Creatina fosfocinasa MB como marcador diagnóstico de disfunción miocárdica en pacientes pediátricos con quemadura eléctrica / Creatine phosphokinase MB levels as a diagnostic marker of myocardial dysfunction in pediatric patients with electrical burns

Resumen Introducción: La disminución de la fracción de eyección ventricular izquierda (FEVI) como consecuencia de una disfunción ventricular se reporta dentro de las alteraciones cardiacas secundarias a una lesión eléctrica. Como complemento de la exploración física, la ecografía cardiaca enfocada (FoCUS) permite una evaluación rápida, no invasiva, que da información para contribuir a tomar mejores decisiones terapéuticas, sobre todo en pacientes en estado crítico. El objetivo de este estudio fue explorar la utilidad de la creatina fosfocinasa MB (CPK-MB) como marcador diagnóstico de disfunción miocárdica en pacientes de 6 a 18 años con quemadura eléctrica. Métodos: Durante el periodo de noviembre de 2018 a agosto de 2019 se llevó a cabo un estudio transversal analítico de 10 pacientes, de 6 a 18 años de edad, con quemadura eléctrica, en quienes se obtuvo el porcentaje de FEVI a través del protocolo FoCUS. Posteriormente, el porcentaje de FEVI se correlacionó con los valores de CPK-MB y el porcentaje de superficie corporal quemada (SCQ) en las primeras 24 horas después de la lesión. Resultados: Se encontraron 10 casos de quemadura eléctrica, ocho de sexo masculino y dos de sexo femenino, con una media de edad de 13 años. El 80% de estos casos presentó disminución leve de la FEVI (45-59%). Al realizar el protocolo FoCUS se reportó hipocinesia miocárdica en siete pacientes. Se encontró una correlación moderada entre la FEVI y los valores de CPK-MB (r = −0.671), aunque no se observó correlación entre la FEVI y la SCQ. Conclusiones: La ecografía cardiaca influye en la toma de decisiones y mejora el pronóstico de estos pacientes.

Abstract Background: The decrease of the left ventricular ejection fraction (LVEF) as consequence of a ventricular dysfunction is reported in cardiac alterations secondary to electrical injury. The focused cardiac ultrasound (FoCUS) helps to complete the clinical examination because it allows a faster non-invasive evaluation, and provides information that contributes to make better therapeutic decisions, especially those for patients in critical condition. The objective of this study was to explore the utility of creatine phosphokinase MB (CPK-MB) as a diagnostic tool of myocardial dysfunction in patients from 6 to 18 years old with electrical burn. Methods: From November 2018 to August 2019, we conducted a transversal analytic study of 10 children with electric burn (6 to 18 years of age), in whom the percentage of LVEF was obtained through the FoCUS protocol in the first 24 hours after injury. Results: We found 10 cases of electrical burn injury, eight males and two females, with an average of 13 years of age. Eighty percent of these cases showed a slight decrease in LVEF (45-59%). When performing the FoCUS protocol, myocardial hypokinesia was reported in seven patients. We observed a moderate correlation between LVEF and CPK-MB levels (r = −0.671), and no correlation between LVEF and body surface area affected by the electrical burn. Conclusions: The cardiac ultrasound influences decision making to improve the prognosis of these patients.

Les electrisations : a propos de 35 cas

Introduction: L'electrisation est rare mais grave. Elle met en jeu le pronostic fonctionnel et vital. Quelles sont les populations les plus affectees; les prejudices qu'elle provoquent et les principales mesures de traitement a appliquer ? Les objectifs etaient d'identifier la population exposee et de rappeler les principes du traitement chirurgical ainsi que les mesures preventives.Materiel et methode : il s 'agissait d'une etude retrospective et analytique realisee de janvier 2011 a decembre 2013; chez des patients; age et sexe confondus; ayant presente une electrisation et dont les dossiers etaient exploitables Resultats et discussion : trente cinq patients; d'une moyenne d'age de 26 ans avec une predominance masculine; ont ete colliges. Les electrisations etaient secondaires a des accidents de travail (48;6) ou domestiques (37;1) dont la majorite etait due a un courant de bas voltage. La surface cutanee brulee moyenne etait de 10;6 de la SCT. Les brulures etaient profondes et siegeaient principalement aux membres superieurs. Le traitement chirurgical etait constitue d'incisions de decharges; d'aponevrotomies; de debridements ou d'excisions iteratifs; d'amputations et de greffes de peau mince. Cinq patients sont decedes. La duree moyenne d'hospitalisation etait de 66 jours.Un retard et une prise en charge inadaptee aggravent le pronostic fonctionnel et vital. La prevention demeure un moyen fondamental pour remedier aux electrisations

Pattern of injuries due to electric current.

A one year study, from October 2007 to September 2008, was under taken in an attempt to study the pattern of electrical injury, the cause of death, manner of death, and diagnosis by histopathological examination. The study was compromised of 62 cases brought with history of electrical shock. Of the total 62 cases, males were 57(91.93%) and females were 5(8.06%) the mean age is 26 .27 year. The peak age of victims are 21-30 years age group 24 cases (38.71%].In the age group of 1n 0-10 years age group victims 3. Most of cases were due to low tension and domestic circuit. The patterns of electrical injuries are noted, such as entry, exit and both entry, exit wounds, flash burns and no electrical signs. The maximum victims showed dermo-epidermal degree of electrical burns .The histopathological examination is an important aid in diagnosis of electrical injuries and recommendations about preventive safety measures to reduce the mortality.

Diagnóstico das lesöes elétricas / Electric burns diagnosis

Muito além de queimaduras de pele e tecidos vizinhos, a corrente elétrica determina alteraçoes importantes em varios órgaos internos. O objetivo deste trabalho é, a partir de uma revisao da literatura, apraesentar as principais complicaçoes decorrentes dos acidentes elétricos e os sinais e sintomas a elas associados. A importância do diagnóstico dessas lesoes se deve ao fato de que, junto com o tratamento inicial das lesoes da pele, deve-se iniciar, de imediato, o tratamento das outras lesoes que, muitas vezes, sao de extrema gravidade. Outro fator preocupante é que, muitas dessas lesoes, têm um início insidioso, podendo aparecer muito tempo após ocorrido o acidente. Também é importante uma avaliaçao inicial multidisciplinar dos pacientes no sentido de prevenir as seqüelas.

Trauma elétrico aos tecidos orais de uma criança: relato de um caso / Mouth eletric burn to the oral tissues of a child: report of a case

Os autores apresentam um caso de queimadura elétrica na boca e, através de uma prévia revisäo da literatura, expöem as causas, mecanismos, características, consequências e tratamento das injúrias elétricas na boca