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THE NATURAL HISTORY OF ELECTRICAL INJURY
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1977
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Electrical injuries cause significant morbidity largely due to unresolved neurological and vascular sequelae. This study examined the natural history of electrical injury (excluding flash burns) in 64 patients. Among these patients, burns were generally small (11% >25% in 14%), yet 114 major complications occurred, including 36% with EKG abnormalities (10 arrhythmias), 25% with neurological sequelae, and numerous vascular injuries leading to 32 amputations in 19 patients; early referral, fluid resuscitation, and aggressive debridement reduced renal failure (1.5%) and mortality (3.1%) and wound sepsis (8%) but had limited impact on limb salvage.
The natural history of electrical injury, exclusive of electrical flash burns, was determined in 64 patients. These patients sustained relatively small burns (x = 11%); only nine patients (14%) had burns greater than 25%. Forty-six patients suffered 114 major complications. EKG abnormalities occurred in 36%, including major cardiac arrhythmias in ten patients. One-fourth of the patients developed neurologic sequelae (CNS–8, peripheral–8). Electrical vascular injury with subsequent arterial occlusion was responsible for many of the major amputations. Nineteen patients required 32 amputations (digits–17, hand–1, foot–2, leg–3, arm–9). Early patient referral and vigorous fluid resuscitation minimized renal failure (1.5%) and mortality (3.1%). Early fasciotomy and vigorous debridement appeared to decrease wound sepsis (8%), but apparently had little if any effect on major limb salvage. The unsolved problems of electrical injury, namely neurological and vascular sequelae, are major contributors to the high morbidity of electrical injury.