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64 - Electrical injuries
- from Part VI - Special resuscitation circumstances
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- By Wolfgang Lederer, Department of Anaesthesiology and Critical Care, Innsbruck Medical University, Austria, Erga Cerchiari, Department of Anaesthesiology and Intensive Therapy, Maggiore Hospital, Bologna, Italy, Norman A. Paradis, University of Colorado Health Sciences Center
- Edited by Norman A. Paradis, University of Colorado, Denver, Henry R. Halperin, The Johns Hopkins University School of Medicine, Karl B. Kern, University of Arizona, Volker Wenzel, Douglas A. Chamberlain, Cardiff University
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- Book:
- Cardiac Arrest
- Published online:
- 06 January 2010
- Print publication:
- 18 October 2007, pp 1136-1147
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- Chapter
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Summary
Today, human-made and natural sources together kill about 1100 to 1200 people each year in the United States. The number of people injured worldwide by electricity, however, remains unclear, because it is generally underreported and it is common for survivors to avoid medical care initially. Although scientific investigations of electrical injuries date back to 1884, with current scientific knowledge and the clinical appearance of electrical injuries, we now know that the outcomes of electrical injuries differ substantially, depending on whether technical electricity with low-volt household current, high-volt current, or lightning is the underlying cause.
Injuries after electrocution are often dramatic and potentially fatal. In the majority of victims injuries are caused by the effects of electrical, thermal, and mechanical energy. Secondary trauma may result from falls, explosions, or violent muscle contractions. Cardiac and respiratory arrest may occur immediately or secondary to direct effects of current. Many victims die before advanced life support can be provided, and survivors may suffer permanent disabilities. What is unique about electrical injuries, however, is the potential for good resuscitation outcome even after long arrest times. This may be a result of the electrical shock itself or because these accidents tend to occur in younger persons with few or no underlying pathological conditions.
Considering the magnitude of the voltage and current involved, it is amazing that anyone survives an encounter with a bolt of lightning. Lightning can cause harm by electrical energy (e.g., direct hit, side splash, upward streamer, ground strike, conducted current, step voltage) and can cause trauma (e.g., heat, explosion, fall).
47 - Postresuscitation syndrome
- from Part V - Postresuscitation disease and its care
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- By Erga L. Cerchiari, Department of Anaesthesia and Critical Care, Ospedale Maggiore, and Area of Anaesthesia and Critical Care, Surgical Department, Provincial Health Care Structure, Bologna, Italy
- Edited by Norman A. Paradis, University of Colorado, Denver, Henry R. Halperin, The Johns Hopkins University School of Medicine, Karl B. Kern, University of Arizona, Volker Wenzel, Douglas A. Chamberlain, Cardiff University
-
- Book:
- Cardiac Arrest
- Published online:
- 06 January 2010
- Print publication:
- 18 October 2007, pp 817-828
-
- Chapter
- Export citation
-
Summary
The postresuscitation syndrome (PRS) has been defined as a condition of an organism resuscitated following prolonged cardiac arrest, caused by a combination of whole body ischemia and reperfusion, and characterized by multiple organ dysfunction, including neurologic impairment.
Background
Following resuscitation from cardiac arrest, patients either recover consciousness or remain unconscious, depending on the duration of cardiac arrest and the effectiveness of any CPR, but also on prearrest conditions such as age and comorbidities.
Shortening no-flowtimes by timely interventions that can maintain some perfusion and promote the restoration of spontaneous circulation (e.g., bystander CPR, early defibrillation, and other means) improves the possibility of a successful outcome with the patient recovering consciousness.
The wider availability of resuscitation techniques to reverse clinical death, however, has led to increasingly frequent observations of a pathological condition occurring in patients who remain unconscious, involving multiple organ injury or failure following reperfusion after prolonged cardiac arrest.
The concept of postresuscitation disease as a unique and new nosological entity was introduced by Negovsky in 1972; the most interesting aspect of this innovative concept was the recognition that the etiology depended on a combination of severe circulatory hypoxia with the unintended sequelae of measures used for resuscitation.
On the basis of the wide variety of ischemic/hypoxic mechanisms that can trigger its development, the disease was redefined by Safar as a syndrome in which pathogenetic processes triggered by cardiac arrest were exacerbated by reperfusion, causing damage to the brain and other organs, the complex interactions of which combine to determine overall outcome (see early experimental findings summary).