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Electrical injury (EI) is a significant, multifaceted trauma often with multi-domain cognitive sequelae, even when the expected current path does not pass through the brain. Chronic pain (CP) research suggests pain may affect cognition directly and indirectly by influencing emotional distress which then impacts cognitive functioning. As chronic pain may be critical to understanding EI-related cognitive difficulties, the aims of the current study were: examine the direct and indirect effects of pain on cognition following EI and compare the relationship between pain and cognition in EI and CP populations.
This cross-sectional study used data from a clinical sample of 50 patients with EI (84.0% male; Mage = 43.7 years) administered standardized measures of pain (Pain Patient Profile), depression, and neurocognitive functioning. A CP comparison sample of 93 patients was also included.
Higher pain levels were associated with poorer attention/processing speed and executive functioning performance among patients with EI. Depression was significantly correlated with pain and mediated the relationship between pain and attention/processing speed in patients with EI. When comparing the patients with EI and CP, the relationship between pain and cognition was similar for both clinical groups.
Findings indicate that pain impacts mood and cognition in patients with EI, and the influence of pain and its effect on cognition should be considered in the assessment and treatment of patients who have experienced an electrical injury.
Although death due to electrical injury and lightning are rare in children, these injuries are often preventable. Twenty years ago, most injuries occurred at home, precipitated by oral contact with electrical cords, contact with wall sockets and faulty electrical equipment. We sought to assess the epidemiology of electrical injuries in children presenting to Emergency Departments (EDs) that participate in the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP).
This study is a retrospective review of electrical and lightning injury data from CHIRPP. The study population included children and youth aged 0-19 presenting to participating CHIRPP EDs from 1997-2010. Age, sex, year, setting, circumstance and disposition were extracted. Variables were tested using Fisher’s exact test and simple linear regression.
The dataset included 1183 electrical injuries, with 84 (7%) resulting in hospitalization. Most events occurred at home in the 2-5 year age group and affected the hands. Since 1997 there has been a gradual decrease in the number of electrical injuries per year (p<0.01) and there is an annual surge in electrical injuries over the summer (p<0.01). Forty-six percent of injuries involved electrical outlets, 65% of injuries involved some sort of electrical equipment. Injuries due to lightning were rare (n=19). No deaths were recorded in the database.
Despite the decrease in the number of electrical injuries per year, a large portion of injuries still appear to be preventable. Further research should focus on effective injury prevention strategies.
This chapter focuses on the principles of disaster management to highlight the key features of a regional burn disaster plan. It highlights typical injuries that are best treated in the burn center facility. As with any mass casualty situation, casualty triage is an initial action with a burn disaster. One well-described method consists of combining the Simple Triage and Rapid Treatment (START) system with the Age/Total Body Surface Area (TBSA) Survival Grid from the American Burn Association. The next higher level of care should have personnel experienced with burn surgery and postoperative burn care. There should also be blood-banking and microbiological testing capabilities. At the burn center, the work begun at the initial patient care site should continue with greater emphasis on three injury types unique to burns: inhalation injury, chemical injury, and electrical injury. Future comprehensive emergency management plans must account for burn patients.
Sid M. Shah, Assistant Clinical Professor Michigan State University; Faculty member of Sparrow/MSU Emergency Medicine Residency Program Lansing, Michigan,
Kevin M. Kelly, Associate Professor of Neurology Drexel University College of Medicine
Many poisonous substances produce their primary toxic effects by affecting neurotransmission. Recognition of several known toxidromes may narrow the diagnostic focus and aid in management. The various types of toxidromes include: cholinergic syndrome, aticholinergic syndrome, adrenergic syndrome, sedative hypnotic syndrome, opioid syndrome, and withdrawal syndromes. Although many drugs depress the level of consciousness and respiratory drive, the agents most frequently responsible for these effects include opioids or sedative/hypnotics. The toxicity from any of these agents can cause hypotension, hypothermia, pulmonary edema, and hyporeflexia. Electrical injuries can result in numerous immediate and delayed neurological complications. The most common cause of death by either alternating current or direct current (lightning strike) is cardiorespiratory arrest. The most common cause of death in persons with significant thermal injury is multiple organ failure and its complications. Alternating current typically induces ventricular fibrillation and lightning strike (direct current) commonly causes asystole.
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