Primary Treatment of 50 Patients with High-Tension Electrical Injuries

Abstract

Fifty patients with high-tension electrical injuries referred for primary treatment to the Burn Center at the University of Uppsala, Sweden during the period 1969 to 1982, have been investigated with special regard to the resuscitation and early complications from internal organs. Seven patients (14%) died, five of them prior to 1974, one in cardiac infarction and four in renal failure. Two died after 1974. one in cardiac infarction and the other in severe shock (98% burn). In 1974 an acute intensive prevention of renal failure was instituted based on forced fluid resuscitation, vasodilators, and supply of alkaline solutions in order to avoid myoglobin and hemoglobin casts in the kidneys. Some degree of renal dysfunction (diminished GFR, a lowered concentration capacity, and an increased fractionate excretion of sodium) was often seen but could usually be reversed without problems. Three patients who developed anuria were successfully treated with hemodialysis. During the years 1974–1982, when the “prevention scheme of renal failure” was applied, all patients with high-tension electrical injury combined with severe myoglobinuria (13 patients) have been successfully treated. 60% of the patients had normal ECG. Five of the seven fatal cases had ST-T abnormalities and two of these patients showed cardiac infarction at autopsy. Early angiography was performed in 20 patients (40%). Obliterated arteries were diagnosed on different levels in 18 extremities in ten patients. The arteriography very precisely indicated the level of amputation of the seriously injured extremities. In high-tension accidents, heat is the principle mediator of tissue injury. The type of deep tissue damage observed in the present investigation following high-tension accidents indicates that the body acts as a volume conductor in which heat is generated as a function of voltage drop and current flow per unit cross-sectional area. This explains the high frequency of severe injury to the extremities with secondary damage to the kidneys and the rarity of major injury to the trunk.