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Section 3. Preventive medicine
Section 3. Preventive medicine
Kuklina Elena Yuryevna, Chita State Medical Academy, Candidate in Medicine, the Department of Traumatology,
E-mail: monalli3a@mail.ru Zhilyaeva Olga Andreevna Chita State Medical Academy, Candidate in Culturology, the Department of Foreign Languages,
E-mail: ol--zh@yandex.ru
The problems of electro burns and electro traumas
Abstract: The electric trauma and electroburns are an integral part in trauma structure in the industrially developed countries. Electric traumas often turn to be the reason of disability and in certain cases patient’s death and it takes great attention and constant vigilance from the persons working with electric power sources, strict observance of safety measures and equipment service regulations.
Keywords: electric trauma, electroburns, strict observance of safety measures, disability, electric current action on the human body.
The problem ofan electric trauma, for an exception of damage by a lightning, became actual rather recently. Today the constant increase in quantity of sources of the electric power, connected with development of scientific and technical progress, certainly, raises level ofcomfort oflife, but at the same time causes stability of frequency of emergence of electric traumas and electro burns. In the general structure of traumatism this type of damage meets seldom but, however, as the reason of lethal outcomes and disability, it is rather high on the list.
In number of patients hospitalized according to various burns, electric trauma is observed at 1,18% of burned cases. Electric traumas are usually combined with electroburns which turn to be deep, and quite often extend far beyond the affected skin. It demands further difficult surgeries for replacement of deep fabric damage.
Electric trauma burns data available in medical literature are not sufficient. Various cases of electroburns, or the hardest cases usually associated with neurologic disorder are commonly described. Such electric current traumas most often lead to cardiovascular system disturbances such as increase in heart sizes, ciliary arrhythmia
of auricles, ventricular fibrillation, coronary spasm, lability of arterial pressure. The neurologic disorders cases caused both by direct influence of electric current, and the accompanying thermal trauma associated with the cascade of human body metabolic disorders are also described in medical literature. Different cases of electric trauma damages of cerebellar functions, damage of a spinal cord and peripheral nerves (accompanied by dyskinesia and sensitive impairment), post-traumatic epilepsy are also commonly studied. Purulent meningitis development is also possible due to accompanying infection.
Toxicoinfectious period often becomes complicated by the development of encephalopathy with the most actual syndromes: amavroticheski-convulsive syndrome, hyperkinetic syndrome, delirio-amential syndrome, syndrome of disseminated organic disturbance, asthenic and vegetativo-trophic disturbances. Burns of eyes and adnexa make from 5 to 13% of all organs of vision injuries during a peace time, flame burns being more prevalent.
Electric trauma is general and local body changes in response to electric current action. Electro burn
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The problems of electro burns and electro traumas
is damage of skin and mucous membranes from thermal contact action of electric current.
Burn from flash of a volt arch is a damage of skin, mucous membranes and eyes as a result of distant thermal influence through short-term flash of an electric discharge with allocation of thermal energy.
Atmospheric electricity damage is a complex energy impact of atmospheric electricity on the human organism in the form of electric, mechanical and sound damage.
The most common clinic classification of electric traumas is as follows:
I degree — convulsive reduction of muscles, without consciousness loss;
II degree — convulsive reduction of muscles with consciousness loss, remained breath and cardiovascular activity;
III degree — loss of consciousness and damage of cardiovascular activity or breath impairment;
IV degree — clinical death.
The degree of an electric trauma depends on many reasons, among which high tension and current intensity, increased humidity both of the environment and skin are very important. The current exposition, especially when there is no opportunity to be exempted from the currentcarrying conductor, and also the direction of current passing through a body is also important.
The electric trauma results from contact with conductors in living and industrial conditions, from atmospheric electricity (lightning). Also it can occur from the so-called “the step tension”. Such situation is created at current distribution round the conductor on a limited ground area.
Damage of skin and the deep tissues caused by electric current impact happens due to thermal and electrochemical influence.
Clinically electro burns differ from the thermal ones:
- volume of tissue damage under skin exceeds damage of the skin itself, tissue damage becomes considerably big in the course of treatment as compared to that one seen at primary survey;
- electro burns usually deep;
- electro burns occupy the small surface;
- flaccid course oflocal wound process is marked. It is connected with impairment of the vascular and
nervous systems in the tissues surrounding the local center. The reparation is complicated;
- expressed pain syndrome connected with receptor field damage in the field of a trauma and the subsequent development of cicatricial process is marked.
The so-called “current tags” or “current signs” on which it is possible to judge about the place of a contact of the conductor, also turn to be electro burns. Commonly the place of contact with the conductor is marked by a thick scab which has been densely connected with underlying tissues. Often the scab includes not only the lost skin, but also coagulated hypodermic cellulose, muscles, fasciae, tendines. Necrosis spreading on a bone is quite natural in such cases, the latter being damaged on a considerable depth. It is connected with the high resistance of bone tissue.
Spontaneous rejection of a scab can last more than a month. Bone tissue being involved in this process, treatment turns to be more complicated. The scab having been rejected, the granulating wound is formed. Granulations usually pale, thinned. The wound is slowly being prepared for surgical treatment.
Electroburns can be accompanied by flame burns, generally as a result of clothes ignition. At extensive burns of skin (more than 10% of the deep - III B-IV of degree and more than 20% superficial -the II-IIIA degree) the complex of symptoms called a burn disease develops.
The lightning usually results from the most powerful discharge in the atmosphere during the increased overcast in the period of a thunder-storm. Tension in the place of discharge reaches one million volts, and the current power of hundreds thousands amperes. Striking action consists of electric current impact, the action of light and sound energy and a shock wave.
The lighting effect occurs in response to strong heating of air (tens of thousands of degrees). This luminescence is usually called a lightning. The shock wave results from pressure increase because of instant heating of air and is accompanied by sound effect called a thunder. Such shock wave may separate the parts of the body and people can be casted away on some distance.
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Section 3. Preventive medicine
Both atmospheric electricity lesions and approaches to their treatment do not commonly differ from those of a high-voltage impact. One of the most important things in all these cases is the prevention of lesions. So during a thunder-storm it is dangerous to be in the open area and close to alone standing trees, columns, etc. If it’s not possible to avoid such positions, it is necessary to lie down on the earth, but, whenever possible, to move away from places with the increased humidity (pools, the river, etc.).
Life of the victim of an electric trauma first of all depends on a given first aid. In this regard the following succession of the first aid procedures is being important:
- to remove current action on the victim;
- to give an urgent help to the victim in order to maintain viability;
- to prepare the victim for transportation.
The victim is supposed to be excluded from the injuring current chain at the place of accident. The conductor should be thrown away from the victim with a dry stick or other subject excluding carrying out current. While approaching to the person lying near the torn-off wire, it is necessary to consider probability of lesion with a step-by-step tension. In this regard, the person giving help has to come nearer to the victim around small steps. If there is an opportunity, it is necessary to switch off a breaker or to unscrew electrojams, to chop the wire going to the victim. When the victim can’t unclench hands and manus due to tonic flexion contraction (“extremity
fixing”), it is necessary to cast the victim away in any ways from a current source, using improvised subjects and not touching him while giving help in order not to be included in an electric chain.
The protective clothes of a man assisting the victim are of great importance. It is necessary to put on rubber boots and gloves, especially contacting with high-tension currents. Resuscitation is necessary to be assisted after release of the victim from the current action. It includes indirect massage of heart in combination with an artificial respiration. These actions need to be carried out anyway when there are no heartbeat and breath. This state is called «mors putative» and often such victim is perceived as the dead one. Urgent first aid given in time can save victim’s life. Carrying out indirect massage of heart and artificial respiration assists to quickly cardiovascular and respiratory activity restoring.
The electric trauma and electroburns are an integral part in trauma structure in the countries with the developed industry and power supply networks. Despite its not common place in the list of injuries, electric trauma often turns to be the reason of disability and in certain cases patient’s death so such lesions may take one of the leading positions among other traumas. Due to both rare occurrence of such lesions and their dangerous complications it takes great attention and from the persons working with electric power sources constant vigilance, strict observance of safety measures and equipment service regulations.
References:
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2. Gusak V. K. Thermal subfasciae defeats / V.K. Gusak, E.Ya. Fistal, E.F. Barinov, A.A. Shtutin. - Donetsk: “Donechchina”, 2000. - 192 pages.
3. Paramonov B. A. Local conservative treatment of burns / B.A. Paramonov, Ya.O. Porembsky, V.G. Yablon-sky//Burns: the management for doctors. - SPb. : Spetslit, 2000. - Pages 10-351.
4. Puchkovskaya N.A. Burns of eyes/N.A. Puchkovskaya, S.A. Yakimenko, V.M. Nepomnyachshaya. - M.: “Medicine”, 2001. - 272 pages.
5. Shmidt T.E. Defeats of nervous system at influence of physical and chemical factors / T.E. Schmidt// Diseases of nervous system / Under the editorship of N.P. Yakhno, D.R. Shtulman, P.V. Melnichuk, etc. - M.: Medicine, 2003. - T. 2. - Pages 379-403.
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