Electrical Injury

The amount of injury depends on following factors

– Type of current

– Voltage

– Frequency

– Resistance of the tissues involved

– Resistance at the points of body contact

– Path of the current through the body

– Duration of contact

Clinical features

– Immediate effect:

• Loss of Consciousness, Visual Disturbance, tinnitus, deafness,

convulsion, amnesia

– Local effect of the curent

• Burns, Gangrene, rhabdomyolysis, neuropathies

– Secondary neuropsychiatric manifestations

Cause of death-

– VF

– Failure of resp centre

– Tetanic spasm

– Renal failure

– sepsis

Treatment

• Free from current

• ABC/ CPR

• 48 hr ICU monitoring

• Adequate hydration
 • Wound debridement

• HAEMODIALYSIS- ARF, Hyperkalemia,

Lightening

• Immediate Effect

– LOC, Asystole, (No convulsion)

• Secondary Effect

– Paralysis, occular palsies, optic atrophy, amnesia, Psychological

• Residual deficits

– Stroke, TM rupture causing deafness

• Cutaneous Injuries- “Lichtenbeg figures”

Prevention

– Avoid direct strike

– Discard Metals

– No wires

Treatment

– Supportive

Radiation Injury

• All human beings are constantly exposed to ionizing radiation.

• Environmental sources

– Cosmic radiation ~28 mrem / yr

– From ground ~26 mrem / yr

– From inhaled and ingested material ~27 mrem / yr

• Common man-made sources of radiation

– X-ray

– Nuclear weapons

– Radioactive medications / Radiotherapy

– Mines
Types of Ionizing Radiation

• Electromagnetic

– X-ray, gamma ray

• Particulate

– Electron, proton, neutron, Alpha particle,

Biologic effects of Radiation

• To kill a cell Radiation must produce double-strand breaks in the DNA

• Interaction with water generate free radicals → damage cell membranes, proteins and
organelles

• Mutation causing cancerous growth

• Bone – most radio-resistant organ.

• Testis, ovary and bone marrow are the most sensitive organs.

Effect of Radiation

• CNS- subacute CNS reaction

– Transient demyelination of Spinal cord

– Mild encephalopathy

– Post-irradiation brain necrosis

– Tr mtelitis

• Skin-

– ~2 wks Erythema followed by desquamation

– Chr reaction 6-12 m atrophic, interstitial fibrosis and telangiectasia,

hyperpigmentation

• Heart and blood vessels-

– Acute pericarditis, pericardial effusion

– Constrictive pericarditis

– Peri/ myo/ endocardial fibrosis

– increase risk of MI
 • Lung-

– radiation pneumonitis

– Lung fibrosis

• GIT-

– Acute Gastritis, AGE

– Chr radiation enteropathy

– Fibrosis, perforation, fistula formation, stenosis

• U bladder-

– symptoms starts after 3 to 6 wks

– Subside in 3 to 4 wks

– Acute cystitis-Increased frequency and dysuria

– Late- Fibrosis

• Testes and ovaries

Acute Toxicity (Acute Radiation Sickness)

– Manifests as three major groups of sign and symptom

– Hematopoietic; GIT; Neurovascular

– 4 major stages of ARS

• Prodrome: Minutes to 4 days

• Latent phase: Minimal or No symptoms, last 2.5-6 wk

• Illness:

• Recovery/Death

Acute total body irradiation

• Prodromal radiation syndrome

– Cerebrovascular syndrome

– >100 Gy, death usually in 24 to 48 hrs

– Gastrointestinal syndrome

– 5 to 12 Gy, death in days

 – Hematopoietic syndrome

– 2 to 8 Gy, death occurs in 2 to 4 weeks

Chronic toxicity

– thyroid failure, cataract, retinal damage

– Decrease saliva, dental caries, poor dentition

– Loss of taste and smell

– Con pericarditis, increase risk of MI

– Lung fibrosis, viscus stricture, radiation enteritis

– Tumors 1%/yr beginning in the second decade after treatment

Treatment Of ARS:

– Supportive- give Damaged organs the chance of recovery

– BT,

– Tx of infection and neutropenia

– Partial or total parenteral nutrition

– Standard therapy for trauma

– Psychological support

Radionuclide Decontamination

1. GIT clearance

2. Blocking agents

3. Iluting agents

4. Mobilizing agents

5. Chelating agents

Radiation induced cancers

• Neck Irradiation -Thyroid ca

• Cranial Irradiation -CNS tumors

• Breast irradiation -Breast Ca

• Uranium mining -Ca lung

• Radium dial painter -Bone sarcomas

• In utero exposure -Leukemia