Electrical Injury

The amount of injury depends on following factors – – – – – – – Type of current Voltage Frequency Resistance of the tissues involved Resistance at the points of body contact Path of the current through the body Duration of contact

Clinical features – Immediate effect: • – Loss of Consciousness, Visual Disturbance, tinnitus, deafness, convulsion, amnesia

Local effect of the curent • Burns, Gangrene, rhabdomyolysis, neuropathies

Secondary neuropsychiatric manifestations

Cause of death– – – – – Treatment • • • • Free from current ABC/ CPR 48 hr ICU monitoring Adequate hydration VF Failure of resp centre Tetanic spasm Renal failure sepsis

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Wound debridement HAEMODIALYSIS- ARF, Hyperkalemia,

Lightening • Immediate Effect – • LOC, Asystole, (No convulsion)

Secondary Effect – Paralysis, occular palsies, optic atrophy, amnesia, Psychological

Residual deficits – Stroke, TM rupture causing deafness

Cutaneous Injuries- “Lichtenbeg figures”

Prevention – – – Treatment – Supportive Avoid direct strike Discard Metals No wires

Radiation Injury • • All human beings are constantly exposed to ionizing radiation. Environmental sources
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Cosmic radiation From ground From inhaled and ingested material

~28 mrem / yr ~26 mrem / yr ~27 mrem / yr

Common man-made sources of radiation – – – – X-ray Nuclear weapons Radioactive medications / Radiotherapy Mines

Types of Ionizing Radiation • Electromagnetic – • X-ray, gamma ray

Particulate – Electron, proton, neutron, Alpha particle,

Biologic effects of Radiation •

To kill a cell Radiation must produce double-strand breaks in the DNA Interaction with water generate free radicals → damage cell membranes, proteins and organelles Mutation causing cancerous growth Bone – most radio-resistant organ. Testis, ovary and bone marrow are the most sensitive organs.

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Effect of Radiation

CNS- subacute CNS reaction – – – – Transient demyelination of Spinal cord Mild encephalopathy Post-irradiation brain necrosis Tr mtelitis

Skin– – ~2 wks Erythema followed by desquamation Chr reaction 6-12 m atrophic, interstitial fibrosis and telangiectasia, hyperpigmentation

Heart and blood vessels– – – – Acute pericarditis, pericardial effusion Constrictive pericarditis Peri/ myo/ endocardial fibrosis increase risk of MI

Lung– – radiation pneumonitis Lung fibrosis

GIT– – – Acute Gastritis, AGE Chr radiation enteropathy Fibrosis, perforation, fistula formation, stenosis

U bladder– – – – symptoms starts after 3 to 6 wks Subside in 3 to 4 wks Acute cystitis-Increased frequency and dysuria Late- Fibrosis

Testes and ovaries

Acute Toxicity (Acute Radiation Sickness)

Manifests as three major groups of sign and symptom Hematopoietic; GIT; Neurovascular 4 major stages of ARS • • • • Prodrome: Minutes to 4 days Latent phase: Minimal or No symptoms, last 2.5-6 wk Illness: Recovery/Death

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Acute total body irradiation • Prodromal radiation syndrome – – – – Cerebrovascular syndrome >100 Gy, death usually in 24 to 48 hrs Gastrointestinal syndrome 5 to 12 Gy, death in days

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Hematopoietic syndrome 2 to 8 Gy, death occurs in 2 to 4 weeks

Chronic toxicity – – – – – – thyroid failure, cataract, retinal damage Decrease saliva, dental caries, poor dentition Loss of taste and smell Con pericarditis, increase risk of MI Lung fibrosis, viscus stricture, radiation enteritis Tumors 1%/yr beginning in the second decade after treatment

Treatment Of ARS: – – – – – – Supportive- give Damaged organs the chance of recovery BT, Tx of infection and neutropenia Partial or total parenteral nutrition Standard therapy for trauma Psychological support

Radionuclide Decontamination 1. GIT clearance 2. Blocking agents 3. Iluting agents 4. Mobilizing agents 5. Chelating agents Radiation induced cancers
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Neck Irradiation Cranial Irradiation Breast irradiation

-Thyroid ca -CNS tumors -Breast Ca

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Uranium mining Radium dial painter In utero exposure

-Ca lung -Bone sarcomas -Leukemia