Paro cardiorrespiratorio por electrocución tratado con éxito extrahospitalariamente / Cardiorespiratory Arrest Caused by Electrocution Successfully Treated in an Extra-Hospital Situation / Parada cardiorrespiratória por eletrocussão tratada com sucesso de maneira extra-hospitalar

Resumen Introducción: son pocos los datos documentados sobre los resultados de la reanimación cardiopulmonar en el paro cardiorrespiratorio extrahospitalario por causa de electrocución. El paro cardiorrespiratorio se produce cuando una descarga eléctrica interrumpe de forma abrupta la actividad eléctrica normal del corazón, lo que genera una electrocución y una alteración en los movimientos cardiacos y, por consiguiente, bombeo anormal de sangre y oxígeno a los tejidos. Ello constituye una emergencia clínica que puede ocasionar nefastas consecuencias de no tomarse medidas enérgicas e inmediatas. Presentación del caso: hombre con paro cardiorrespiratorio producido por electrocución y manejado en un ámbito extra-hospitalario, quien respondió con éxito a las maniobras aplicadas. Personal técnico y de salud iniciaron precozmente la reanimación cardiopulmonar y luego fue reforzada por personal médico, que aplicó desflbrilación en dos ocasiones con desflbrilador externo automático (DEA). Con ello se logró recuperar los signos vitales del paciente y trasladarlo a un centro asistencial para continuar su manejo intrahospitalario. Conclusión: la realización de una reanimación precoz y la desfibrilación de pacientes electrocutados, así como las medidas encaminadas a la protección del cerebro, son la norma prioritaria en la asistencia pre-hospitalaria de estos pacientes, quienes son potencialmente recuperables. Por tal razón, es importante que la comunidad, en general, esté preparada y que el personal de salud se reentrene en soporte vital básico, que incluye el manejo del DEA para dar oportunidad de sobrevivir a personas que sufran un paro cardiorrespiratorio extrahospitalario.

Abstract Introduction: There are few the documented data about the cardiopulmonary resuscitation results in the cardiorespiratory arrest extra-hospital due to the electrocution. The cardiorespiratory arrest occurs when the heart's normal electrical activity is abruptly interrupted by electric shocks generated by electrocution, causing the disturbance in the cardiac movements and, consequently, abnormal pumping of blood and oxygen to the tissues. The cardiorespiratory arrest due to electrocution is one clinic emergency that can cause disastrous consequences, if energetic measures are not taken immediately. Case presentation: A man with cardiorespiratory arrest produced by electrocution and managed in an extra-hospital area, who responded successfully to the maneuvers applied. The cardiopulmonary resus-citation maneuvers were precociously started by the health technical staff; next, reinforced by medical it, applying the defibrillation on two occasions, with external automatic defibrillator (AED), recovering the patient's vital signs and allowing his transfer to a healthcare center to continue in-hospital management. Conclusion: The performing of early resuscitation and defibrillation of electrocuted patients, as well as the measures aimed at protecting the brain, are the priority rules in the pre-hospital scene of these patients, who are potentially recoverable. For this reason, it is important that the community, in general, be ready, and the health staff gets trained in basic vital support that includes the management of AED to give the opportunity of surviving to people that suffer a cardiorespiratory arrest.

Resumo Introdução: são poucos os dados documentados sobre os resultados da reanimação cardiopulmonar na parada cardiorrespiratória extra-hospitalar por causa de eletrocussão. A parada cardiorrespiratória se produz quando a atividade elétrica normal do coração é interrompida abruptamente pela descarga elétrica que gera a eletrocussão causando alterado nos movimentos cardíacos e por conseguinte bombeamento anormal de sangue e oxigeno aos tecidos. A parada cardiorrespiratória causada por eletrocussão é uma emergência clínica que pode ocasionar nefastas consequências, de não tomar medidas enérgicas e imediatas. Apresentação do caso: homem com parada cardiorrespiratória, produzida por eletrocussão e manejado em um âmbito extra-hospitalar, quem respondeu com sucesso ás manobras aplicadas. A rearrumação cardiopulmonar foi iniciada precocemente por pessoal técnico de saúde, posteriormente reforjadas por pessoal médico, aplicando a desfibrilação em duas ocasiões, com desfibrilador automático externo (DEA), recuperando os signos vitais do paciente e permitindo seu traslado e um centro assistencial para continuar manejo intra-hospitalar. Conclusão: a realizado de uma rearrumação precoce e desfibrilação de pacientes eletrocutados, assim como as medidas encaminhadas á proteção do cérebro, são a norma prioritária na assistência pré-hospitalar destes pacientes, os quais são potencialmente recuperáveis; por esta razão é importante que a comunidade, em geral, esteja preparada e que o pessoal de saúde se retreine em suporte vital básico que inclua o manejo do DEA para dar oportunidade de sobrevida a pessoas que sofram uma parada cardiorrespiratória extra-hospitalar.

Development of Educational Content for Nurses to Prevent Safety Accidents of Hospitalized Children: Delphi Approach

PURPOSE: The purpose of this study was to develop content for safety education to prevent hospital safety accidents among hospitalized children and to investigate the status of safety education performed by nurses. METHODS: First, the Delphi method was used, with 18 experts, to develop educational contents for preventing safety accidents. Second, an exploratory survey was performed of the actual status of safety education for preventing safety accidents among hospitalized children using a questionnaire developed based on the Delphi method. The participants of this study were 159 nurses with at least 6 months of work experience. RESULTS: The educational content developed through the Delphi method for preventing safety accidents among hospitalized children contained seven domains (falls, injury, electric shocks/burns, suffocation/aspiration, poisoning/abuse, kidnapping, medical devices) with 44 topics. The item mean of nurses'perceptions of the importance of child safety education was 4.18, and the actual performance score was 3.72, which was a statistically significant difference (t=11.58, p < .001). CONCLUSION: These seven comprehensive domains of accident prevention education for hospitalized children are expected to be useful for interventions to support the safety of hospitalized children.

Metabolomics Changes of Serum in Rats Dying from Untypical Electric Injury / 法医学杂志

Objective To study the differential metabolites of serum in rats dying from untypical electric injury by 1H nuclear magnetic resonance （1 NMR）-based metabolomics methods, in order to provide clues for identification of death from antemortem untypical electric injury and instant postmortem electric injury. Methods Models of rats dying from untypical electric injury, instant postmortem electric injury, mechanical asphyxia, mechanical injury, and high temperature injury were established. The rats in control group were executed without any treatment. The serums of rats from every group were detected by 1H NMR-based metabolomics technology to screen differential metabolites. Results The rats dying from untypical electric injury group was compared with those from mechanical asphyxia group, mechanical injury group, high temperature injury group, and control group, respectively. Four chemical shift points with diagnostic value, and their corresponding metabolites were screened. These chemical shift points contained many small molecules, such as alcohols, phenols, sugars, amino acids, etc. The death from untypical electric injury group was compared with those from instant postmortem electric injury group and control group, and then eight chemical shift points with diagnostic value and their corresponding metabolites were screened. These chemical shift points contained small molecules, such as sugars, amino acids, esters, nucleic acids, etc. Conclusion The 1H NMR-based metabolomics technology can identify differential metabolites of serum in rats dying from untypical electric injury, therefore it may provide a basis for the diagnosis of death from untypical electric injury and the identification of antemortem electric injury and instant postmortem electric injury.

Analysis of 4 Cases of Electrocution due to Direct Current Electronic Hunter / 法医学杂志

Objective To summarize the characteristics of cases of electrocution due to direct current （DC） electronic hunter, and to provide references for forensic identification. Methods Four cases of electrocution due to DC electronic hunter were collected. Statistical analysis was carried out from the perspective of the scene and electric marks distribution, damage characteristics and histopathological changes. Results All the 4 cases of electrocution were accidental events. There were multiple electric marks, most of which were located in the lower limbs with serious damage. Some strip type electric marks were visible. Conclusion The distribution, morphological characteristics and severity of the electric marks caused by DC electronic hunter are different from those of the ordinary low-voltage alternating current damage. It is alerting that there would be actions of destroying the scene and abandoning the corpse in such cases.

Tratamiento interdisciplinario en paciente con quemadura eléctrica de alto voltaje / Interdisciplinary treatment of a patient with high-voltage electrical burns

Las quemaduras eléctricas de alto voltaje constituyen una de las causas más graves de trauma, con una elevada tasa de mortalidad. En este artículo se presenta el caso de un paciente de sexo masculino de 31 años de edad que sufrió quemaduras eléctricas de alto voltaje al manipular red de suministro eléctrico en la vía pública. Presentó quemaduras tipo B en miembro superior derecho, cara, y cuero cabelludo. El objetivo de este trabajo es establecer la importancia del trabajo interdisciplinario en este tipo de pacientes cuya complejidad requiere trabajo coordinado en equipo para lograr optimizar la recuperación de las lesiones.

High-voltage electrical burns are one of the most serious causes of trauma, with a high mortality rate. This paper presents the case of a 32-year-old male patient who suffered high-voltage electrical burns when handling an electrical supply network in a public area. He had B-type burns in the right upper extremity, face and scalp. This paper aims at stating the importance of interdisciplinary work on this kind of patients whose complexity require a coordinated team work in order to optimize their recovery.

Acidentes de trabalho e os religadores automáticos no setor elétrico: para além das causas imediatas / Work accidents and automatic circuit reclosers in the electricity sector: beyond the immediate causes / Accidentes de trabajo y reconectadores automáticos en el sector eléctrico: más allá de las causas inmediatas

Resumo: O setor elétrico brasileiro registra elevados índices de mortalidade por acidentes de trabalho que vêm sendo associados à terceirização, introduzida como forma de rebaixamento de custos. Para diminuir o tempo de interrupção do fornecimento de energia aos consumidores, o setor adotou, como solução tecnológica, o religador automático. Essa medida apresenta características perversas para os trabalhadores de manutenção. O objetivo deste estudo é analisar origens e consequências de acidentes de trabalho em sistemas elétricos dotados de religador automático utilizando o Modelo de Análise e Prevenção de Acidentes (MAPA). O MAPA foi usado na investigação de dois acidentes de trabalho visando a explorar as origens organizacionais dos eventos. Caso 1 - ao trocar linha secundária desenergizada, um trabalhador foi atingido por cabo primário energizado (13,8kV). O sistema foi religado três vezes, agravando as lesões (amputação de membro inferior). Caso 2 - acidente de trabalho fatal ocorrido durante instalação de cruzeta nova, em linha energizada, parcialmente isolada. A extremidade de uma mão francesa metálica encostou na linha secundária energizada e eletrocutou o operador de manutenção. O componente desligador do religador automático não funcionou. As análises contribuem para desvelar como a lógica de gestão de negócios pode participar nas origens de acidentes de trabalho via falhas da gestão de manutenção, da gestão de força de trabalho de terceiras e, em especial, da gestão de segurança em sistemas dotados de religadores. As decisões pela automação para garantir a distribuição de energia não podem negligenciar os riscos aos trabalhadores da rede elétrica e, tampouco, deixar de reconhecer a importância do controle sobre as condições de segurança.

Abstract: The Brazilian electricity sector has recorded high work-related mortality rates that have been associated with outsourcing, used to cut costs. In order to decrease the power outage time for consumers, the industry adopted the automatic circuit recloser as the technical solution. The device has hazardous implications for maintenance workers. The aim of this study was to analyze the origins and consequences of work accidents in power systems with automatic circuit recloser, using the Accident Analysis and Prevention (AAP) model. The AAP model was used to investigate two work accidents, aimed to explore the events' organizational origins. Case 1 - when changing a deenergized secondary line, a worker received a shock from the energized primary cable (13.8kV). The system reclosed three times, causing severe injury to the worker (amputation of a lower limb). Case 2 - a fatal work accident occurred during installation of a new crosshead on a partially insulated energized line. The tip of a metal cross arm section strap touched the energized secondary line and electrocuted the maintenance operator. The circuit breaker component of the automatic circuit recloser failed. The analyses revealed how business management logic can participate in the root causes of work accidents through failures in maintenance management, outsourced workforce management, and especially safety management in systems with reclosers. Decisions to adopt automation to guarantee power distribution should not overlook the risks to workers in overhead power lines or fail to acknowledge the importance of ensuring safe conditions.

Resumen: El sector eléctrico brasileño registra elevados índices de mortalidad por accidentes de trabajo, que están siendo asociados a la tercerización, introducida como forma de reducción de costes. Para disminuir el tiempo de interrupción de la energía a los consumidores, el sector adoptó como solución tecnológica, el reconectador automático. Esta medida presenta características perversas para los trabajadores del sector de mantenimiento. El objetivo de este estudio es analizar los orígenes y consecuencias de los accidentes de trabajo en sistemas eléctricos dotados de reconectador automático, utilizando el Modelo de Análisis y Prevención de Accidentes (MAPA). El MAPA se usó en la investigación de dos accidentes de trabajo, con el objetivo de explorar las causas organizativas de los eventos. Caso 1 - al cambiar la línea secundaria sin energía, un trabajador fue alcanzado por un cable primario con energía (13,8kV). El sistema se reconectó tres veces, agravando las lesiones (amputación de miembro inferior). Caso 2 - accidente de trabajo fatal ocurrido durante la instalación de una cruceta nueva, en una línea con energía, parcialmente aislada. La extremidad de una cruceta metálica cayó en la línea secundaria con energía y electrocutó al obrero de mantenimiento. El componente que desconectaba el reconectador automático no funcionó. Los análisis contribuyen a desvelar cómo la lógica de gestión de negocios puede ser partícipe en las causas de accidentes de trabajo, vía fallos en la gestión del mantenimiento, de la gestión de fuerza de trabajo de terceras personas y, en especial, de la gestión de seguridad en sistemas dotados de reconectadores. Las decisiones de la automatización para garantizar la distribución de energía no pueden obviar los riesgos para los trabajadores de la red eléctrica y tampoco dejar de reconocer la importancia del control sobre las condiciones de seguridad.

Contribuição da autopsia médico-legal para a investigação do acidente de trabalho fatal: relato de caso / Contribution of medico-legal autopsy to the investigation of fatal occupational accidents: case report

Os acidentes de trabalho são um importante problema de saúde pública. Embora entendidos como eventos não intencionais, podem ser previsíveis e preveníveis. Os institutos médico-legais desempenham importante papel na investigação de acidentes de trabalho fatais (ATF), pois todos os casos de morte violenta ou suspeita devem ser submetidos à necropsia forense. Este trabalho é um relato de caso necroscópico de ATF em que os dados obtidos na necropsia poderão contribuir para a melhor compreensão da dinâmica do ocorrido. Tratava-se de indivíduo do sexo masculino, com 34 anos de idade e suspeita de ter sido vítima de queda em ambiente de trabalho. Havia equimoses avermelhadas e arroxeadas no tórax, nos membros superiores e na região occipital do periciado. Na epiderme dos dedos das mãos foram observadas lesões cutâneas endurecidas, com destacamento parcial, que apresentavam aspectos macro e microscópico característicos de passagem de corrente elétrica em vida. Evidenciou-se fratura de crânio nos ossos parietal esquerdo e occipital, hemorragia subaracnoidea difusa, além de petéquias laríngeas, subpleurais e subepicárdicas. A pesquisa de alcoolemia e o exame toxicológico foram negativos. A causa do óbito foi traumatismo cranioencefálico contuso, tendo sido observados no periciado indícios de contato com corrente elétrica em vida. A autopsia permitiu melhor entendimento do mecanismo de morte e eliminou a possibilidade do trabalhador estar sob efeito de substâncias psicoativas no momento da ocorrência. Isso pode ser importante para a determinação da sequência dos eventos, auxiliando na implantação de medidas de prevenção.

Work accidents are a major public health problem. Although they are understood to be unintentional events, they are both predictable and preventable. Medico-legal institutes play a key role in the investigation of fatal work-related accidents (FWRA) because all cases of violent or suspicious death must be subjected to forensic autopsy. The present is a report of a case of FWRA in which autopsy contributed to a better understanding of the event's dynamics. The case concerns a 34-year-old man believed to have suffered a fall at the workplace. Examination revealed reddish and purple bruises on the chest, upper limbs and the occipital area, and hardened, partially detached epidermal lesions on the fingers, with the characteristic macro- and microscopic appearance of passage of electric current while alive. Fractures on the left parietal and occipital bones were found, as well as diffuse traumatic subarachnoid hemorrhage and laryngeal, subpleural and subepicardial petechiae. Blood alcohol and toxicology tests were negative. The cause of death was blunt head trauma, with signs of contact with electric current while alive. The autopsy therefore allowed for a better understanding of the mechanism of death, and ruled out the possibility of the worker having been under the effect of psychoactive substances at the time of event. Autopsy might be relevant to determine the sequence of events, thus contributing to the implementation of preventive measures.

A Case of Prehospital Ventricular Fibrillation due to Electrical Injury

These days, the frequency of electrical injuries is increasing with the increased spread of electricity use. Electrical injuries cause various complications, ranging from a local superficial skin injury to extensive internal organ damage, including essential vital organs, such as the cardiovascular or central nervous system. We encountered the patient who collapsed after an electrical injury on the scene and was resuscitated successfully after the prehospital early recognition of ventricular fibrillation, and rapid defibrillation, followed by post cardiac arrest care in the hospital. Prehospital early electrocardiogram monitoring and defibrillation may be needed in electrical injured patients.

Extension of a Scapular Fracture into the Glenoid Cavity after Low-voltage Electric Shock

We, herein, present a patient with no history of trauma who developed shoulder pain after undergoing low-voltage electric shock. According to the computed tomography, there was a multi-segmental fracture that extended into the glenoid cavity of the left scapula. A good outcome was obtained after open reduction and internal fixation. Emergency physicians should be aware of the possibility of scapular fracture extending into the glenoid cavity, especially in patients with shoulder pain after electrical injury.

Medial Lemniscus Tract Lesion After High Voltage Electrical Injury: A Case Report

We present the case of a 33-year-old man who experienced a 10,000-V electrical shock when working with electrical wiring. He suffered third-degree burns on his scalp at the right occiput (entry wound) and on his left arm (exit would), and a second-degree burn on his left foot (exit wound). He presented with severe spasticity of both lower extremities, motor weakness with a Medical Research Council grade of 3, and sensory impairments below thoracic level 11 that included an inability to sense light touch and defects in proprioception. Initial magnetic resonance imaging (MRI) scans of his spine and brain showed no definite abnormalities. However, tractography obtained by diffusion tensor imaging of the brain showed absence of the right medial lemniscus tract. A cervical MRI scan 1 month later showed spinal cord swelling from cervical 1-5 levels, and signal changes in the lateral and posterior white matter in the axial view. After 6 months of rehabilitation, he recovered almost normal degree of motor function in his lower extremities and disappearance of spasticity. However, since the sensory impairments persisted, especially defects in proprioception, he was unable to walk independently.

Trauma Eléctrico / Electrical trauma

El trauma eléctrico puede ocurrir por contacto con un cable eléctricamente activo o con un rayo, clasificándose elmismo en lesiones por bajo voltaje para aquellas de menos de 1000V y lesiones por alto voltaje para aquellas demás de 1000V. Posee una incidencia poco despreciable siendo una causa frecuente de lesión por un fenómenonatural. Diferentes factores entre ellos el tipo de corriente, la resistencia de los tejidos, la duración del contacto,el voltaje, y los factores ambientales definen la gravedad y extensión de las lesiones que produce. Los tejidosafectados con mayor frecuencia son los nervios, vasos, hueso, músculo y piel siendo prevalentes las quemaduras,arritmias, parestesias y otros daños a los sistemas nervioso y cardiovascular. A pesar de tener una mortalidadbaja, la lesión difusa causada por el trauma eléctrico deriva en una importante cantidad de secuelas a cortoy largo plazo que se presenta en un alto porcentaje de los sobrevivientes y que, debido a su sintomatologíainespecífica podría resultar difícil de identificar y diagnosticar.

Electric trauma can occur by contact with an active electric wire or a lightning, being classified in low-voltage injuriesfor those under 1000V and high- voltage injuries for those over 1000V. It has a little despicable incidence beinga frequent cause of injury from a natural phenomenon. Different factors including the type of current, resistanceof the tissues, duration of contact, voltage, and environmental factors determine the severity and extent of theinjuries that it produces. The tissues most commonly affected are the nerves, vessels, bones, muscle and skin beingprevalent the burns, arrhythmias, paresthesia, and other damages to the nervous and cardiovascular systems.Despite having a low mortality, diffuse injury caused by electric trauma results in an important amount of short andlong-term sequelae that occurs in a high percentage of the survivors, and because of its non-specific symptoms maybe difficult to identify and diagnose.

Elevación transitoria del segmento st en paciente victima de trauma eléctrico en el Hospital San Rafael de Alajuela / Transient ST-segment elevation victim of electric trauma patient in the hospital alajuela

El trauma eléctrico ocurre cuando un organismo vivo participa de un circuito eléctrico. Esto produce un síndrome traumático que involucra daño térmico y alteraciones eléctricas en el cuerpo. Para entenderlo mejor es necesario conocer la física de la electricidad. En este articulo se revisara un caso que se presento en el hospital San Rafael en el cual fue posible observar anormalidades electrocardiografícas en un paciente expuesto a traumas eléctrico leve.

Electrical injuries happen when a living organism takes part in an electrical circuit through the tissues of that organism.Because of this, the result is trauma syndrome that involves termal damage an electrical disturbances into the body.For a better understanding, is necessary to know about the physics of electricity.We`ll rewiew a clinical case happened in Hospital San Rafael, in which was possible to see electrocardiograma anormalities in pacient exposed to low electrical trauma.

Queimaduras domésticas na população infantojuvenil: atendimentos de urgência e emergência / Domestic burns among children, adolescents and young adults: urgency and emergency cases

Estudo cujo objetivo foi analisar as queimaduras domiciliares decorrentes de exposição à corrente elétrica/radiação/temperatura, fumaça/fogo/chamas e contato com fonte de calor/substâncias quentes, em vítimas crianças, adolescentes e jovens, atendidos em serviço de urgência/emergência de referência. Estudo descritivo, transversal, com vítimas de queimaduras domiciliares (entre zero a 24 anos) atendidas por serviço de pronto-atendimento em uma capital do centro oeste brasileiro, no ano de 2013. Foram estudadas 84 vítimas de queimaduras domiciliares, prevaleceu o sexo feminino (59,5%) e a faixa etária de 1-4 anos (27,4%). As queimaduras mais frequentes foram por contato com fonte de calor/substâncias quentes (82,1%) e exposição à fumaça/fogo/chamas (15,5%). As regiões corpóreas mais atingidas foram cabeça, tronco, membros superiores e inferiores (90,5%) e prevaleceu a queimadura de segundo grau (40,5%). Queimaduras domiciliares atingem significativamente o público infantojuvenil com destaque para o sexo feminino, apontando para a importância de atividades preventivas e educativas direcionadas para as meninas.

The objective of this study was to analyze domestic burns caused by the exposure to electric current/radiation/temperature, smoke/fire/flames and contact with a source of heat/hot substances, in children, adolescents and young adults treated at an urgency/emergency service of reference. A descriptive, cross-sectional study was conducted with victims (0 to 24 years of age) of home burns treated at an urgency/emergency service of a capital city located in the center-west region of Brazil, in 2013. In total, 84 victims of home burns were studied, with prevalence of female victims (59.5%) and age group of 1-4 years of age (27.4%). The most frequent burns were caused by contact with a source of heat/hot substances (82.1%) and exposure to smoke/fire/flames (15.5%). The body areas most commonly affected by home burns were head, trunk, and upper and lower limbs (90.5%), with prevalence of second-degree burns (40.5%). Home burns significantly affect children, adolescents and young adults, particularly female subjects, highlighting the importance of providing preventive and educational activities to female victims.

Bilateral maculopathy following electrical burn: case report / Maculopatia bilateral após queimadura elétrica: relato de caso

CONTEXT: Electrical burns are an important etiology in dealing with patients suffering from burns. In situations of extensive deep lesions of multiple organs and systems affecting young and economically active people, there is a need for expensive multidisciplinary treatment, with a high socioeconomic cost for the community. Among the permanent injuries that explain this high cost, eye injuries stand out, since they are widely disabling. Although rare, lesions of the posterior segment of the eye are associated with higher incidence of major sequelae, and thus deserve special attention for dissemination and discussion of the few cases observed. CASE REPORT: The authors report the case of a patient who suffered high-voltage electrical burns and presented bilateral maculopathy, which evolved with a need for a surgical approach to repair retinal detachment and permanent low visual acuity. CONCLUSION: This report highlights the rarity of the etiology of maculopathy and the need for campaigns for prevention not only of burns in general, but also especially of electrical burns. .

CONTEXTO: As queimaduras elétricas representam etiologia importante na abordagem de pacientes vítimas de queimaduras. Lesões extensas e profundas de múltiplos órgãos e sistemas e o acometimento de população jovem economicamente ativa apontam para a necessidade de tratamento multidisciplinar dispendioso, com alto custo socioeconômico para as comunidades. Dentre as lesões permanentes que justificam esse alto custo, as oculares têm local de destaque, porque são amplamente incapacitantes. Embora raras, as lesões do segmento posterior do olho estão associadas a maior incidência de sequelas importantes, merecendo atenção especial para divulgação e discussão dos poucos casos observados. RELATO DE CASO: Os autores relatam o caso de paciente vítima de queimadura elétrica com fio de alta voltagem que apresentou maculopatia bilateral, evoluindo com necessidade de abordagem cirúrgica para correção de descolamento de retina e baixa acuidade visual permanente. CONCLUSÃO: Este relato destaca a raridade da etiologia da maculopatia e a necessidade de campanhas de prevenção não só das queimaduras em geral, mas especialmente das queimaduras elétricas. .

Correlación macroscópica-microscópica en muertes por electrocución: Morgue Central de Lima periodo 2006-2011 / Macroscopic-microscopic correlation in deaths by electrocution: Central Morgue of Lima 2006-2011

Introducción: La electrocución es una causa de muerte de índole traumática y de alta mortalidad, que produce lesiones y signos externos que deben ser corroborados por hallazgos microscópicos. Objetivo: Correlacionar hallazgos macroscópicos con resultados histopatológicos en muertes por electrocución. Diseño: Descriptivo, transversal, correlacional, retrospectivo. Institución: Instituto Medicina Legal-MP, Instituto Patología, Universidad Nacional Mayor de San Marcos, Lima, Perú. Material: Informes de Necropsia Médicolegal. Intervenciones: En la Morgue Central de Lima, en el periodo 2006-2011, se hizo búsqueda y análisis de información de electrocución. Principales medidas de resultados: Medida de tendencia central, frecuencias y porcentaje. Análisis de correlación. Resultados: De 116 casos, 108 varones y 8 mujeres, la media de edad fue 31,3 años, 23 por ciento fueron electricistas, 18 por ciento trabajaban en construcción. El hecho ocurrió en el centro de trabajo 51 por ciento, con etiología suicida en dos casos. Los hallazgos macroscópicos más frecuentes fueron signos generales de asfixia, lesiones por entrada de corriente eléctrica, hemorragia miocárdica y petequias subpleurales, en 73,3 por ciento. Las alteraciones microscópicas fueron: necrosis coagulativa en piel 87 casos, edema cerebral 101 casos, hemorragia pulmonar 83 casos, infarto agudo de miocardio 87 casos, necrosis tubular aguda 72 casos. Al correlacionar los hallazgos macroscópicos y microscópicos más frecuentes, encontramos una asociación significativa (valor V de Cramer de 0,592, p<0,0001). Conclusiones: Los hallazgos macroscópicos más frecuentes (lesión de entrada, hemorragia miocárdica y petequias subpleurales) y los hallazgos microscópicos más frecuentes (necrosis coagulativa en piel, infarto agudo de miocardio y necrosis tubular aguda) relacionados a electrocución parecen estar significativamente asociados.

Introduction: Electrocution is a frequent cause of traumatic death. It produces lesions and external signs that should be corroborated by microscopic findings. Objective: To correlate macroscopic findings with histopathologic results in electrocution deaths. Design: Descriptive, cross-sectional, correlational, retrospective study. Setting: Legal Medicine Institute-MP, Pathology Institute, Universidad Nacional Mayor de San Marcos, Lima, Peru. Material: Medicolegal necropsy reports. Results: From 116 cases, 8 were women and 108 males, mean age was 31.3 years. Twenty three per cent were electricians and 18 per cent worked in construction. The incident occurred at labor center in 51 per cent. Suicide accounted for two cases. Frequent macroscopic findings were general signs of choking, power input injuries, myocardial hemorrhage and subpleural petechiae in 73.3 per cent. Microscopic alterations were skin coagulative necrosis in 87 cases, cerebral edema in 101, pulmonary hemorrhage in 83, acute myocardial infarction in 87, and acute tubular necrosis in 72 cases. A significant association between macroscopic and microscopic findings (0.592 V Cramer value; p <0.0001) was found. Conclusions: Most common macroscopic findings (lesion input, myocardial hemorrhage and subpleural petechiae) and most frequent microscopic findings (skin coagulative necrosis, acute myocardial infarction and acute tubular necrosis) related to electrocution seemed to be significantly associated.

hospital based autopsy study of 50 cases at combined military hospital [CMH], Sialkot

To analyze the pattern of deaths on autopsy carried out on armed forces personnel in CMH sialkot. Retrospective analytical study. Combined military hospital sialkot [CMH], from 2009 t0 2012. In a total of fifty [50] cases detailed postmortems were carried out and gross features on external examination and different systemic examinations were recorded. Histopathology of various organs was done in all cases. Chemical and toxicological examination of various abdominal viscera was carried out in all sudden and suspicious deaths. Ischemic heart disease [IHD] was most common cause of death [38%] followed by road traffic accidents [14%] and electrocution [8%]. Sudden adult death syndrome accounted for 4 cases of deaths. Other causes were drowning,cerebral malaria, heat stroke, gunshot wounds, myocarditis, brain hemorrhage, meningitis and diabetic ketoacidosis. Most of these cases were young soldiers [n=30] followed by non-commissioned officers [n=17]. A large number of our young soldiers dying of heart problems is an alarming situation. Awareness among the troops of various risk factors is most important. Precautionary measures against preventable causes should be taken

Neurological Complication After Low-Voltage Electric Injury: A Case Report

Electrical shock can result in neurological complications, involving both peripheral and central nervous systems, which may present immediately or later on. However, delayed neurological complications caused by low-voltage electric shock are rarely reported. Here, a case of a man suffering from weakness and aphasia due to the delayed-onset of the peripheral nerve injury and ischemic stroke following an electrical shock is presented. Possible mechanisms underlying the neurological complications include thermal injury to perineural tissue, overactivity of the sympathetic nervous system, vascular injury, and histological or electrophysiological changes. Moreover, vasospasms caused by low-voltage alternating current may predispose individuals to ischemic stroke. Therefore, clinicians should consider the possibility of neurological complications, even if the onset of the symptoms is delayed, and should perform diagnostic tests, such as electrophysiology or imaging, when patients present with weakness following an electric injury.

Ritmo nodal secundario a descarga eléctrica de alto voltaje: Report of one case / Transient high frequency nodal rhythm after a high voltage electric shock

Electrical shock can cause a direct myocardial damage and different types of arrhythmias, which are uncommon and occur more often when there is a high voltage exposure. We report a 19-year-old male that received a high voltage shock, falling thereafter from an altitude of four meters. On admission to the emergency room, he had second and third degree burns in the right hand and the left thigh. The electrocardiogram showed a nodal rhythm of 72 beats per minute. After four hours of monitoring, sinus rhythm returned spontaneously.

Simultaneous bilateral femoral neck fractures after electrical shock injury: a case report / 中华创伤杂志(英文版)

Simultaneous bilateral fractures of the femoral necks are rare injuries, especially when there is no underlying pathological condition. We report a 20-year-old man who sustained bilateral femoral neck fractures resulting from an accidental electric shock with 440 V direct current. Simultaneous bilateral femoral neck fractures after electrical shock injury without falling from a height are rather uncommon in clinic. The main cause of the fracture may be muscle contraction. This case highlights that even in the absence of primary and secondary bone disease, bilateral fractures of the femoral necks can occur following electric shock injury. We successfully managed this case with bilateral cannulated screw fixation without bone grafting. Surgeons caring for patients with electrical injury should be aware of the possibility of skeletal injuries which can go unnoticed, leading to delay in diagnosis and increased risk of complications.