Electrical Injuries: Medical and Bioengineering Aspects, Second Edition

Author: Raymond M. Fish, Leslie A. Geddes ISBN-10: 1-933264-63-2 ISBN-13: 978-1-933264-63-9 Copyright Date Ed: January 18, 2009 Pages: 616 Binding Information: Casebound Size: 8.5 ✕ 11 Inches (US) Since the first edition of this book six years ago, new information about many aspects of electrical and blast injuries has become available. As a result, a variety of topics have been added and updated in this second edition. You will be pleased with the results. This book explains electrical and blast injuries in a useful way to physicians and other medical personnel, military personnel, patients and their families, educators, engineers, attorneys, and other professionals. Divided into six sections for ease of use and navigation, this book covers clinical management, bioengineering, body system injuries, electrical sources, accident reconstruction, and much more! Understanding electrical injuries and explosions (electrical or bombing-related) is complex and a multi-disciplinary perspective is required. Information from both medicine and engineering is relevant to the understanding of such injuries. This new edition offers you this approach. This book is also available as an eBook. Click here to purchase and download: Topics include: Basic concepts needed to understand electrical injury The let-go phenomenon Initial priorities: accident scene and emergency department Subtle diagnostic and prognostic factors in electrical trauma Treatment of specific injuries Patient disposition: indications for monitoring Electrical and terrorism-related explosions Sympathetically mediated pain Clinical approach to the electrocardiogram The physiology of cardiopulmonary resuscitation Electrical stimulation of the heart Table of Contents Chapter 1: Basic Concepts Needed to Understand Electrical Injury 1.1 Basic Electrical Terms 1.2 Basic Concepts Regarding the Flow of Electric Current 1.3 Capacitance 1.4 Primary versus Secondary Injury 1.5 Power 1.6 Voltages Involved in Electrical Injury 1.7 Skin Impedance 1.8 Stimulation of Excitable Cells 1.9 Simplified Resistance Model of the Human 1.10 Current Path 1.11 Amounts of Current Carried by Various Tissues 1.12 Injury without Burn Marks 1.13 Death Occurring without Skin Burns 1.14 Effects of Various Amounts of Current 1.15 Terminology: Static Stray, Fault, Step, and Touch Electricity Chapter 2: The Let-Go Phenomenon 2.1 Types of Current Producing the Inability to Let Go 2.2 Pathophysiology 2.3 Why Inability to Let Go Results in More Severe Injury 2.4 Case Examples Chapter 3:Initial Priorities: Accident Scene and Emergency Department 3.1 Accident Scene Care 3.2 The Accident Scene 3.3 Initial Emergency Department Approach to the Patient Chapter 4: Subtle Diagnostic and Prognostic Factors in Electrical Trauma 4.1 History and Physical Examination Can Be Revealing 4.3 Predicting Future Effects of Electric Injury 4.4 Recognition of Occult or Developing Sequelae of Electrical Injury 4.5 Factors Suggesting Deep-Tissue Injury 4.6 Unusual, Delayed, and Apparently Exaggerated Signs and Symptoms Following Injury Chapter 5: Treatment of Specific Injuries 5.1 Myoglobinuria 5.2 Gastrointestinal Injury 5.3 Vascular Insufficiency 5.4 Disseminated Intravascular Coagulation 5.5 Burns 5.6 Microwave Oven Injury 5.7 Progressive Tissue Necrosis Following High-Voltage Contact Chapter 6: Treatment of Brain and Spinal Cord Injury 6.1 Brain Injury 6.2 Spinal Injury Chapter 7: Patient Disposition: Indications for Monitoring 7.1 Recommendations for Monitoring 7.2 Studies Relevant to Cardiac Monitoring Recommendations 7.3 Discussion 7.4 Conclusion: Suggestions for Monitoring Patients Chapter 8: Electrical and Terrorism-Related Explosions:Injury Characteristics 8.1 Sources of Blast Forces in Electrical Accidents 8.2 Terminology 8.3 Blast Injury 8.4 Cognitive Deficits Related to Blast Effects 8.5 Penetrating Injury 8.6 Toxic Chemicals in Explosions 8.7 Biological Materials in Explosions 8.8 Radioactive Materials In Explosions Chapter 9: Electrical and Terrorism-Related Explosions:Diagnosis and Treatment 9.1 Initial Treatment Priorities 9.2 Specific Injuries Chapter 10: Sympathetically Mediated Pain: RSD, CRPS, Causalgia, and Neuropathic Pain 10.1 Background Information 10.2 Diagnostic Criteria for Various Types of Sympathetically Mediated Pain 10.3 Types of Nerves Affected in Reflex Sympathetic Dystrophy 10.4 Skin Lesions in RSD 10.5 Delayed Onset of Reflex Sympathetic Dystrophy 10.6 RSD Following Electric Injury 10.7 RSD Following Lightning Injury 10.8 Causalgia due to Electric Current 10.9 Definitions of Some Signs and Symptoms 10.10 Abnormal Response to Cold in RSD 10.11 Edema (an Excessive Accumulation of Watery Fluid) Caused by Electrical Injury and RSD 10.12 Nerve Entrapment: A Sometimes Late Complication of RSD 10.13 CRPS, or Complex Regional Pain Syndrome 10.14 Treatment Sympathetically Medicated Pain, including RSD and Causalgia Chapter 11: Clinical Approach to the Electrocardiogram 11.1 A General System for ECG Interpretation 11.2 Heart Rate 11.3 Rhythm Decoding 11.4 Effects of Electrolyte Imbalance Chapter 12: The Physiology of Cardiopulmonary Resuscitation 12.1 Cardiac and Respiratory Arrest 12.2 Conventional CPR 12.3 Improved CPR 12.4 Modern Physiology of Blood Flow During CPR: Three Pump Mechanisms 12.5 Improved Methods of CPR Enhance the Operation of the Pumps Chapter 13: Electrical Stimulation Basics 13.1 Strength-Duration Curves 13.2 Alternating-Current Stimulation 13.3 Electrode-Subject Impedance 13.4 Direct-Current Stimulation 13.5 Static Electricity Stimulation 13.6 Summary Chapter 14: Stimulators: Historical and Technical Aspects 14.1 Stimulators Excite Nerve and Muscle 14.2 Early Experimental Stimulators 14.3 Stimulation Parameters 14.4 Basis for Stimulation 14.5 Galvanic-Faradic Stimuli to Diagnose NerveInjury 14.6 Modern Stimulators Chapter 15: The Heart: Background Information with an Emphasis on Electrical Issues 15.1 Structure and Function of the Heart 1 15.2 Electrical Character of the Heart 15.3 The Electrocardiogram 15.4 Electrical Problems in the Heart 15.5 Electronic Monitoring during MyocardialInfarction 15.6 Cardiac Arrest 15.7 How Cardiac Arrest Is Treated 15.8 Consciousness during Cardiac Arrest Chapter 16: Electrical Stimulation of the Heart-Introduction 16.1 The Natural Pacemaker and Signal Conduction System of the Heart 16.2 Fibrillation: Atrial and Ventricular 16.3 Defibrillation 16.4 Pacemakers for Bradycardia (Slow Heartbeat) 16.5 Failure to Detect Cardiac or Respiratory Arrest Because of Pacemaker Signals 16.6 MRI (Magnetic Resonance Imaging) for Patients with Pacemakers 16.7 The ICD (Implantable Cardioverter Defibrillator) Chapter 17: Historical and Technical Highlights in Cardiac Pacing 17.1 Introduction to Historical Landmarks 17.2 The Earliest Cardiac Pacing 17.3 Human Transcutaneous Pacing 17.4 Clinically Useful Pacing 17.5 Transvenous Pacing 17.6 Closed-Chest Pacing 17.7 The Monopolar Catheter Electrode 17.8 The Implantable Pacemaker 17.9 Prolonging Battery Life 17.10 Unexpected Sudden Deaths Chapter 18: Ventricular Fibrillation I: Basic Aspects 18.1 Cardiac Activity during Ventricular Fibrillation 18.2 The Vulnerable Period 18.3 Electrosurgical Current Produces Ventricular Fibrillation Chapter 19: Ventricular Fibrillation II: Sudden Death from Electric Shock 19.1 Physiological Effects of Ventricular Fibrillation 19.2 Stimulation of Excitable Tissue 19.3 Electrophysiology of Ventricular Fibrillation 19.4 Summary Chapter 20: Patient Monitoring and Measurements 20.1 The Electrocardiogram (ECG or EKG) 20.2 Circulation of the Blood 20.3 Central Venous Pressure (CVP) 20.4 Pulmonary Artery Capillary Wedge Pressure 20.5 Cardiac Output Measurements 20.6 Arterial Blood Gases 20.7 Blood Pressure Chapter 21: Blood Pressure Measurement 21.1 The Concept of Counterpressure 21.2 Criteria for Systolic and Diastolic Pressure 21.3 The Modern Era Chapter 22: Pulse Oximetry: Heritage of the Tissue-Bed Oximeter 22.1 The Importance of Pulse Oximetry 22.2 The First Oximeters 22.3 Historical Summary Chapter 23: The Respiratory System 23.1 Respiratory System Structure and Function 23.2 Smoking 23.3 Control of Breathing 23.4 Arterial Blood Gases 23.5 Blood Gas Changes due to Respiratory Arrest 23.6 Oxygenation of Intubated Patients 23.7 Measuring Breathing: Spirometry 23.8 Respirators Chapter 24: Burns I: Types of Electrical Contact and Related Burns 24.1 Electrothermal Burns 24.2 Arc Burns 24.3 Conduction by Streams of Liquid 24.4 Conduction through Shoes and Truck Tires 24.5 Electric Cord Injuries 24.6 Conduction by Moisture, Surface Contamination, Insulation Breakdown and Tiny Holes 24.7 Case Report: Holes in Rubber Overshoes, Loose, Jumping Power Line Contact Chapter 25: Burns II: Characteristics of Skin Burns 25.1 General Appearance of Burns 25.2 Degrees of Burns 25.3 Gross and Microscopic Examination of Current Marks 25.4 Difficulty of Determining Extent of Deep Injury Related to Burns 25.5 Factors Related to the Formation of Burns Chapter 26: Muscle and Skeletal Injury 26.1 Muscle Injury 26.2 Bone and Joint Injury Chapter 27: Mechanical Brain Injury 27.1 The Physical Nature of Mechanical Head Injury 27.2 Sequelae of Head Injuries 27.3 Brain Imaging: CT, MRI, and SPECT 27.4 Case Examples 27.5 Conclusions Chapter 28: Spinal Injury 28.1 Overview 28.2 MRI and Spinal Injury 28.3 Subacute Progressive Ascending Myelopathy 28.4 Defibrillations and Cardioversions 28.5 Cord Lesions from Hand-to-Hand Electric Contact 28.6 Vascular Injury Can Lead to Delayed Peripheral Nerve and Spinal Cord Dysfunction 28.7 Delayed Onset of Spinal Cord and Brain Dysfunction: Multiple Case Listing28.8 Case Reports Chapter 29: Peripheral Nerve Injury 29.1 Mechanisms of Electric Injury to Peripheral Nerves 29.2 Pathophysiology of Delayed Nerve Injury 29.3 Specific Peripheral Nerve Injuries 29.4 Amount of Current Needed to Cause Injury 29.5 Case Examples of Delayed Peripheral Nerve Injury Chapter 30: Auditory and Visual System Injury 30.1 Auditory System Injury 30.2 Visual System Injury Chapter 31: Pulmonary, Cardiac, and Vascular Tissue Injury 31.1 Pulmonary Injury 31.2 Myocardial Injury 31.3 Vascular Injury Chapter 32: Electroconvulsive Therapy (EST or ECT) 32.1 Types of Electric Current Used in Electroconvulsive Therapy 32.2 Complications 32.3 Making ECT Safer and More Effective Chapter 33: Fetal Injury 33.1 Incidence of Fetal Death with Apparently Minor Maternal Electrical Injury 33.2 Fetal Movements: A Sign of Fetal Well-Being 3.3 Case Reports of Fetal Death 33.4 Case Reports of Fetal Injury with Survival 33.5 Treatment of Electrical Injury in Pregnancy 33.6 Information Relevant to Interpreting Case Report Chapter 34: Psychological Effects of Electrical Accidents 34.1 Introduction 34.2 Neuropsychological Testing Is Often More Sensitive and Specific than Brain Imaging 34.3 Methodological Problems of Neuropsychological Studies Involving Electrical Accidents 34.4 Electric Current Flow through the Head 34.5 Impairment from Apparently Minor Blunt Head Trauma 34.6 Non-Contact Head Injury 34.7 How DSM Diagnostic Criteria are Organized 34.8 The Postconcussive Syndrome 34.9 Mild Traumatic Brain Injury 34.10 Medical Records Frequently Fail to Document Signs of Brain Dysfunction 34.11 Delayed Onset of Depression and Other Psychological Problems 34.12 Posttraumatic Amnesia and Prognosis 34.13 Recurrent Major Depressive Episodes 34.14 Posttraumatic Stress Disorder (PTSD) 34.15 Memory Dysfunction to Problems with Attention and Concentration Chapter 35: Lightning Physics and Injuries 35.1 Lightning Facts 35.2 Incidence of Injury 35.3 Early Scientific Studies and Invention of the Lightning Rod 35.4 Physics of the Lightning Stroke 35.5 Basic Mechanisms in Lightning Injury 35.6 Pathophysiology of Lightning Injury (The Effect of Lightning on Tissue, Producing Pathological Changes) 35.7 Injuries from Lightning 35.8 Recognition and Treatment of Lightning Injuries 35.9 Prevention of Injury 35.10 Controversies in Lightning Injury 35.11 Conclusion Chapter 36: Ball Lightning 36.1 Incidence 36.2 Properties Observed 3 6.3 Ball Lightning Associated with Man-Made Electric Power Sources 3 6.4 Experimentally Produced Ball Lightning 36.5 Types of Ball Lightning 36.6 Reported Injuries from Ball Lightning 36.7 Conclusions Chapter 37: Electric Fences 37.1 Grounding 37.2 Sparks from Electric Fences 37.3 Fence Controllers with Continuous AC Output 37.4 Respiratory Arrest and Death from Continuous AC Fence Current Chapter 38: Microwave Oven Injuries 38.1 Nerve Injury from Microwave Radiation 38.2 Steam Burns 38.3 Burns from Microwave Energy 38.4 Case Reports of Children Put in Microwave Ovens 38.5 Exploding Eggs and Eye Injury 38.6 Investigation and Treatment of Possible Microwave Burns Chapter 39: Overhead Power Line Contact 39.1 Nature and Significance of the Problem 39.2 General Features of High-Voltage Burns: Results of a Representative Study 39.3 Fatality with Minimal Signs of Injury 39.4 Ground Faults 39.5 Case Examples Chapter 40: Startle Reactions and Reflex Movements from Man-Made and Static Electricity 40.1 Startle Reactions and Reflex Movements Lead to Mechanical Trauma 40.2 Strong Muscle Contraction from Nerve or Muscle Stimulation 40.3 Reflex Reactions to Pain 40.4 The Trigemino-Cervical Reflex Protects the Face 40.5 Direct and Alternating Current 40.6 Startle Reactions 40.7 High-Voltage Power Sources 40.8 Static Electricity 40.9 Published Descriptions of Involuntary Reactions to Electric Current 40.10 Conclusions Chapter 41: Electric Shock Drowning 41.1 A Tragic Story that Repeats 41.2 Voltage Gradients 41.3 Bonding Systems in Boats 41.4 Ground Faults 41.5 Swimming Pools 41.6 Body Resistance 41.7 Electric Shock Drowning Incidents in Marinas Chapter 42: TASER(r) Electronic Control Devices 42.1 Some Basic Questions 42.2 Glossary of TASER-Related Terms 42.3 Cardiac Rhythm Glossary 42.4 Relevant Electrical Principles 42.5 How the ECD Indirectly Captures Muscles 42.6 Why TASER ECDs Do Not Cause Lethal Cardiac Rhythms 42.7 The TASER ECD Cannot Cause Cardiac Electroporation 42.8 The TASER ECD Cannot Cause Cardiac or Remote Burns 42.9 Lethal Fainting or Vasovagal Reaction 42.10 Emotional Stress as an Indirect Cause of Cardiac Arrest 42.11 No Increased Risk From Multiple Devices 42.12 Pacemakers and Implantable Defibrillators 42.13 The TASER ECD Does Not Harm Other Organs 42.14 Why Do Some People Die While Being Taken into Custody? 42.15 Anti-Police Organization Fund-Raising "Studies" are Junk Science 42.16 Epidemiology Chapter 43: Forensic Perspectives in Electrical Fatality Cases: Guidelines for Investigators 43.1 Forensic Evidence 43.2 Forensic Investigation Guidelines: Electrocution Fatality Cases Chapter 44: Accident Reconstruction in Electrical Injury Cases 44.1 Physiology and Accident Reconstruction 44.2 Tasks in Electrical Injury Accident Reconstruction 44.3 Case Examples 44.4 Conclusions Chapter 45: Conscious Awareness During Fatal Electric Injury 45.1 Immediate Cardiac and Respiratory Effects of Various Amounts of Current 45.2 Mechanisms of Death 45.3 Cardiac Arrest 45.4 Consciousness and Awareness during Cardiac Arrest 45.5 Respiratory Arrest 45.6 Absence of Burns in Fatal Electric Injury 45.7 Conclusions Chapter 46: Understanding the Information in Medical Records 46.1 The Importance of Medical Record Information 46.2 Difficulties in Obtaining Information 46.3 Information That Cannot Be Used 46.4 Sources of Information 46.5 History of an Accident 46.6 The Mechanism of Injury 46.7 Time Factors 46.8 Vital Signs 46.9 Preliminary Reports 46.10 Who Sees What 46.11 The Methodology of Medical Diagnosis 46.12 Misleading Test Results 46.13 Death Certificates and Autopsy Reports 46.14 Conclusion Chapter 47: Researching the Medical Literature 47.1 PubMed Searches 47.2 Search Issues 47.3 Medical Literature Limitations 47.4 Conclusions Chapter 48: Determining if an Electrical Accident is the Etiology of a Medical Condition 48.1 A Previous Evaluation Protocol 48.2 Modifying the Protocol 48.3 Determination of Medical Etiology 48.4 Epidemiological Studies Are Not Likely to Be Done 48.5 Autopsy-Related Considerations Chapter 49: Illustrative Case Examples 49.1 Non-Accidental Electrical Injuries 49.2 The GFCI (Ground Fault Circuit Interrupter) 49.3 Touching of Plug Prongs, Moisture, Failure to Use GFCI and Delayed CPR Contribute to a Death 49.4 Talking after Fatal Electrocution, Current Path through Shoes, Straightening of Body with Hand-to-Foot Current Path, Ambulance Diverted from Hospital to Morgue 49.5 Need for GFCI Near Water