electric burn injuries among adults --muhammad saaiq

ELECTRICAL BURN INJURY AMONG ADULTS:EXPERIENCE AT PIMS, ISLAMABAD.

Presenter: Muhammad Saaiq Authors:

Muhammad Saaiq , Hameed-ud-din, M.Ibrahim Khan,DEPARTMENT OF PLASTIC & RECONSTRUCTIVE SURGERY, PIMS ,

ISLAMABAD, PAKISTANPIMS , ISLAMABAD.

Presented at:IBCAST 2009 (International Bhurban Conference on Applied

Sciences and Technology ) Held at Centres of Excellence in Sciencesand Applied Technologies ( CESAT ), Islamabad.

Jan 19, 2009.

ELECTRICAL BURN INJURY

TYPES

High Voltage Injuries

Low Voltage Injuries

Cloud to ground Lightning

ELECTRICAL BURN INJURY

PATHOPHYSIOLOGY

Direct tissue damage from electrical energy.

Conversion to thermal energy.

Mechanical injuries.

ELECTRICAL BURN INJURY

FACTORS INFLUENCING THE SEVERITY

ELECTRICAL BURN INJURY

Magnitude of Energy delivered

Type of Current

Pathway of the Current

Duration of Exposure

Others

CLINICAL PRESENTATION

• Skin burns• Cardiac arrhythmias• Renal failure• Limb Compartment syndrome• Others

ELECTRICAL BURN INJURY

MANAGEMENT OF THE VICTIM

• General Management i.e ABCDEs

• Specific measures: a) Medical measures

I.V Fluid resuscitation

IV Bicarbonate

IV Mannitol

b) Surgical measures:Debridements

Fasciotomies

Amputations

Various Reconstructive Procedures.

ELECTRICAL BURN INJURY

A) Magnitude of Energy delivered

FACTORS INFLUENCING SEVERITY Of EBI

FACTORS INFLUENCING SEVERITY Of EBI

(Cont’d)

B) Type of Current

FACTORS INFLUENCING SEVERITY Of EBI

(Cont’d)

C) Duration of Exposure

FACTORS INFLUENCING SEVERITY Of EBI

(Cont’d)

D) Resistance Offered by the Tissues

FACTORS INFLUENCING SEVERITY Of EBI

(Cont’d)

E) Pathway of the Current

CLINICAL PRESENTATION of

ELECTRICAL BURN INJURY

• Skin burns / tissue trauma• Cardiac arrhythmias• Renal failure• Limb Compartment syndrome• Others

INVESTIGATIONS OF EBI VICTIM

• Basic essential tests• ECG• Urine for Myoglobin• CK• Others

MANAGEMENT OF EBI VICTIM

• General Management

• EBI specific measures

MANAGEMENT OF EBI VICTIM(Cont’d)

GENERAL MEASURES INCLUDE:

• A• B• C• D• E

F ?

EBI Specific Measures

a) Medical measures:• I.V Fluid resuscitation• IV Bicarbonate• IV Mannitol

EBI Specific Measures(Cont’d)

b) Surgical measures:• Debridement• Fasciotomies• Amputations• Reconstructive Procedures.

ELECTRICAL BURN INJURY;EXPERIENCE AT PIMS, ISLAMABAD.

Duration of the Study:Jan 01 2005 to June 30, 2007

Objective: To document the presentation and outcome of Electrical burn Injury in our set up.

Study Design: Descriptive Study.Place of the Study : Department of Plastic &

Reconstructive Surgery, PIMS, Islamabad. Duration of the Study:Jan 01 2005 to June 30, 2007Subjects and Methods: All adult Electrical burn

Injury victims presenting to the Department and consenting to participate in the study.

Data Collection and Processing: Proforma

Distribution of Burn Injuries Overall (n=561)

263

172

81

32

13

0 50 100 150 200 250 300

Flame burns

Scalds

Chemical

Electrical

Miscellaneous

5.70% of the total Patients were of Electrical Burn Injuries

016

11

3

1

1

0 5 10 15 20

Household Accidents

Workplace accidents

Iatrogenic

Contact with E. pole

Contact with transformer

NUMBER OF PATIENTS

Causes of Electrical burn injury (n=32)

Gender Distribution (n=32)

Male59%

Female41%

Age Distribution (n=32)

1

6

910

5

10

2

4

6

8

10

Number of Patients

0-10 11 20 21 -30 31 -40 41 -50 51 -60

Age ( Years)

Voltage Distribution Of Electrical burn injury (n=32)

High41%

Low59%

PROCEDURE NUMBER1 Debridements 282 Amputations 153 STSGs 144 Flaps 75 Fasciotomies / Carpal

tunnel Release6

Surgical Procedures Undertaken among the Victims of Electrical burn injury ( n=70)

AMPUTATION NUMBER

1 Upper Limb:RightLeft

63

2 Hand 1

3 Finger(s) 5

Various Amputations Undertaken among the Victims of Electrical burn injury (n=15)

ASSOCIATED INJURIES

NUMBER

1 Long bone fracture 1

2 Spinal cord trauma 1

3 Mild head injury 2

4 Genital injury 1

Associated Injuries found (n=4)

COMPLICATIONS NUMBER

1 Wound infection 5

2 Cardiac dysrhythmia 1

3 Renal failure 1

4 Sepsis 1

Complications Encountered (n=8)

Rate of Hospitalization : 71.87%

Average Hospital stay: 17 days ( Range 3-63 days)

Inhospital mortality: 01

Conclusion & Message