Tag: electric and Lightening burns.

Thermal injuries: chemical, electric and Lightening burns.

Thermal injuries: chemical and electric burns.

Q. 1 Regarding high-voltage electrical burns to an extremity
 A Injuries are generally more superficial than those of thermal burns
 B Intravenous fluid replacement is based on the percentage of body surface area burned
 C Antibiotic prophylaxis is not required
 D Evaluation for fracture of the other extremities and visceral injury is indicated
Q. 1 Regarding high-voltage electrical burns to an extremity
 A Injuries are generally more superficial than those of thermal burns
 B Intravenous fluid replacement is based on the percentage of body surface area burned
 C Antibiotic prophylaxis is not required
 D Evaluation for fracture of the other extremities and visceral injury is indicated
Ans. D

Explanation:

The treatment of electrical injury should be modified from that of thermal burns because tissue damage is much deeper than is apparent at first inspection. The heat generated is proportional to the resistance to the flow of current. Bone, fat, and tendons offer the greatest resistance. Therefore, the tissue deep within the center of an extremity may be injured while more superficial tissues are spared. For this reason, the quantification of fluid requirements cannot be based on the percentage of body surface area involved, as in the Parkland,Brooke, or Baxter formulas, which are used to calculate fluid replacement after thermal burns. Massive fluid replacement is usually essential. A brisk urine output is desirable because of the likelihood of myonecrosis with consequent myoglobinuria and renal damage. As with deep thermal burns, debridement, skin grafting, and amputation of extremities may be required following electrical injury. However, fasciotomy is more frequently required than escharotomy with electrical injury because deep myonecrosis results in increased intracompartmental pressures and compromised limb perfusion. In addition, distant fractures may result owing to vigorous muscle contraction during the accident or if subsequent falls occur. Cardiac or respiratory arrest may occur if the pathway of the current includes the heart or brain. An electrical current can also damage the pulmonary alveoli and capillaries and lead to respiratory infections, a major cause of death in these victims. Owing to the deep myonecrosis that often accompanies high-voltage injury, prophylaxis for clostridia with high-dose penicillin may be considered.


Q. 2 High tension electrical burns from overhead electric lines can cause-
 A Myoglobinuria and Acute renal failure
 B Severe alkalosis
 C No ECG change will be seen in the first 24 hours
 D Blood vessels are spared
Q. 2 High tension electrical burns from overhead electric lines can cause-
 A Myoglobinuria and Acute renal failure
 B Severe alkalosis
 C No ECG change will be seen in the first 24 hours
 D Blood vessels are spared
Ans. A

Explanation:

• Electricity exerts its tissue damaging effects by conversion to thermal energy.

• Tissue damage following a  high-voltage electrical injury not only occurs at the Cutaneous contact site but may also involve underlying tissues and organs along the route taken by the current between the entrance and exit sites.

• Misleading small cutaneous lesions may overlie extensive areas of devitalized muscle, which may liberate significant quantities of myoglobin and cause acute renal failure if an adequate renal output is not maintained.

• High-voltage electric injury and lightning injury both can cause cardiopulmonary arrest. Cardiopulmonary resuscitation (CPR) must be initiated immediately for the treatment of cardiac arrest.

•Patients may require operative treatment as soon as hemodynamic stability is achieved.

•A number of neurological changes may occur in the patient ranging from immediate peripheral deficits to relatively late- appearing deficits.

•In general motor nerves appear to be more commonly affected than the sensory nerves. [FAQ]

•Liver necrosis, intestinal perforation, focal pancreatic necrosis and focal gall bladder necrosis have been reported.

• Late complications include delayed hemorrhage even from moderate sized blood vessels.


Q. 3

Suspended animation may be seen with :

 A

Electrocution

 B

Strangulation / hanging

 C

Drowning

 D

Burn

Q. 3

Suspended animation may be seen with :

 A

Electrocution

 B

Strangulation / hanging

 C

Drowning

 D

Burn

Ans. A

Explanation:

A i.e. Electrocution

Suspended animation (i.e. apparent death) is seen in electrocution & apparently drowned (not drowning)Q

Quiz In Between


Q. 4

Joule burns is seen in :

 A

Electrocution

 B

Thermal injury

 C

Radiation injury

 D

Lightning

Q. 4

Joule burns is seen in :

 A

Electrocution

 B

Thermal injury

 C

Radiation injury

 D

Lightning

Ans. A

Explanation:

A i.e. Electrocution


Q. 5

Myoglobinuria is seen in which type of burns:

 A

Contact burn

 B

Electric burn

 C

Scald

 D

Flame burn

Q. 5

Myoglobinuria is seen in which type of burns:

 A

Contact burn

 B

Electric burn

 C

Scald

 D

Flame burn

Ans. B

Explanation:

Ans is ‘b’ i.e. Electric burn 

Electrical burns may cause extensive muscle necrosis and consequent myoglobinuria and hemoglobinuria, both of which may lead to renal insufficiency.


Q. 6

The most serious alkali burns of the eye are produced by:

 A

Strong liquid ammonia

 B

Caustic soda

 C

Lime

 D

None of the above

Q. 6

The most serious alkali burns of the eye are produced by:

 A

Strong liquid ammonia

 B

Caustic soda

 C

Lime

 D

None of the above

Ans. A

Explanation:

Ans. Strong liquid ammonia

Quiz In Between


Q. 7

All of the following are true of chemical burns of the eye except:

 A

Acid burns are more serious than the alkali burns

 B

Alkalies combine with lipids of cells to form soluble compounds, which produce a condition of softening and gelatinisation

 C

Acids cause instant coagulation of all the proteins

 D

Symblepharon is a distressing sequelae

Q. 7

All of the following are true of chemical burns of the eye except:

 A

Acid burns are more serious than the alkali burns

 B

Alkalies combine with lipids of cells to form soluble compounds, which produce a condition of softening and gelatinisation

 C

Acids cause instant coagulation of all the proteins

 D

Symblepharon is a distressing sequelae

Ans. A

Explanation:

Ans. Acid burns are more serious than the alkali burns


Q. 8

Electrocution is rare below:          

MP 09

 A

100 volt

 B

150 V

 C

200 V

 D

240 V

Q. 8

Electrocution is rare below:          

MP 09

 A

100 volt

 B

150 V

 C

200 V

 D

240 V

Ans. A

Explanation:

Ans. 100 volt

Quiz In Between



Thermal injuries: chemical, electric and Lightening burns.

Thermal injuries: chemical, electric and Lightening burns.


Introduction:

Chemical burns:-

  • Chemical burns are produced by corrosive acids and alkalis.
  • Acids with a pH less than 2 precipitate proteins causing coagulation necrosis.
  • Nitric acid gives a yellow-brown scab, sulphuric (vitriol) a black-brown scab,
  • Hydrochloric acid (spirit of salt) a white to grey scab, and carbolic acid (phenol or Lysol) gives a light grey to light brown scab.
  • Alkalis with a pH above 11.5 cause more tissue damage than acids because they induce liquefactive necrosis, which facilitates ever deeper penetration of the alkali.
  • The caustic alkalis, such as sodium hydroxide (caustic soda or lye) and ammonium hydroxide, leave a grey-white mucoid burn.
  • Vesicles  and blisters, Charring  (soot)  and  singeing  are absent, except  in  cases  of mineral  acids  where  they  are present.
  • The most serious alkali burns of the eye are produced by: Strong liquid ammonia.

Electric burns:-

  • High tension electrical burns from overhead electric lines can cause Myoglobinuria and Acute renal failure.
  • Electric  burns  are  at  times,  also  referred  to  as joule  burns.
  • Regarding high-voltage electrical burns to an extremity.  Evaluation for fracture of the other extremities and visceral injury is indicated.
  • Ulceration  is  present, Coagulative necrosis  is  seen  at the  site of contact  except  for  hydrogen  fluoride  which chelate  calcium.
  • Calcium  phosphate  of bones  may also  melt and  is  radiologically  seen  as  bone pearls  (wax  dripping), Muscles  show  Zenker’s  degeneration.
  • commonest  cause  of  death in electric injury  is  ventricular  fibrillation.
  • The skin may get coloured due to metallic pigment :- green (in brass electrode), black (in iron electrode), blue (in copper electrode) and grey (in aluminium electrode).
  • In high-voltage (more than 1,000 volts) electrical burns the contact injury of exit often appears as a blow-out type of wound.
  • Alternating current (AC) is more dangerous than direct current (DC).

Lightening  burns

  • Lightening refers  to  discharge  of current  between  a negatively charged  cloud and  positively  charged  article  on  earth.
  • Direct  effect  of high voltage  current.
  • Heat,  i.e.  super  heated  air causing  burns.
  • Expanded  and displaced  air, which acts as  a  blast wave
  • Sledge  hammer  blow  by compressed  air pushed before.
  • The  characteristic  finding  in  lightening  burns is  filigree  burns.

Exam Important

  • Chemical burns are produced by corrosive acids and alkalis.
  • Acids with a pH less than 2 precipitate proteins causing coagulation necrosis.
  • Nitric acid gives a yellow-brown scab, sulphuric (vitriol) a black-brown scab,
  • Hydrochloric acid (spirit of salt) a white to grey scab, and carbolic acid (phenol or Lysol) gives a light grey to light brown scab.
  • Alkalis with a pH above 11.5 cause more tissue damage than acids because they induce liquefactive necrosis, which facilitates ever deeper penetration of the alkali.
  • The caustic alkalis, such as sodium hydroxide (caustic soda or lye) and ammonium hydroxide, leave a grey-white mucoid burn.
  • Vesicles  and blisters, Charring  (soot)  and  singeing  are absent, except  in  cases  of mineral  acids  where  they  are present.
  • The most serious alkali burns of the eye are produced by: Strong liquid ammonia.
  • High tension electrical burns from overhead electric lines can cause Myoglobinuria and Acute renal failure.
  • Electric  burns  are  at  times,  also  referred  to  as joule  burns.
  • Regarding high-voltage electrical burns to an extremity.  Evaluation for fracture of the other extremities and visceral injury is indicated.
  • Ulceration  is  present, Coagulative necrosis  is  seen  at the  site of contact  except  for  hydrogen  fluoride  which chelate  calcium.
  • Calcium  phosphate  of bones  may also  melt and  is  radiologically  seen  as  bone pearls  (wax  dripping), Muscles  show  Zenker’s  degeneration.
  • commonest  cause  of  death in electric injury  is  ventricular  fibrillation.
  • The skin may get coloured due to metallic pigment :- green (in brass electrode), black (in iron electrode), blue (in copper electrode) and grey (in aluminium electrode).
  • In high-voltage (more than 1,000 volts) electrical burns the contact injury of exit often appears as a blow-out type of wound.
  • Alternating current (AC) is more dangerous than direct current (DC)
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