Notfallmedizinische Versorgung von Blitz- und Stromschlagverletzungen

Abstract

The pattern of injuries following electrical accidents and the treatment by emergency teams differ depending on whether exposure was to a low-voltage or high-voltage power source or to a lightning bolt. Tissue damage results from the direct effect of current on cell membranes and from conversion of electrical energy into heat. Depending on the magnitude of electrical energy and the duration of exposure, cardiac dysrhythmia, damage to nerve tissue, extensive burns and shock may occur. Multi-system injury is frequently observed, either directly related to electrical shock or secondary to concurrent trauma. Extrication of victims from the energy field must be performed under strict observance of self-protection measures for the rescuers. In high-voltage incidents the rescuers must wait at a distance until the power supply has been turned off and demonstrably grounded. Analgesia, anxiolysis and administration of crystalloid fluids are needed, especially for injuries from high-voltage power sources. Severe burns of the face and neck call for early intubation and ventilation. Monitoring is performed with pulsoximetry, blood pressure measurement and ECG, giving highest priority to the unconscious patient with cardiac and respiratory arrest. Cardio-pulmonary resuscitation (CPR) follows the international guidelines for resuscitation and may be effective after delayed onset and even after prolonged resuscitation attempts.

Injuries, Sequelae, and Treatment of Lightning-Induced Injuries: 10 Years of Experience at a Swiss Trauma Center

“…Generally, the extent of injuries from electric current are dependent on voltage, electrical tissue resistance, and duration of exposure [12]. …”

“…The incidence of lightning strikes worldwide is estimated to be 0.09–0.12/100,000 people [12]. In the UK, three people are killed annually by lightning strikes, and about 50 people are injured every year [1].…”

“…Also, epidemiological data is not regularly recorded and evaluated in many countries [12]. Generally, the literature about lightning strikes and related injuries is scarce [17, 18].…”

Keraunoparalysis: What a neurosurgeon should know about it?

“…[9] Massive muscular contraction following electric shock may lead to release of myoglobin leading to ARF. Constant diuretic and fluid therapy may help to reverse the ARF, while fasciotomy may be needed to treat compartment syndrome secondary to muscle trauma.…”

Notfall-Management bei Elektrounfällen

“…wohner und Jahr ausgegangen [3] . Auf schweizerische Verh ä ltnisse umgerechnet (7 Millionen Einwohner) entspricht dies 490 Unf ä llen, f ü r Deutschland (80 Millionen Einwohner) 5 600 Elektrounf ä llen pro Jahr.…”