Electrical and lightning injuries.

Electricity and lightning can cause injury in a variety of ways, some of which may remain hidden from the unsuspecting physician until it is too late. Prompt and, if necessary, prolonged resuscitation are of proven benefit. Particular attention must be paid to the patient who suffers high-voltage injury, and deep electrothermal burns on damage to vital organs should be excluded. Uncommonly late sequelae are seen, and such patients require appropriate care.     

Electrical and lightning injuries

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.     

When lightning strikes. Pathophysiology and treatment of lightning injuries

Lightning accidents are responsible for several hundred deaths and thousands of injuries each year in this country. Survivors sustain a variety of cardiac, neurologic, musculoskeletal, and dermatologic injuries. Eye and ear injuries are also occasionally noted. Education on how to minimize the possibility of such an accident is the best method of dealing with the problem. When prevention fails, prompt cardiopulmonary resuscitation and supportive treatment for the patient's particular injury are indicated.     

Prevention and treatment of lightning injuries

Lightning ranks first among natural disasters in terms of fatalities and property damage each year. If fortunate enough to survive, the victim of a lightning or electrical accident often presents with numerous complicated clinical manifestations. The astute nurse practitioner will be challenged to identify the immediate signs and symptoms of possible system disruption, and to institute the follow-up management necessary to prevent further complications. This article explores the nurse practitioner's role in the physical assessment of the client and the protocol for management and follow-up care. Case studies are presented to illustrate the various multisystem findings of clients struck either directly or indirectly by lightning. Environmental precautions to decrease the likelihood of lightning's harmful effects are also discussed. It is easier to prevent a lightning and/or electrical accident than to treat the victim.     

Electrical injuries

Electrical injuries may occur from high or low voltage contact. Low voltage injuries usually occur in the home, tetany may lead to sustained contact, and dangerous cardiac disturbances often result. High voltage injuries are usually work related and result from brief contact but may cause serious tissue destruction and secondary injuries. Both forms may be fatal. Electrical injury more closely resembles a crush injury than a thermal injury and is managed accordingly. External manifestations often belie the severity of deeper wounds.     

Electrical burn injuries

This article examines electrical burn injuries, how they occur and the nature of the injuries caused when people come into contact with electrical currents. The aetiology of tissue damage is discussed along with the pathophysiology of such encounters. The management of patients presenting with such injuries is explored including the vital role of the nurse in stabilizing and reassuring the patient. Careful handling of patients is needed in order to minimize further damage and this is discussed along with the resuscitation measures required and fluid replacement protocols. Pain management requires careful consideration as does the nursing care the patient receives. These are explored along with the support required by the family at such a time. The importance of communication is also stressed. Conclusions are drawn along with preventative measures to help avoid electrical burn injuries occurring.     

Childhood lightning injuries on the playing field

Two young boys were struck by lightning during summer outdoor activities. One of them died. A literature review reveals that the most commonly reported locations of childhood lightning injuries are on the playing field, at the swimming pool, and in tents. Knowledge of measures to lower the risks of lightning strikes as well as the use of new lightning detection technology should help to reduce the numbers of these tragic events in the future.     

Electrical injuries: a 20-year review

Electrical injuries continue to present problems with devastating complications and long-term socioeconomic impact. The purpose of this study is to review one institution's experience with electrical injuries. From 1982 to 2002, there were 700 electric injury admissions. A computerized burn registry was used for data collection and analysis. Of these injuries, 263 were high voltage (> or =1000 V), 143 were low voltage (<1000 V), 277 were electric arc flash burns, and 17 were lightning injuries. Mortality was highest in the lightning strikes (17.6%) compared with the high voltage (5.3%) and low voltage (2.8%) injuries, and mortality was least in electric arc injuries without passage of current through the patient (1.1%). Complications were most common in the high-voltage group. Mean length of stay was longest in this group (18.9 +/- 1.4 days), and the patients in this group also required the most operations (3 +/- 0.2). Work-related activity was responsible for the majority of these high-voltage injuries, with the most common occupations being linemen and electricians. These patients tended to be younger men in the prime of their working lives. Electrical injuries continue to make up an important subgroup of patients admitted to burn centers. High-voltage injuries in particular have far reaching social and economic impact largely because of the patient population at greatest risk, that is, younger men at the height of their earning potential. Injury prevention, although appropriate, remains difficult in this group because of occupation-related risk.     

Electrical injuries in childhood (author's transl)]

11 children were admitted with electrical injuries to the Department of Paediatrics, University of Graz, over the 10-year period 1965 to 1974. The electricity was of low voltage in the case of 9 of these children, who were injured whilst playing with plug sockets of defective cables and of high voltage in 4 case. 1 child was stuck by lightning. Cessation of respiration occurred in 4 of the patients and was successfully counteracted in all cases by prompt mouth-to-mouth breathing. 7 children were still shocked on admission. All children showed the characteristic skin lesions of electrical injury (current marks of linear, round or spidery form). The boy injured by high voltage electricity received extensive burns, in addition. The modes of electrical injury in childhood, the various forms of the resultant lesions, especially of the skin and the treatment of electrical burns are discussed.     

Dance injuries.

Dancers are athletes in an artistic setting. Their injuries, as in other sports, are acute and chronic. Usually, the acute problems are not severe but still can be devastating, especially to the career performer. Chronic problems abound, especially in the lumbosacral spine and lower extremities. Evaluating the dancer with an understanding of the technical and physical demands aids in their care. Treating this dedicated population can be rewarding, and one will find possibly no greater appreciation for one's efforts as a medical practitioner.