by high-voltage exposure and their effects on metabolism, particularly in relation to hypokalemia.

Monocular Electrical Cataract: A Case Report

Introduction : An electric shock is experienced when an electric current passes through a part of the body from an entry point to an exit point. Cataract is frequently described as a complication of electrical injury and it is usually bilateral. We report a rare case of high voltage electric injury in young male patient resulting in monocular cataract.
 Case Illustration : A 23 years old man was presented with a diminution of vision one year after sustaining an overhead high voltage power transmission wire that stung his head. The visual acuity of the right eye was hand movement dan 1.0 in the left eye. On slit-lamp examination, opacities were presented in the lens of the right eye and a clear lens in the left eye. Being diagnosed as having monocular cataract, the patient was then performed phacoemulsification on his right eye (April 12th 2023). The pupil shrank until 5 mm during the surgery but foldable IOL was successfully inserted in the capsule. The right eye vision was improved to 0.5 one day after surgery.
 Discussion : The consequences of high-voltage electric burns are complex. Electrical shock can cause protein coagulation and cataract formation. Lens manifestations are more likely when the transmission of current involves the patient’s head. Proper management of electrical cataracts will result in good visual rehabilitation if the eye does not suffer additional damage as in this case.
 Conclusion : Secondary cataract formation due to electric injury may occur, therefore routine examinations with the ophthalmologist are needed after the electrical trauma. The incidence of monocular cataracts after the electric injury is rare.

Skin Care Experience of a Case of Multiple Organ Failure Caused by High-Voltage Electrical Injury

Background: High-voltage electrical burns are caused by the direct transmission of electric current through the body and the conversion of electric energy into heat energy, which directly heats the tissues and leads to organ function damage. Especially after high-voltage electric burns (more than 1000W), it can not only cause coagulation necrosis of the skin and even carbonization, but also cause serious deep tissue damage .The degree of tissue damage depends on the type of current, the magnitude of current, the frequency, the voltage, the resistance of the tissue, the skin humidity, the duration, the contact area, and other factors. Low voltage and low frequency electric shock mainly affect the heart and respiration, which can lead to insignificant soft tissue damage. High voltage electric shock mainly causes serious soft tissue damage, which can be accompanied by changes in the circulatory system and respiratory system.[1] Subject and Method: We collected the data of a case of multiple organ failure caused by high-voltage electricity that was successfully treated in July 2023.In the course of this patient's successful treatment, The main nursing measures were analyzed: The intake and output volume were actively controlled. Albumin supplementation, Debridement and dressing change were performed daily, Covered with nano-silver ion dressing, Try to ensure a sterile environment during operation, Maintain ambient temperature and humidity. Results: Twenty days later,the skin damage caused by electric burns was reduced from 30% to 1%. Conclusion: These are very important links: The intake and output volume were actively controlled, The balance of intake and output was maintained for 24 hours, and lactic acid was less than 2mmol/L. Albumin supplementation Controlled above 30g/L, Debridement and dressing change were performed daily, Covered with nano-silver ion dressing, Try to ensure a sterile environment during operation, Maintain ambient temperature 28~30℃ and humidity 40%~50%.

Treatment of a teenager with fall from height and high-voltage electrical injury complicated by sepsis-associated encephalopathy

Treatment of a teenager with fall from height and high-voltage electrical injury complicated by sepsis-associated encephalopathy

Double whammy – High voltage optic neuropathy and compressive optic neuropathy

Electric current flows in the body between two contact points. The degree of damage caused by the current is dependent on voltage intensity, tissue resistance, type of current, duration and area of contact and the route the current traveled within the body. Ophthalmic injuries are common with electrical damage to the body. Blepharospasm, keratopathy, uveitis, corneal opacities, cataracts, vitreous hemorrhage, retinal edema, macular hole and vascular occlusions are the frequently encountered ones. Here in this case, we report a very rare coincidence of optic neuropathy triggered by high voltage electrical injury (electrocution) and an occult pituitary macroadenoma which coexisted in the same individual causing compressive optic neuropathy. The patient was treated initially as optic neuropathy with steroids and later the macroadenoma was excised under neuro-surgical guidance. This case necessitates the importance of investigating temporal pallor in young individuals and arrival at a proper diagnosis which otherwise could be vision as well as life threatening.

A rare case of small bowel gangrene and perforation following high voltage electrical injury

This case is a 42-year-old male with an alleged history of electric shock. About 8 h after the insult, an ulcer in the right iliac fossa increased in size with fecal matter coming out. Contrast-enhanced computed tomography of the abdomen revealed a full thickness anterior abdominal wall defect with prolapse of a segment of the distal ileal loop, showing discontinuous wall and no wall enhancement suggestive of evisceration and perforation of bowel with gangrene.

566 Posterior Spinal Cord Syndrome after High Voltage Electrical Injury

Abstract Introduction High voltage electrical injuries have been called “the grand masquerader”, and significant neurological sequalae have been described. Here, we report the case of a 73-year-old man who sustained a 14.5% total body surface area (TBSA) full thickness electrical burns, most significantly to his scalp (Figure 1). On initial evaluation, there was concern for loss of proprioception resulting in gait instability. A magnetic resonance image (MRI) of the cervical spine performed on post injury day 9 showed no evidence of cervical spinal cord injury. Methods A novel descriptive case report of a high-voltage electrical injury with incomplete spinal cord injury Results The patient underwent several operative interventions for wound coverage and preservation of function with the known challenges experienced with high voltage burn wounds. Despite lack of imaging confirmation, suspicion for an occult neurological injury remained high. Neurological consultation confirmed limited proprioception and loss of 2-point discrimination. Due to these specific findings that resulted in an inability to make significant rehabilitation gains, a subsequent MRI of his cervical spine performed on post-injury day 30 demonstrated T2 hyperintensity in the dorsal column in the cervical spine at the C2-3 and C5-6 levels, suggestive of myelopathy (Figure 2). Conclusions To our knowledge, this is the first reported case of an incomplete spinal cord injury (posterior spinal cord syndrome in this case) due to an electrical injury without bony abnormality the association of paralysis. With the knowledge of this injury, our burn therapists have been able to develop a rehabilitation plan with reasonable expectation and goals. While discussing prognosis with the patient and his family, we noted the absence of data regarding outcomes after injuries of this nature and sought to contribute to the literature with this case. Applicability of Research to Practice A novel case of delayed imaging confirmation of posterior cord syndrome contributes to the body of evidence for neurological sequelae due to electrical injuries.

Recovery from progressive cervical myelopathy following high-voltage electrical injury

Recovery from progressive cervical myelopathy following high-voltage electrical injury

213: ONE SHOCK TREATED WITH ANOTHER: NEW-ONSET ATRIAL FIBRILLATION AFTER HIGH-VOLTAGE ELECTRICAL INJURY

Introduction: Development of atrial fibrillation following electrical injury has been rarely reported in literature. This can place medical providers in a situation where they are uncertain on how to manage such event. We present a case of high voltage electrical injury (7200V) resulting in new onset atrial fibrillation. Description: A 38-year-old electric line worker with no previous medical history came in with complaint of new onset palpitations and lightheadedness that started an hour prior to arrival. Patient stated he was standing on a boom lift, pressure-washing a church’s tower when his lance touched an electrical wire overhead. The lines were coming from a main electric pole estimated to be 7200V that connected to the transformer. Patient felt a shock pass through his right hand down to the rest of his body for a few seconds, and then he fell. He was not wearing any gloves. He denied any loss of consciousness, alcohol use, chest pain or any previous heart condition. In the ED, he was found to be in atrial fibrillation with heart rate ranging from 110-150. His CPK was 295 units/L and troponin was < 6 ng/L. Patient received IV diltiazem 15mg and IV amiodarone 150mg. He was started on amiodarone drip, admitted to ICU for monitoring and transitioned to Metoprolol 25mg BID and Xarelto 15mg daily the next day before discharge. Three weeks later, he underwent transesophageal echocardiogram (TEE) guided electrical cardioversion for persistent atrial fibrillation. Discussion: Electrical injury can induce cardiac arrhythmias via different mechanisms. The sheer energy of the electric current could directly stimulate the myocytes. It could also impair the sodium-potassium adenosine triphosphatase transporter which plays a major role in electrical-mechanical activity of cardiac muscle. Myocardial necrosis can also lead to production of new arrhythmogenic foci. Troponin and CPK are not always strong indicators of myocardial injury, however, high CK levels >400 units/L may be associated with longer hospitalization, and a greater risk of skin grafting or amputation. Atrial fibrillation in setting of electrical injury is managed with the use of beta blockers, anti-arrhythmics and in some cases, electrical cardioversion.

Upper Limb Amputations Following Electric Burn: Experience Sharing from Tertiary Hospitals in Bangladesh

Introduction: High voltage electrical burn is one of the most devastating burn injuries involving upper limbs in Bangladesh. It causes serious disfigurement and may lead to loss of the whole upper limb. The aim of this study was to see the severity of electric burn injury involving upper limbs pausing amputations at different levels in two tertiary level referral hospitals of Bangladesh. Methods: A prospective observational study was designed to collect the data from Burn and Plastic Surgery Unit, Dhaka Medical College Hospital and Sheikh Hasina National Institute of Burn and Plastic Surgery from January 2019 to December 2019. One hundred and sixty-nine (169) patients with high voltage electrical burn injury involving upper limb underwent amputation were analyzed according to the severity based on clinical assessment. Results: Male predominance (89%) was observed where right upper limb was involved in 49% of the cases and in 11% cases amputation was bilateral. The most alarming finding was 57.4% patients were below the age of 21 years. Below elbow amputation was done in 48.5% cases followed by above elbow amputations in 32.54% cases. Conclusion: Male sex and younger age are the two most common association with electric burn and subsequent limb amputation. The incidence in higher in upper limbs. This study will help us to create the awareness and for prevention of electric burn. J Bangladesh Coll Phys Surg 2022; 40: 279-286

Geriatric Patient Outcomes of Major Burn due to High-Voltage Electrical Injury: A Case Report

Introduction: Electrical burns are uncommon but result in high morbidity and mortality due to severe tissue damage. Geriatrics are vulnerable to aggressive burns because of skin atrophy, comorbidities, diminished host defence mechanisms and reduced mobility. A high-voltage electrical injury has complex complications, especially long-term complications. This study aimed to present the case of geriatric patient outcomes of major burn due to high-voltage electrical injury. Case Presentation: This is a case report of electrical burn injuries; a 70 years old man came to the emergency room approximately 1 hour after the incident, and a chief complaint was burning due to electrical shock. The patient had a history of electrical shock when fishing on the side of the river bank, where there is a high-voltage electrical central behind him. When he threw his fishing line, the fishing line caught on the exposed high-voltage transformer cable causing an electric shock. The examination showed that the patient was conscious of burns on the right chest to the abdomen and palm to the right hand, as well as on both soles of the feet. Another complaint was a pain in the wound due to electrical shock without a history of fainting, shortness of breath, chest pain, headache, and vomiting. The patient’s previous medical history showed uncontrolled hypertension. Conclusion: Our study demonstrates a rare geriatric patient discharged without complications due to a high-voltage injury. Strict multi-specialty management and rehabilitation are required to treat electrical injuries properly.

Prevalence of Cardiac Arrhythmias, Clinical Spectrum and Complications of Electrical Injury

Background: Electrical accidents (EA) are rare, but can cause serious and potentially life-threatening injuries to multiple organs. The majority of epidemiological data refers to workplace accidents which account for a significant share of such accidents in adults. Exposure to electric shock has been associated with an increased risk of developing immediate and delayed cardiac arrhythmias. Objective: To evaluate the prevalence of cardiac arrhythmias and different symptoms in patient with high voltage and low voltage electrical injury. Methods: This was observational prospective study was carried out at the Dept. of Cardiology, Bangabandhu Sheikh Mujib Medical College Hospital, Faridpur, Bangladesh from January to June 2021. 51 consecutive patients with electrical injury who were admitted. Admission criteria were age ≥15 years, loss of consciousness, cardiac arrest, electrocardiographic abnormalities, soft tissue damage and burns. Patients were categorized into high and low voltage injury group and their variables were compared. Results: The mean age of the patients was 32.3±10.4 years among them 41 (82.3%) were male. Patients who sustain high voltage electrical injury (&gt;1000V) were 18 (35.2%) and low voltage injury (&lt;1000V) were 33 (64.7%).Cardiac arrhythmias like sinus tachycardia (11.1% vs 6.0%, p=0.054), sinus bradycardia (11.1% vs 3.0% p=0.254), ventricular premature beats (5.6% vs3.0%, p=0.674), atrial fibrillation (11.1% vs 0%, p=0.054) were observed in high voltage and low voltage group. The commonest presenting symptoms in both groups were pain (77.8% vs 81.8% p=0.560) and fatigue (55.6% vs 39.3%, p=0.328). Conclusion: In this study few non-fatal cardiac arrhythmias were observed in both high and low voltage electrical injury group. Parameters considered to be risk factors such as known structural heart disease, loss of consciousness, high voltage electric shock, burn and soft tissue injuries were also not significant predictors of the occurrence of arrhythmias. There is no significant difference in the presenting symptoms and types of arrhythmias observed between low voltage and high voltage injury group.

High voltage electrical injury- Knowledge and need of the hour

Electrical burns are linked to a high rate of morbidity and mortality, and are usually avoidable with basic safety precautions. High voltage electrical injuries are uncommon, yet they have a high death rate. Electrocution refers to any death caused by an electrical shock to the body. Although the introduction of electricity was hailed as a gift to civilization, its use in domestic households has continued to increase fatalities, either because of lack of public awareness, total negligence on the part of the general people and electrical distribution agencies. Electricity's ever-increasing reliance on industry and domestic demands exposes man to injury from electric current and equipment that runs on it.

An Algorithm for Reconstruction of Electrical Injuries of the Scalp.

Electrical injuries of the scalp are a frequent occurrence in developing countries. Burns can be contact or conductive and result in extensive tissue damage. The authors present their experience with treatment of scalp and calvarial electrical injuries and propose a management algorithm. This was a retrospective cohort study comprising all patients with electrical injuries of the scalp treated at the authors' center between January of 2010 and December of 2016. Noncontrast computed tomography scans were obtained to assess viability of the calvarium in patients who presented more than 2 weeks after injury. Single-stage débridement and reconstruction were performed. All nonviable soft tissue and bone was removed. Soft-tissue reconstruction was performed with skin grafts, local scalp flaps, pedicled trapezius flaps, and free flaps (anterolateral thigh, latissimus dorsi, and scapular). Cranioplasty was performed in a delayed manner with autologous bone grafts. Over a 7-year period, a total of 52 patients underwent scalp reconstruction for high-voltage (44 patients) and low-voltage (eight patients) electrical injury. All patients underwent successful soft-tissue reconstruction. Osteomyelitis with draining sinuses developed in three patients; these patients underwent flap re-elevation and bone débridement, which resulted in a healed wound and stable reconstruction. Cranioplasty was performed with split calvarial grafts in two patients and split rib grafts in four patients. One patient underwent scalp tissue expansion for hair restoration. The authors propose an algorithm for reconstruction of electrical injuries of the scalp. Thorough débridement of the calvarium is the most important determinant of a successful outcome. Therapeutic, IV.

Cranial-entry electrical burns with neurological sequelae: A case report

Cranial-entry high-voltage electrical burn injury rarely occurs. Hence, early presentation is rare. We herein present a case of a teenage male with mainly fullthickness electrical burn injury covering 9% of the total body surface area, with gangrenous mid-fronto-parietal scalp and calvarium, moderate head injury with bihemispheric deficits, and left frontoparietotemporal intracerebral hematoma and exit wounds (right thumb, thigh, and toes). He underwent initial outer-strip and, later, inner-strip corticectomy, covered with splitthickness skin graft (STSG) and bilateral posteriorauricular artery-based flap, respectively, as well as tangential burn wound excisions with STSG and louvre flap cover for the digits. He also underwent right upper eyelid contracture release and tarsorrhaphy. He developed late post-traumatic seizures, which were managed with anti-epileptic drugs. Definitive calvarial reconstruction is underway. Cranial-entry electrical injury had high morbidity and mortality risks. The spectrum of nervous damage causation mimics nervous syndromes and their presentations. Although elaborate surgical and medical care offers the possibility of survival, the neurological and neuropsychological syndromes in the post-acute and rehabilitative phases of care should be taken care of.

Anterolateral Thigh Flap for Low-Voltage Fourth-Degree Electrical Burn Injury With Immediate Radial Nerve Palsy at the Elbow: A Case Report

Abstract While high-voltage electrical injuries usually cause severe burn wounds and axonal polyneuropathy, low-voltage electrical injuries cause limited cutaneous wounds and demyelinating mononeuropathy, of which the median and ulnar nerves are the most commonly involved. We present the case of a 42-year-old man who suffered a 480-voltage electrical injury at his right elbow, resulting in a 24 × 10 cm fourth-degree burn wound and immediate radial nerve palsy. The burn wound was debrided with confirmation and preservation of radial nerve continuity. The wound was covered with a free anterolateral thigh flap and it healed uneventfully. The Tinel’s sign continued to advance at follow-up, and electrodiagnostic studies showed progressive reinnervation. His radial nerve function recovered completely in 9 months. This is a rare case of low-voltage electrical injury with a fourth-degree burn wound and immediate radial nerve palsy. We treated the wound aggressively with early debridement and prompt flap coverage, but conservatively treated the radial nerve injury. The nerve recovery course indicates that it had a “shocked-cooked” injury and served itself as a well-placed nerve graft for the subsequent regeneration. We believe that our successful outcome in this case can provide more insights into the management of such injuries.

598 Reconstruction of Trochanteric Pressure Ulcers with Pedicled Vastus Lateralis-Anterolateral Thigh Flap

IntroductionTrochanteric region is one of the most frequent site for pressure ulcer development. High-voltage electric injuries with neurovascular damage is an important reason of paraplegia. These patients have prolonged hospitalization period and develop cachexia by time. Grade 3-4 sores with thoracanter major of femur exposition generally need flap reconstruction. Musculocutaneous flaps are preferred to cover exposed bone and fill the dead space. Although loco regional flaps such as tensor fasia lata, gluteus Maximus muscle flap have been used for thoracanteric ulcers, these flaps have mandatory muscles for ambulation in the following rehabilitation period. Another disadvantage of these flaps are the possible donor site problems due to pressure loading. Thus, we aimed to used vastus lateralis- anterolateral thigh(VL-ALT) flap for decreasing donor-site morbidity and tension.MethodsBetween 2019 and 2021 we have operated 6 trochanteric pressure ulcers in 5 patients. All patients had history of electric injury related paraplegia. The mean age of the patients was 33 (24-50) The defect size were ranging between 5x4cm and 10x12 cm. Flap size were planned according to exact size of the defect. VL muscle were harvested according to the size of dead space. The donor site was closed primarily in 3 patients. Split thickness skin graft were needed in 2 patients. Patients were hospitalized in lateral decubitus or supine position during follow –up.ResultsMean follow up time was 10 months (6-18). All flaps were survived. Hematoma development were seen in 1 patient in the donor site which were treated with bedside debridement. No recurrence was seen during follow-up period. No restriction or morbidity were encountered during ambulation.ConclusionsVL-ALT musculocutaneous flap provides the required tissue for dead space filling and defect closing simultaneously. The advantages of this flap are; lower donor site morbidity, perfect match in terms of skin quality and bulk, protecting the major muscles such as gluteus maximus and tensor fascia lata. The technique needs knowledge of quadratus femoris anatomy which has a short learning curve.

805 Case Report: Atrial Perforation in the Setting of Electrical Injury and Subsequent Cardiopulmonary Resuscitation

IntroductionElectrical injuries cause 500 to 1000 deaths per year in the United States and are the fourth leading cause of death in the workplace. Rates and types of cardiac complication secondary to electrical injuries vary widely throughout the literature. Case reports describing cardiac perforation in the setting of electrical injury are exceedingly sparse. To our knowledge, there are no documented cases of cardiac perforation as a direct result of electrical injury.MethodsThis is a case report and review of relevant literature.ResultsCase Description:We present a case of myocardial perforation in the setting of high voltage electrical injury. An otherwise healthy 46-year old male sustained a 13.8 kV electrical. Resuscitation included bystander cardiopulmonary resuscitation (CPR), defibrillation by emergency medical responders, finger thoracostomies and massive transfusion protocol in the trauma bay, and finally emergent sternotomy and repair of two injuries to the right atrial appendage. Given this patient’s pattern of injury, including a sternal fracture and bilateral upper anterior rib fractures, the etiology of his right atrial perforation is more likely due to mechanical injury from CPR instead of thermal or electrical injury to the myocardium. However, intraoperative findings confound this theory as no defects were identified in the pericardium of the mediastinal pleura during the operation. This would argue against mechanical injury during CPR. However, the presence of a left hemothorax may could indicate that a pericardial injury was missed in the operation. We argue that the most likely cause of injury is mechanical perforation of the pericardium and myocardium during CPR with a possible missed pericardiotomy during surgical exploration. An alternative hypothesis is an isolated electrical injury to the myocardium and left hemothorax from rib fractures without communication between the two cavities. This patient expired on postoperative day two due to anoxic brain injury.ConclusionsThis case highlights myocardial injury as a rare but lethal complication of high voltage electrical injury and serves as a reminder that cardiac perforation and hemodynamic collapse due to hypovolemic shock can compound and complicate the resuscitation and management of a patient with electrical injury. Further, the widely varying data regarding cardiac complications secondary to electrical injury warrants further investigation and large-scale prospective data.

Challenges in the Rehabilitation Management of a Patient with Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) Secondary to High-voltage Electrical Burn Injury with Multiple Disabilities: A Case Report

A 22-year-old male who came in contact with a high-voltage wire, with entry point at the head and exit points at the ankles, presented with flaccid paraplegia and loss of sensation of bilateral lower extremities with no radiographic abnormalities. Several burn-related medical complications arose during the admission, as well as episodes of demotivation. Bilateral below the knee amputation was done because of extensive burn injuries of the lower extremities. The rehabilitation management for a patient with multiple disabilities needed to be tailored depending on the limitations and needs of the patient at a certain point in time. Despite the challenges, satisfactory results were achieved, through telerehabilitation and employing a multidisciplinary team approach.