Electrical injury emergency. Electrical injury emergency care Medical emergency care

Electrical burns are the result of the conversion of electrical energy into heat. The severity and localization of burns depend on the type of electric current (direct or alternating), current strength, voltage, body resistance, the path of current through the body and the duration of exposure. The interaction of these factors determines the variety of clinical manifestations of electrical injury.

Direct and alternating electric current act on the body in different ways. Low voltage (less than 1000 V) and low frequency (40-150 Hz) alternating current used in household electrical appliances and incandescent lamps is three times more dangerous than direct current. It can cause ventricular fibrillation and sudden death, as well as respiratory arrest or asphyxia due to tetanic contraction of the respiratory muscles. Due to tetanic contraction of the muscles of the hand, the victim often convulsively squeezes the current source with his hand; this leads to longer exposure to current and more severe electrical injury. Skin burns are usually minor or none at all. At high voltage, unlike low voltage, high frequency alternating current and direct current are equally life-threatening.

The severity of the injury depends primarily on the voltage of the current, although there are known cases of survival from shocks with voltages of more than 100,000 V and death from exposure to currents of as little as 50 V. Low voltage current, although it can be fatal, never causes such extensive tissue necrosis, like high voltage current. The path of current through the body and the degree of tissue damage is determined primarily by their resistance. In order of increasing resistance, tissues can be arranged as follows: nerves, blood vessels, muscles, skin, tendons, adipose tissue, and bones. The resistance of the skin depends on its thickness, cleanliness and moisture content. Wet skin resistance is only 0.1% of dry skin resistance. With high skin resistance, pronounced tissue damage is observed at the point of contact, and with low resistance, on the contrary, the systemic effect of the current predominates, in particular, on the heart and brain. The total resistance between two points of contact is the sum of the skin resistances at the points of contact and the internal resistance of the body.

Electric shock can affect any organs and tissues. For the successful treatment of wounds caused by electric current, it must be remembered that skin burns with them are usually minor, and the severity of damage to deeper tissues may be different. Skin wounds at the points of current entry and exit are yellow-brown or charred areas with a depression in the center. Burns can occur during an arc discharge, when the victim is in close proximity to the current source, but does not directly touch it. Sometimes in such cases, burns of the flexor surfaces of the wrist and elbow joints and armpits are observed. After a few days, there is a clear distinction between viable and non-viable tissues. Ignition of clothes in an arc discharge leads to skin burns, which can be very severe, because a person paralyzed with fear is not able to extinguish the flame.

The most severe complications from the cardiovascular and respiratory systems - respiratory arrest, ventricular fibrillation and sudden death - are observed immediately at the time of the lesion.

Vessels in electrical injury are affected more often than in other types of burns. The blood flow in large arteries and veins is usually high enough to dissipate the heat generated by the passage of electrical current, but small vessels are severely damaged by high temperature, and thrombosis develops in them. The high frequency of amputations of limbs in case of high-voltage current injury is apparently associated precisely with damage to blood vessels. With necrosis of the wall of large vessels, delayed bleeding is possible.

In 3-15% of cases, electrical injury leads to acute renal failure; this is more common than with thermal burns. Nervous tissue has low resistance, so it is very susceptible to the damaging effects of electric current. Neurological disorders are observed more often than other consequences of electrical injury; they can appear immediately and then disappear on their own or occur only after 6-9 months, and sometimes even three years after the injury. For their diagnosis, it is very important to ask the patient about the circumstances of electric shock. If he cannot remember them, this means that the electric current has led to the loss of short-term memory.

Damage to the central nervous system can be manifested by depression of consciousness and paralysis (usually transient). Persistent disorders, represented by encephalopathy or hemiplegia, sometimes in combination with aphasia, gradually appear after several days or months and progress slowly. Disorders such as abasia are often only detected during the recovery period. The most common persistent consequence of electrical injury is partial, and sometimes complete

Primary disorders of gas exchange in the lungs are usually the result of a titanic spasm of the respiratory muscles and vocal cords. Therefore, the victim cannot call for help or draw attention to himself with gestures, since it is impossible to unclench the hands and independently break away from the current-carrying object (current 50-100 mA). These violations persist only during the period of exposure to electric current and in the near future after the release of the victim from contact with current. Less often, apnea is caused by damage to the medulla oblongata, when the current loop captures the respiratory center. In these cases, respiratory arrest persists even after the termination of contact with the current, which requires mechanical ventilation. When the current loop passes through the chest, various cardiac disorders occur, up to ventricular fibrillation.

Lightning strikes cause less severe cardiac problems, with the exception of head injuries.. Respiratory disorders in this case occur secondary due to reflex cardiac arrest or as a result of damage to the chest (fractures of the ribs, sternum), as well as a bruise of the brain during the throwing and falling of the victim.

The diagnosis of electrical injury is made on the basis of a survey of the victim or witnesses of the incident, the presence of traces of contact (current marks on the body); the smell of ozone or burning, damage to wires or equipment at the scene.

Depending on the general condition of the victims, four degrees of severity of electrical injury are distinguished.:

• I degree - easy when there is a convulsive contraction of the muscles without loss of consciousness and without disturbances in breathing and cardiac activity;
• II degree - moderate when muscle contraction occurs with loss of consciousness, but without respiratory and cardiac disorders;
• III degree - severe when, against the background of convulsive muscle contraction with loss of consciousness, cardiac or pulmonary disorders are noted;
• IV degree - extremely severe when, under the influence of current, clinical death occurs instantly.

Subjective sensations during electrical injury are diverse: from a slight push to burning pain, convulsive muscle contraction, trembling. After the cessation of the current, the victim often feels tired, frightened, heaviness throughout the body, depression or excitement..

With electrical injury I and II degree neuropsychiatric disorders and symptoms of increased intracranial pressure may occur. With electrical injury III degree besides this, deafness of heart sounds, tachycardia, and sometimes arrhythmia are noted.

With mild (I-II) degree lesions, these phenomena are stopped within 1-2 weeks. In severe injury there are persistent changes in the cardiovascular system, up to myocardial infarction. Patients require long-term and intensive therapy.

Local tissue damage is manifested by electrical burns, which are formed at the points of current entry and exit, where electrical energy is converted into heat. The higher the voltage, the more severe the burns..

Electrical burns are characterized by swelling of the surrounding tissues and hypoesthesia. Sensitivity disorders, which are determined within a radius of up to 2 cm from the wound, are the result of exposure to nerve endings, mainly electrical energy. Often there are changes in the peripheral nerves according to the type of ascending neuritis with paresis, sensory and trophic disorders.. If the nerve is in the affected area, then flaccid paralysis occurs immediately after the injury.

At the time of passage of a high current through the body, a convulsive contraction of the muscles occurs, which can cause avulsion and compression fractures, fractures, dislocations and dislocations.. Vertebral compression, avulsion of the greater tubercle of the humerus, fracture of the neck of the scapula, and dislocation of the shoulder are more common.

See electrical injury

Saenko I. A.

Sources:

1. Nursing guide / N. I. Belova, B. A. Berenbein, D. A. Velikoretsky and others; Ed. N. R. Paleeva.- M.: Medicine, 1989.
2. Zaryanskaya V. G. Fundamentals of resuscitation and anesthesiology for medical colleges (2nd ed.) / Series "Secondary vocational education" .- Rostov n / D: Phoenix, 2004.

Electrical injury is damage caused by exposure to an electric current. Often leads to death.

Electrical injury can occur when the body is in direct contact with an electric current source or during arc contact, when a person is in close proximity to the current source, but does not touch him. This type of electric shock should be distinguished from damage caused by a voltaic arc (burn, light damage to the eyes).

The degree of influence of electric current on the body is determined by various factors, incl. the physical parameters of the current, the physiological state of the body, the characteristics of the environment, etc. It has been established that at a voltage of up to 450-500 V, alternating current is more dangerous, and at a higher voltage, direct current. The initial irritating effect of the electric current appears at a current of 1 mA. At a current of 15 mA, a convulsive contraction of the muscles occurs, which, as it were, “chains” the victim to a source of electrical energy. However, the “pinning” effect is also possible at lower current strengths. Fatal electrical injury at a current strength of more than 100 mA.

The impact of current on the body causes various local and general disorders. Local phenomena with E. can vary from minor pain to severe burns with charring and burning of individual parts of the body (printing table, article 529, 3-5). The general phenomena at E. are expressed in disturbance of activity of the central nervous system, respiratory organs and blood circulation. With E., fainting, loss of consciousness, speech disorders, convulsions, respiratory disorders (up to a stop), and in severe cases, shock are observed. In severe E., instant death may occur. Electric burns are characterized by "current signs" - dense scabs at the site of skin contact with the wire. In those struck by lightning, traces of the passage of current in the form of reddish stripes remain on the skin - “signs of lightning”. If clothing ignites during E., ordinary burns are possible.

Electrical injury treatment

Emergency assistance to the victim is to quickly stop the action of the electric current. To do this, turn off the switch (fuses), pull the wire out of the hands of the victim with a dry wooden stick or other non-conductive objects. If this is not possible, then it is necessary to pull the victim away from the current source, having previously ensured his safety (do not touch the open parts of the victim’s body, hold him only by his clothes, after putting on rubber or dry wool gloves, wrapping his hands in dry clothes or standing on an insulating object, for example on a car tire, board, dry rags). In the absence of these items, it is recommended to chop or cut the wires (each separately) with a tool with a dry wooden handle. When providing assistance to a victim from exposure to electric current with a voltage of over 1000 V, you must first put on rubber shoes (boots, boots), gloves. Immediately after the elimination of the current exposure directly at the scene and if the victim has signs of clinical death, he is given artificial respiration, closed heart massage and defibrillation. It is possible to stop carrying out these resuscitation measures only if the victim recovers spontaneous breathing or signs of biological death appear. Regardless of the condition of the victim, he must be immediately hospitalized for observation and treatment.

In a medical institution, according to indications, anti-shock measures and oxygen therapy are carried out. With a sharp excitation, sedatives are prescribed. From the first hours they begin to fight against hypoxia (oxygen tent, oxygen inhalation equipment). With increased intracranial pressure, dehydration is performed, sometimes a spinal puncture. With functional disorders of the nervous system, hypnotics are prescribed.

Treatment of local manifestations of electrical injury begins with the application of aseptic dressings to the burns. All victims are given tetanus toxoid. In case of severe damage to the limb with pronounced signs of vascular and muscle spasm, case or vagosympathetic novocaine blockade is indicated, which can be repeated after 3 days. Antiseptic agents are applied locally.

Rejection of necrotic tissues during electrical trauma can be long-term, and its acceleration is one of the tasks of treatment. For this purpose, with small burns, baths with a solution of potassium permanganate, UV irradiation, oil-balsamic dressings are shown. After the boundaries of the necrosis zone are finally determined (5-7 days after E.), in a satisfactory general condition, the victim is performed necrectomy with plasty of the skin defect. With total necrosis of the limb or its parts (fingers, hand), if the main vessels are damaged, amputation is performed.

The most common cause is suffocation with pieces of food or other objects (especially in children)

Classification of foreign bodies of the respiratory tract

Depending on the level of localization, foreign bodies of the larynx, trachea and bronchi are isolated.

Etiology of foreign bodies in the respiratory tract

Foreign bodies usually enter the respiratory tract naturally through the oral cavity. It is possible for foreign bodies to enter from the gastrointestinal tract with regurgitation of gastric contents, the creeping of worms, as well as the penetration of leeches when drinking water from reservoirs. When coughing, foreign bodies from the bronchi can penetrate into the larynx, which previously got there, which is accompanied by a severe attack of asphyxia.

The pathogenesis of foreign bodies in the respiratory tract

The immediate cause of foreign body entry is an unexpected deep breath that entrains the foreign body into the respiratory tract. The development of bronchopulmonary complications depends on the nature of the foreign body, the duration of its stay and the level of localization in the respiratory tract, on concomitant diseases of the tracheobronchial tree, the timeliness of the removal of the foreign body by the most gentle method, and on the skill level of the emergency physician.

Clinic of foreign bodies of the respiratory tract

There are three periods of the clinical course: acute respiratory disorders, the latent period and the period of development of complications. Acute respiratory disorders correspond to the moment of aspiration and the passage of a foreign body through the larynx and trachea. The clinical picture is bright and characteristic. Suddenly, among full health during the day, while eating or playing with small objects, an asthma attack occurs, which is accompanied by a sharp convulsive cough, cyanosis of the skin, dysphonia, and the appearance of petechial rashes on the skin of the face. Respiration becomes stenotic, with chest wall indrawing and frequent bouts of coughing. Entry of a large foreign body can cause instant death due to asphyxia. The threat of suffocation is present in all cases of a foreign body entering the glottis. Smaller foreign bodies during the subsequent forced inspiration are carried away into the underlying parts of the respiratory tract. The latent period occurs after the movement of the foreign body into the bronchus, and the farther from the main bronchi the foreign body is located, the less clinical symptoms are expressed. Then comes the period of development of complications.

Foreign bodies of the larynx cause the most severe condition of patients. The main symptoms are pronounced stenotic breathing, a sharp paroxysmal whooping cough, dysphonia to the degree of aphonia. With pointed foreign bodies, pain behind the sternum is possible, aggravated by coughing and sudden movements, and an admixture of blood appears in the sputum. Asphyxiation develops immediately when large foreign bodies enter or increases gradually if pointed foreign bodies get stuck in the larynx, due to the progression of reactive edema.

Foreign bodies of the trachea cause a reflex convulsive cough, aggravated at night and with restless behavior of the child. The voice is restored. Stenosis from permanent localization in the larynx becomes paroxysmal due to the balloting of a foreign body. Balloting of a foreign body is clinically manifested by a “pop” symptom, which is heard at a distance and occurs as a result of blows of a moving foreign body against the walls of the trachea and against closed vocal folds that prevent the removal of a foreign body during forced breathing and coughing. Balloting foreign bodies pose a great danger due to the possibility of infringement in the glottis and the development of severe suffocation. Respiratory failure is not as pronounced as with foreign bodies of the larynx, and is repeated periodically against the background of laryngospasm caused by contact of a foreign body with the vocal folds. Self-removal of a foreign body is hindered by the so-called valve mechanism of the tracheobronchial tree (“piggy bank” phenomenon), which consists in expanding the lumen of the airways during inhalation and narrowing it during exhalation. Negative pressure in the lungs drags the foreign body into the lower airways. The elastic properties of the lung tissue, the strength of the muscles of the diaphragm, the auxiliary respiratory muscles in children are not so developed as to remove the foreign body. The contact of a foreign body with the vocal folds when coughing causes a spasm of the glottis, and the forced breath that follows again drags the foreign body into the lower respiratory tract. With foreign bodies of the trachea, a boxed shade of percussion sound, a weakening of breathing throughout the lung field are determined, and an increased transparency of the lungs is noted during radiography.

When the foreign body moves into the bronchus, all subjective symptoms stop. The voice is restored, breathing stabilizes, becomes free, compensated by the second lung, the bronchus of which is free, coughing fits become rare. A foreign body fixed in the bronchus causes at first meager symptoms, followed by profound changes in the bronchopulmonary system. Large foreign bodies linger in the main bronchi, small ones penetrate into the lobar and segmental bronchi.

Clinical symptoms associated with the presence of a foreign body in the bronchus depend on the level of localization of this foreign body and the degree of obstruction of the lumen of the bronchus. There are three types of bronchoconstriction: with complete atelectasis, with partial, along with the displacement of the mediastinal organs towards the obstructed bronchus, the unequal intensity of the shadow of both lungs, the slanting of the ribs, the lag or immobility of the dome of the diaphragm during breathing on the side of the obturated bronchus are noted; with valve, emphysema of the corresponding section of the lungs is formed.

Auscultation determines the weakening of breathing and voice trembling, respectively, the localization of the foreign body, wheezing.
The development of bonchopulmonary complications is facilitated by a violation of ventilation with the exclusion of significant areas of the lung parenchyma from breathing; possible damage to the walls of the bronchi, infection. In the early stages after aspiration of a foreign body, asphyxia, laryngeal edema, and atelectasis occur predominantly, respectively, in the area of ​​the obstructed bronchus. Atelectasis in young children causes a sharp deterioration in breathing.
Perhaps the development of trachebronchitis, acute and chronic pneumonia, lung abscess.

Diagnosis of foreign bodies of the respiratory tract

Physical examination

Laboratory research

Common clinical tests that help assess the severity of inflammatory bronchopulmonary processes. Instrumental Research
Chest X-ray with contrasting foreign bodies and chest X-ray with aspiration of non-contrast foreign bodies in order to detect the Goltzknecht-Jakobson symptom - displacement of the mediastinal organs towards the obstructed bronchus at the height of inspiration. Bronchography, specifying the localization of a foreign body in the tracheobronchial tree if it is suspected of moving beyond the bronchial wall. X-ray examination allows you to clarify the nature and causes of complications.

Differential diagnosis of foreign bodies of the respiratory tract

It is carried out with respiratory viral diseases, influenza stenosing laryngotracheobronchitis, pneumonia, asthmatic bronchitis, bronchial asthma, diphtheria, subglottic laryngitis, whooping cough, allergic laryngeal edema, spasmophilia, tuberculosis of the peribronchial nodes, tumors and other diseases that cause various types of respiratory disorders and bronchoconstriction .

The problem of electrical injury, with the exception of lightning strikes, has become relevant relatively recently. To date, the constant increase in the number of sources of electricity associated with the development of scientific and technological progress, of course, increases the level of comfort of life, but at the same time causes a high incidence of electrical injuries and electrical burns.

Despite the fact that electricity has firmly entered the life of mankind relatively recently, the history of electric shocks from artificial sources has been studied for a long time. The first report of death due to electric shock of a carpenter from an alternator appeared in 1879 in Lyon, France.

The first electrocution death in the United States was the death of Samuel Smith in contact with an alternator in Buffalo. Since this event took place in the presence of many witnesses, and the death of the victim was regarded as quick and painless, it was proposed to use electric current as a "humane" means of death. The first criminal to be executed using this method was William Kemmeler, who was sentenced to death in New York State in 1890.

The frequency of electric shock injuries in developed countries is 2-3 cases per 100,000 population. Electrical burns account for 2-3% of burns from other causes, but, despite a relatively modest place, they often cause disability, and in some cases death, which puts them in one of the first places in importance.

Electric injuries most often affect people of young and able-bodied age. Men die from electrical injury almost 4 times more often than women.

Pathogenesis

The pathogenesis of electric shock is not completely clear, since it is practically impossible to study the processes occurring in living tissues at the moment an electric current passes through them.

Abnormal passage of electrons through the body at the time of electric shock leads to damage or death of the body by depolarization of the cell membranes of nerves and muscles, causing the occurrence of pathological electrical rhythms in the heart and central nervous system, leads to the occurrence of external and internal electrical burns due to heating and evaporation of cell membranes .

The passage of electric current through the brain leads to loss of consciousness and the occurrence of seizures due to the occurrence of foci of pathological depolarization of neuronal membranes. In severe cases, this depolarization leads to respiratory paralysis, which is one of the causes of death from electric shock.

The defeat of alternating current when passing it through the heart can cause fibrillation.

If the victim is subjected to continuous current for some time, impaired oxygen transport due to respiratory failure and vascular smooth muscle spasm can lead to ischemic damage to the brain and internal organs.

Electric current has a thermal, electrochemical and biological effect on a person. Electric energy, passing through the tissues of the body, encounters resistance on its way and, according to Joule's law, passes into thermal energy.

Electrochemical changes under the influence of current lead to the aggregation of platelets and leukocytes, the movement of intra- and extracellular ions, the polarization of proteins, the formation of gas and steam, giving the tissues a cellular appearance, etc.

The biological effect is manifested by a violation of the conduction of the heart, a violation of the nervous system, a contraction of skeletal muscles, etc.

Actually, electric burns are formed as a result of the conversion of electrical energy into heat in the tissues of the victim. Electrical burns occur mainly at the points of current entry (from the source of electricity) and its exit (to the ground), in places of greatest resistance, forming burn surfaces of various areas and depths, most often in the form of so-called marks, or current signs.

Electrical energy, turning into heat, coagulates and destroys tissues. However, the specificity of the manifestation of electrical burns is due not only to the depth of the coagulation necrosis itself, but also to the damage to the tissues surrounding the burn and the general changes resulting from the passage of electricity. It should be remembered that electric current damages tissues not only at the site of its application, but also along the entire path.

The severity and nature of electrical injury is mainly determined by the following factors: the type, strength and voltage of the current, the way it passes through the body, the duration of its action and the resistance of tissues.

It is known that direct current is less dangerous than alternating current. The effect of alternating current on the body depends on its frequency. So, low-frequency currents (50-60 Hz) are more dangerous than high-frequency ones.

However, the most important are the strength and voltage of the electric current. The threshold for perceiving the strength of direct current entering the body is 5-10 milliamps (mA), the threshold for perceiving alternating current used in everyday life (60 Hz) is 1-10 mA.

At a current of 10-15 mA, a person cannot take his hands off the electrical wires. A current of 0.05-0.1 amperes (A) is considered fatal, although in some cases death can occur with less force.

There are electric shocks of low and high voltage, as well as damage by atmospheric electricity (lightning). Low voltage is considered to be up to 1000 volts, high - more than 1000 volts.

It should be noted that high voltage shock can also occur without direct contact with a power source as a result of the action of a step voltage or a voltaic arc.

under the term " step voltage» understand the difference in voltage between two points on the ground that are at a step distance (usually 0.8 m). It occurs as a result of the electrification of the earth by a conductor with a high voltage that has accidentally fallen or laid in the ground, or it can be observed during the entry of a discharge of atmospheric electricity (lightning) into the ground.

under the term " voltaic arc» understand the movement of an electric charge through the air at a distance of several centimeters to a meter from a current source with a high voltage of several kilovolts. The resulting local burns are limited, but spread to a great depth. The occurrence of arc contact is facilitated by increased humidity.

Low-voltage burns are predominantly domestic. The low voltage electrical current usually travels in the path of least resistance, i.e., through low resistance tissues, which are arranged in the order described below.

High-voltage burns often occur at work (when installing devices, in contact with high-voltage lines, etc.), as a rule, they are more severe, often combined with mechanical injury and flame burns from burning clothes and nearby objects.

The high voltage current travels along the shortest path, causing much more severe damage. Burns often develop. Combined and combined lesions of the main vessels with necrosis of muscle masses, damage to internal organs are characteristic. The general effect of the current on the body is observed in most patients. Fatal outcomes, as a rule, occur precisely as a result of high-voltage lesions.

Along with the strength and voltage of the current, the path of its passage from the entry point to the exit point is of great importance. The path of current through the body is called current loop. The most dangerous option is the so-called. full loop (two arms - two legs), in this case, the current inevitably passes through the heart, which can cause disruption of its work up to a stop.

The passage of electric current along various paths is somewhat arbitrary. Even with the same loop, the current in the body can move along a number of parallel conductors with different resistance and branches according to Kirchhoff's law.

The resistance of different tissues varies significantly and is related to the specific gravity of the fluid present in them. So, the nervous system, blood, mucous membranes and muscles have the least resistance. Dry skin has medium resistance. High resistance is characteristic of cartilage, bones and adipose tissue.

It should be noted that the resistance may vary depending on the objective circumstances. Thus, the dry and thickened skin of people engaged in manual labor has a much greater resistance compared to moist and thin skin.

The duration of contact of the victim with the source of electricity is essential. So, when exposed to a high voltage current, the victim can be immediately thrown away due to a sharp contraction of the muscles. At the same time, at a lower voltage, muscle spasm can cause a prolonged grip of the conductor with the hands. The longer the action of the current, the greater the severity of the lesion and the higher the likelihood of death.

Along with the characteristics of the electricity itself, there are some other factors to consider. So, in damp and damp rooms (baths, bathrooms, dugouts, etc.), the conductivity of electricity increases significantly. The outcome of electrical injuries at the same time largely depends on the state of the body at the time of injury and the age of the victim.

Clinical picture

The clinical picture is very diverse and largely depends on the severity and characteristics of the electrical injury itself. The current, passing through various organs and tissues, causes a number of serious disorders.

To classify the severity of electrical lesions, the scale proposed by G.L. Frenkel, as well as the classification of S.A. Polishchuk and S.Ya. Fistal.

G.L. Frenkel proposes to classify the severity of electrical injury as follows:

• I degree - partial convulsions;
• II degree - a general spasm, which does not entail a state of prostration after the current is turned off;
• III degree - severe prostration and the inability to move for some time even after the current is turned off, with or without loss of consciousness;
• IV degree - instant death or death with previous prostration.

• Light electrical injury - convulsive muscle contraction without loss of consciousness.
• Electric injury of moderate severity - convulsive contraction of muscles and loss of consciousness, ECG is normal.
• Severe electrical injury - loss of consciousness and impaired cardiac and respiratory activity.
• Extremely severe electrical injury - clinical death.

The main causes of deaths in electrical trauma are considered to be cardiac arrest, more often due to fibrillation, respiratory arrest due to paralysis of the respiratory center, shock, and also due to a combination of these causes.

Many cases of sudden death of victims a few hours after an electrical injury against the background of apparent well-being have been described. Therefore, any victim of an electric shock must be hospitalized without fail in a specialized hospital, where, if necessary, he can be provided with emergency resuscitation.

When exposed to a high voltage electric current, a deep disorder of the central nervous system can occur with inhibition of the centers of the cardiovascular and respiratory systems, called imaginary death or electrical lethargy. Clinically, this condition is manifested by imperceptible cardiac and respiratory activity. If in such cases the necessary resuscitation measures are taken, then most often they lead to success, otherwise, in the absence of adequate assistance, actual death may occur.

In the event of a massive electrical injury, signs of shock may develop, requiring intensive care.

Often noted nervous system damage, disorders of blood circulation, respiration, electric burns of varying degrees of extent occur.

An electric current passing through the structures of the nervous system leads to a violation of its functions, sometimes leaving behind severe damage in the form of bleeding, swelling, etc. There may be loss of consciousness of varying duration and degree, followed by retrograde amnesia, convulsions, dizziness, headache.

In some cases, there are symptoms of increased intracranial pressure (photophobia, neck stiffness, Kernig's symptom, epileptiform seizures, etc.). Often more or less persistent paresis or paralysis of the nerves with motor, sensory and trophic disorders.

It is possible that there is a disorder of thermoregulation with temperature asymmetry in various areas of the body, the disappearance of physiological reflexes and the appearance of pathological ones, etc. In milder cases, clinical manifestations are limited to flashing in the eyes, weakness, weakness, etc.

Among organic injuries, spinal atrophic diseases associated with damage to the spinal cord in the region of the anterior horns of the brain and gray matter in the circumference of the central canal, manifested by trophic and vasomotor disorders in the innervated areas, are considered typical.

Cardiovascular disorders, as a rule, are more functional in nature and are often expressed in the form of various cardiac arrhythmias (sinus arrhythmia, tachycardia and bradycardia, extrasystole, heart block phenomena). The most severe disorder is ventricular fibrillation and cardiac arrest.

Prolonged vasospasm, as already mentioned, can lead to ischemic lesions of the central nervous system, limbs and internal organs. For a prolonged spasm of the vessels of the extremities, their cyanosis, swelling, coldness and the absence of a pulse in the main vessels are clinically characteristic.

The effect of current on striated and smooth muscles leads to its spasm, which can be expressed in skeletal muscle spasms, spasm of the muscular layer of blood vessels with an increase in blood pressure, coronary spasm. In some cases, damage to the walls of blood vessels by current leads to subsequent arrosive bleeding.

Significant contraction of skeletal muscles when struck by high voltage current or atmospheric electricity can lead to fractures of the spine and long bones.

The predominance of the phenomena of evaporation and necrosis in the striated muscles leads to its edema with infringement in the fascial cases, which requires urgent surgical correction. In addition, muscle edema causes or aggravates compression of the neurovascular bundles of the extremities, with aggravation of edema and ischemia.

Due to exposure to bright light, which occurs, for example, with a voltaic arc, vision can be affected, which manifests itself in the form of keratitis, choroiditis, followed by the development of cataracts, which is observed in about 6% of cases of high voltage electric shock. Retinal detachment and hyphema may also be seen.

Damage to the sense organs is possible, which is manifested by tinnitus, hearing loss, and a disorder of touch. When exposed to high voltage current or lightning, ruptures of the eardrums, injuries of the middle ear with the development of hematotympanum, otoliquorrhea and subsequent deafness can be observed.

Sometimes there is traumatic emphysema and pulmonary edema, and in case of high voltage shock, bruises and ruptures of the lungs, functional liver failure, glomerulonephritis, transient enteritis. Cases of damage to the stomach, pancreas, gallbladder are described.

In places of greatest current resistance - input and output - due to the transition of electrical energy into thermal energy, burns are formed, up to charring of the limbs and body parts in case of severe lesions, or most often in the form of electrical marks, or current signs, which are areas of dry necrosis.

The shape of electrotags is round or oval, but it can also be linear; the color is usually lighter than the surrounding skin - grayish white or pale yellow. Often, along the edges of the affected skin there is a roller-like elevation, as a result of which the middle of the mark seems to be somewhat sunken.

A characteristic feature of electrotags is their complete painlessness due to damage to nerve endings. Sometimes there is a detachment of the epidermis in the form of blisters, but, unlike thermal burns, without liquid content. Hair in the area of ​​electrotags, retaining its structure, twists in a spiral.

The phenomenon of metallization is characteristic - deposits of conductor metal particles in the skin (yellow-brown color - iron, blue-green color - copper, etc.). In low voltage electrical injury, they are located on the surface, high voltage - spread deep into the skin. As a consequence, details of the conductor configuration may be displayed in the contact zone.

Exit marks tend to be more pronounced than entry marks. In places of folds, the current, passing along a shorter path, can exit the body and re-enter, leaving milestone electrical marks.

It should be noted that electrical burns are often not limited to signs of current on the skin. They are characterized by a deeper spread with primary necrosis of deeper tissues - muscles, tendons, joints, bones, etc., which determines the real severity of the lesion of patients.

Often, foci of necrosis are located under apparently healthy skin. With massive muscle damage and the release of myoglobin, a syndrome similar to crash syndrome may develop.

In some cases, when exposed to high voltage current, so-called “pearl beads” can form in the bones, which are the result of melting and subsequent solidification of calcium phosphate in the form of rounded white formations with a diameter of 1-2 mm.

Possible subsequent secondary expansion of necrosis zones due to thrombosis and partial death of blood vessels after exposure to electric current, which makes it difficult to early determine the entire volume of the lesion. Rejection of a dry scab occurs slowly. Frequent arrosive bleeding during demarcation.

Secondary injuries in case of electrical injury, not directly related to the action of current, are most often thermal burns from ignited objects, mechanical injuries as a result of falling from a height, being thrown from a power source, etc., which can significantly aggravate the general condition of the victims.

The clinical course of electrical burns is in many ways similar to the course of thermal burns. With extensive lesions, including deep-lying tissues (muscles, bones, etc.), there is a high probability of developing a burn disease.

Some features have a clinical picture of lightning damage. There is a higher mortality, which is usually 70-90%, and frequent loss of consciousness. In places of contact, lightning causes deep charring of tissues, and sometimes ruptures of the skin. Characterized by the symmetry of the lesions during the passage of an electric discharge from the head to both legs and the predominant defeat of the lower body from the step voltage that occurs when a lightning strike near the victim.

It should be noted that the clinical manifestations of electrical injury, depending on its specific features, can vary significantly - from mild lesions to extremely severe conditions, leading in some cases to the death of the victims.

Treatment

The final outcome of electrical injury largely depends on the provision of prompt and adequate first aid.

First of all, if the victim is under the influence of electric current, the specified impact must be stopped, observing the established safety rules. If possible, open the electrical circuit with a circuit breaker or switch, or by pulling the plug out of the socket.

If this cannot be done for any reason, then it is necessary to remove the current source from the victim using insulating objects, for example, a dry wooden stick, clothes, rope, leather or rubber gloves, etc.

To isolate the rescuer himself, you can also use insulating objects - dry boards, rubber, car tires, etc. When releasing the victim from a source above 1000 volts, special security measures should be taken.

After the release of the victim from the action of the current, they begin to provide first aid. It is important to immediately correctly assess the state of cardiac and respiratory activity. If necessary, resuscitation measures are started according to the ABC algorithm - closed heart massage, artificial ventilation of the lungs (mouth-to-mouth breathing, etc.).

The emergency medical team that arrived at the scene of the injury should quickly assess the situation and determine the sequence of resuscitation measures. If there are signs of clinical death, it is necessary to immediately begin (or continue) chest compressions and artificial ventilation of the lungs with a breathing apparatus through a mask, and if ineffective, tracheal intubation should be performed.

If these measures are unsuccessful, within 2-3 minutes it is necessary to intracardially inject 1 ml of a 0.1% solution of adrenaline and 10 ml of a 10% solution of calcium chloride, intravenously (in / in) - 1 ml of a 0.05% solution of strophanthin, diluted in 20 ml of 40% glucose solution, or electrical defibrillation of the heart.

The victims with signs of shock are transported to a medical institution only in the supine position with constant monitoring of cardiac activity. The evacuation of such patients, if it lasts more than 20-25 minutes, should be accompanied by anti-shock measures along the way: oxygen inhalation, intravenous administration of colloidal plasma-substituting and electrolyte solutions (reopoliglyukin, gemodez, lactasol, etc.), the use of cardiotonic, antihistamine, antispasmodics, analgesics, etc.

In the hospital, after taking emergency measures to stabilize cardiac and respiratory activity, an anamnesis is taken, the conditions of the injury are clarified, a general examination is performed (radiography of the chest and abdominal cavity, ECG, computed tomography of the head, as well as chest and abdominal cavity according to indications) to exclude a possible combined injury ( fractures, blunt trauma, etc.).

The principles of intensive care for electrical injury, burn shock and local treatment of electrical injuries at all stages of medical care are the same.

Before transportation, dry gauze or contour dressings are applied to the burned surfaces. The imposition of ointment bandages is contraindicated.

Patients with deep electrical burns, electrothermal lesions of any localization should be provided with specialized treatment as early as possible.

All victims with symptoms of shock are subject to hospitalization in the department or wards of resuscitation and intensive care. Patients with limited electrical burns without signs of electrical or burn shock are hospitalized in general wards of a surgical hospital.

Victims without local lesions, even in a satisfactory condition, are hospitalized for 2-3 days in the general therapeutic department for observation and examination. They are given local conservative treatment: toilet burn wounds, according to indications - dressings.

Patients with electrical trauma are also treated here. According to indications, they are administered cardiac and antiarrhythmic drugs, vitamins, other symptomatic agents (corglicon, ATP, cocarboxylase, nitroglycerin, aminofillin, lidocaine, vitamin C, etc.).

Transfusion antishock therapy for electrical trauma should be aimed at normalizing the central and peripheral hemodynamics. It is advisable to start such therapy with the introduction of electrolyte balanced solutions to correct rapidly developed water-salt disorders in various water sectors of the body.

After that, colloidal plasma substitutes are administered, and isogenic protein preparations are used, as a rule, not earlier than 8-12 hours after the injury. The volume of infusion therapy on the first day of shock ranges from 30 to 80 ml/kg of the victim's body weight (depending on the severity of shock) under the control of hourly urine output (optimally - 1.5-2.0 ml/kg of body weight).

The number of administered transfusion agents in the next two days is reduced by 25-35%. The complex of transfusion therapy for electrical trauma requires the inclusion of a relatively large amount of 10% glucose (100-150 ml/s).

They also prescribe direct anticoagulants (heparin) and antiplatelet agents (trental, chimes, troxevasin), drugs that improve the metabolism of the heart muscle, according to indications, antihistamines and corticosteroids, analgesics, antispasmodics, a-blockers, vitamins, osmodiuretics and saluretics are used.

For the treatment or prevention of arrhythmia, the introduction of antiarrhythmic drugs (Isoptin 0.25% 2 ml IV, lidocaine 10% 2 ml intramuscularly) is indicated. Indispensable is the use of sodium bicarbonate and proteolysis inhibitors (gordox, contrykal, etc.).

With the localization of lesions in the head, especially with prolonged loss of consciousness, it is necessary to increase dehydration therapy with loop or osmotic diuretics (lasix, mannitol).

With lesions of the extremities, intra-arterial (worse - intravenous) administration of antispasmodics (papaverine 2% 2 ml, nicotinic acid 0.1% 1 ml with novocaine 0.5-1% 10 ml) and heparin 5-10 thousand units is shown as an urgent measure. . The daily dose of heparin should not exceed 20-30 thousand units.

Along with early intensive transfusion therapy, other medical prescriptions, victims with electrical trauma need urgent active surgical interventions - necrotomy, dissection of the fascia, opening and drainage of the entire muscle mass of the affected limb segments. With circular deep lesions, decompressive necrotomy is necessary in the first hours after injury, including in a state of burn shock.

Any suspicion of damage to the great vessels is an indication for fasciotomy to the proximal level of muscle necrosis. Fasciotomy is indicated for subfascial edema and an increase in the volume of the limb segment, the absence or weakening of the pulsation of the main vessels, a change in the color of the skin of the limb segment (pallor, cyanosis, marbling), a decrease or absence of tactile or pain sensitivity. A prerequisite is the dissection of the fascia over each muscle group.

Decompressive necrotomy, fasciomyotomy, intra-arterial administration of antispasmodics and heparin are effective in the first 6-12 hours after injury. Carrying out these activities later than 24 hours is often belated, and after 36-48 hours - ineffective.

In case of arrosive bleeding already in the CRB or CGB, ligation of the vessels should be carried out throughout.

In case of combined lesions with the presence of bruised wounds, open fractures, dislocations, primary surgical treatment of wounds, osteosynthesis, and hardware stabilization are carried out after anti-shock measures.

Local treatment begins with the primary treatment of burnt surfaces. First of all, urgent surgical interventions are performed (decompressive incisions, ligation of blood vessels, amputations).

With deep necrosis, causing compression of soft tissues, decompressive incisions in the form of necrotomies, fasciotomies, myofasciotomies are performed as early as possible. Such incisions reduce the compression of the neurovascular bundle, prevent secondary ischemic necrosis and, at the same time, are an informative diagnostic technique that determines the depth of necrosis.

With arrosive bleeding, ligation of the vessels is performed throughout.

A significant depth of necrosis in electrical burns often requires a solution to the issue of amputations (in 10-15% of cases). The indication for amputation is total necrosis of the soft tissues of the extremities or their segments with the involvement of the joints, great vessels and nerve trunks in the process. Delay in amputation in such cases is fraught with the development of gangrene, acute renal failure, sepsis and death of the patient.

As a rule, wounds after amputation are left open to control the further course of the wound process. In the case of its favorable course, the wounds are closed with the help of skin grafting. The formation of a stump for wearing a prosthesis is usually carried out already during the rehabilitation period.

Surgical treatment, osteosynthesis and other necessary surgical interventions for combined trauma with mechanical wounds, open fractures, etc. usually performed after anti-shock measures and stabilization of the general condition of the patient.

Surgical and chemical necrectomy remains one of the main methods of local treatment of electrical burns. The difficulty of early detection of the entire depth of tissue damage determines the relative frequency of staged necrectomy. Their implementation allows not only to prevent the development of purulent-inflammatory complications, but also significantly accelerate the preparation of wounds for plastic closure.

Prepared wounds are closed, as a rule, with the help of autodermoplasty or, in cases of exposure of deep-lying structures - bones, joints, nerves, etc., plastics with skin-fascial or skin-muscle flaps on a feeding leg.

Convalescents who have undergone electrical trauma often need long-term rehabilitation, since the action of electric current can cause complications in the long term. Such complications include lesions of the central and peripheral nervous system (encephalopathy, paresis, neuritis, trophic ulcers), cardiovascular system (dystrophic changes in the myocardium, rhythm and conduction disturbances), cataracts, hearing impairment, as well as disorders of the functions of other organs and systems.

Repeated exposure to electricity can lead to early arteriosclerosis, obliterating endarteritis, and persistent vegetative changes. In addition, electrical burns often heal with the formation of deformities and contractures that require reconstructive and restorative operations.

Thus, emergency care and subsequent staged treatment of electrical injury, taking into account its severity, require intensive anti-shock measures, as well as compensation for respiration and cardiac activity, while actively managing local injuries, including emergency surgical interventions.

The treatment of electrical injury, which is characterized by an extraordinary variety of clinical manifestations and structural and functional disorders, is certainly a multidisciplinary task and requires the close attention of physicians of various specialties.

electrical injury occurs due to the damaging effect of electric current. Depends on the strength of the current, voltage, duration of exposure, the path of passage through the body, as well as on the condition of the victim. The most dangerous technical alternating current with a frequency of 50 Hz, a power of 0.1 A and a voltage above 250 V.
Electric current has biological, thermal, chemical and mechanical effects. With electric shock, sudden death can occur from respiratory and cardiac arrest.
At a current strength of 15-25 mA, convulsive muscle contractions occur and the victim cannot independently free himself from the current-carrying object (grip force). A current of 25-80 mA can cause acute asphyxia due to spasm of the glottis, tonic contraction of the respiratory muscles, paralysis of the respiratory center. Sudden cessation of breathing is also possible with the direct effect of electric current on the respiratory center.
Exposure to a current of more than 100 mA can lead to irritation of the vagus nerve, disruption of coronary blood flow due to spasm of the coronary vessels or fibrillation of the ventricles of the heart, which is especially often observed when the current loop passes through the region of the heart.
Symptoms. When exposed to electric current, there is severe pain, convulsive muscle contraction. The victim can be thrown away from current-carrying objects. Possible short-term or prolonged loss of consciousness, psychomotor agitation, retrograde amnesia, weakness, headache, fear, involuntary urination and defecation. Heart sounds are muffled, bradycardia or tachycardia occurs, blood pressure is often lowered, sometimes arrhythmia is observed. Breathing is difficult, asphyxia, development of a terminal state and clinical death are possible. In severe lesions, pulmonary and cerebral edema and acute renal failure develop.
Local symptoms are "current signs" - whitish-grayish areas of necrosis on the skin, swelling or lacerations, burns of varying degrees up to charring. When struck by lightning, pigmentation of the skin in the form of a branched tree is characteristic, which is of forensic medical significance.
Diagnosis. It is established on the basis of anamnestic data and clinical signs.
Urgent care. It is carried out at the scene and should be aimed at eliminating life-threatening phenomena. Before rendering assistance, it is necessary to turn off the current or carefully pull the victim away from the current source. It is always necessary to remember about your own safety (put on rubber gloves, galoshes, pull the wire with a dry stick, etc.).
If the injury was not accompanied by loss of consciousness and the victim is frightened, it is necessary to calm him down, administer antihistamines (diphenhydramine, pipolfen), give validol, erinitis, valocordin for retrosternal pain.
With tonic contraction of the respiratory muscles, spasm of the glottis, intravenous administration of muscle relaxants is indicated, followed by intubation and mechanical ventilation (see cardiopulmonary resuscitation).
In order to reduce ischemia and hypoxia of the heart muscle - 1-2 tablets of nitroglycerin under the tongue. With supraventricular arrhythmias, the introduction of 5 mg (2 ml of a 0.25% solution) of verapamil (Isoptin) is indicated; with ventricular extrasystole or ventricular tachycardia - 100-200 mg (10-20 ml of a 1% solution; lidocaine intravenously in isotonic sodium chloride solution
With the development of clinical death, mechanical ventilation, external heart massage, defibrillation and drug therapy are carried out aimed at eliminating acidosis, preventing the often developing pulmonary and cerebral edema. Electrical injury is often accompanied by damage to bone and muscle tissue. In connection with the possibility of developing tubular necrosis due to myoglobin entering the bloodstream and limiting urine output (rhabdomyolysis), it is necessary to limit the volume of infused fluid during resuscitation due to the danger of water overload.
Apply sterile dressings to burned areas and wounds.
Hospitalization. All victims with an electrical injury, accompanied by at least a short-term loss of consciousness, are subject to urgent hospitalization. During transportation, monitor breathing and cardiac activity.