![]() Consider discharge after arranging outpatient follow-up to assess for delayed effects.Typically, no specific diagnostics or treatment are required.See “ Management of electrical injuries” for further information.Admit for continuous cardiac monitoring for ≥ 24 hours.Obtain ECG and echocardiography for all patients.Management is similar to patients with high-voltage electrical injuries.Suspect a lightning strike in any patient found outdoors with altered mental status or cardiopulmonary arrest during a thunderstorm even if evidence of external injury is absent. Delayed onset: myelopathy, complex regional pain syndrome īlunt trauma and cardiopulmonary arrest are more common than severe burns in lightning strike victims.Peripheral nerve injury, intracranial hemorrhage, traumatic brain injury.Keraunoparalysis: transient flaccid paralysis and sensory loss with signs of vascular spasm (e.g., pulselessness).Loss of consciousness, seizures, amnesia.QTc prolongation, depressed cardiac contractility, pericardial effusion, acute myocardial injury.Arrhythmia (common): e.g., ventricular fibrillation, asystole.Metalization: deposition of metal particles into the skin at sites where metallic objects (e.g., jewelry) are in contact with the body.Lichtenberg figure : branching (fern‑like), erythematous patterns on the skin ( pathognomonic for lightning injury ).Skin : Signs may be minimal or absent despite substantial other injuries.Clothing: often singed, torn, and/or tattered, with melted metal items (e.g., zippers).Thermal burns : superficial or, less commonly, deep.Cardiopulmonary arrest: due to transient stunning of the cardiac conduction system and/or the brain stem.Blast injury : due to rapid heating and expansion of surrounding air. ![]() Low-voltage sources ( 10 6 V) electrical discharge → flashover effect (most of the current travels along the outside of the body) → lower risk of deep tissue injury compared with other electrical injuries.High-voltage sources ( ≥ 1000 V): e.g., lightning strike, industrial devices, power supply lines, conducted electrical weapon ( CEW).Workplace-related electrical injuries cause approx.Adults: most often found in occupational settings.Children: most often a household injury.4% of admissions to specialized burn services. Electrical injuries account for approx.Work-related respiratory conditions, e.g.:Įlectrical injury Epidemiology.Injuries related to changes in ambient pressure Frostbite and nonfreezing cold injuries.OverviewĮlectrical, thermal, and radiation injury Other environmental pathologies are covered in separate articles see “ Overview of environmental pathologies” for links. Treatment is usually conservative but rare, life-threatening complications (e.g., pneumothorax) may occur.Īgricultural health hazards include green tobacco sickness and anhydrous ammonia poisoning. ![]() Barotrauma is caused by a large pressure difference between the ambient environment and air-filled structures such as the middle ear, sinuses, and/or lungs. Treatment involves 100% oxygen and hyperbaric oxygen therapy ( HBOT). Decompression illness is caused by the presence of gas bubbles in the blood or tissue and manifests as musculoskeletal pain, altered mental status, and/or circulatory collapse. Preventative measures include staged ascent and prophylactic medications.ĭiving-related illnesses are caused by rapid changes in ambient pressure. Management involves descent, supplemental oxygen, and possible pharmacotherapy. Manifestations include acute mountain sickness, high-altitude pulmonary edema, and high-altitude cerebral edema. ![]() High-altitude illnesses result from inadequate acclimatization to the low partial pressure of inspired oxygen found at elevations > 2500 m ( ∼ 8000 feet). Management may include ATLS, ACLS, cardiac monitoring, and treatment of complications such as fractures. Individuals with an electrical injury require a thorough assessment for burns, cardiac complications (e.g., with a screening ECG), and traumatic injuries. Lightning injuries can manifest with fixed dilated pupils, cardiorespiratory arrest, and characteristic skin findings such as Lichtenberg figures. Environmental pathologies are conditions caused by exposure to environmental factors such as extreme temperature, rapid changes in ambient pressure, electricity, wildlife, and environmental and occupational toxins and irritants.Įlectrical injuries typically manifest with burns, cardiac dysrhythmias, and/or traumatic injuries.
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