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The clinical picture is caused by predominant damage to the heart, brain and spinal cord, parenchymal organs, burns. Oppression of consciousness varying degrees, convulsive contractions of individual muscle groups, often turning into generalized convulsions. Respiratory and circulatory disorders up to the development terminal state. Skin lesions of varying size and severity (up to charring).

First aid

Immediately release the victim from the effects of electric current: turn off the switch, unscrew the fuse, cut the wires with an ax (shovel) with a wooden handle, pull the victim by dry clothes, having first secured yourself (stand on a dry board or rubber). In case of cardiac and respiratory arrest - indirect massage heart, mechanical ventilation using the mouth-to-mouth method.

First aid

In addition to first aid measures - subcutaneously 1 ml of a 1% solution of morphine or 2 ml of a 2% solution of promedol (omnopon), 0.5-1 ml of a 0.1% solution of atropine.

Medical emergency care

Medical station

If breathing and blood circulation are preserved, provide assistance as in case of collapse or acute heart failure. If breathing stops (typical of high-voltage direct current injury), perform mechanical ventilation. In case of cardiac arrest or fibrillation - indirect cardiac massage in combination with mechanical ventilation. Evacuation to a hospital (medical hospital) by ambulance, lying on a stretcher, accompanied by a doctor or paramedic.

Electrical injury is damage caused by exposure to electric current on the body. It can occur through direct body contact with an electrical source or through arc contact when a person is close to the source but does not touch it. It has been established that at voltages up to 450–500 V, alternating current is more dangerous, and at higher voltages, direct current is more dangerous. Electric current, spreading through the tissues of the human body from the point of entry to the point of exit, forms a “current loop”. The least dangerous is the bottom loop (from leg to leg), the more dangerous is the top loop (from arm to arm), and the most dangerous is the full loop (both arms and both legs).

Electric current passing through the heart can cause severe violations cardiac activity.

Local lesions tissues during electrical trauma appear in the form of “current signs” mainly at the points of entry and exit of current, where electrical energy goes into heat. The higher the electrical voltage, the more severe the burns. A voltage above 36 V and a current strength of more than 0.1 A are considered dangerous for humans (a current strength of 0.5 A is lethal). How more water contain fabrics, the less resistance they have. Lowest resistance blood vessels and muscles (about 1.5 kOhm/cm2). The skin has the maximum resistance. At the same time important has its moisture content: dry skin has a resistance of up to 1000–2000 kOhm/cm2,

and wet - only 200–500 kOhm/cm2

Deep burns occur at voltages above 380 V

Electrical burns are divided according to the depth of damage:

First degree burns - areas of coagulation of the epidermis are formed;

Second degree burns - detachment of the epidermis occurs with the formation of blisters;

Burns III degree- coagulation of the entire thickness of the dermis occurs;

IV degree burns - the dermis, tendons, muscles, blood vessels, nerves, and bones are affected.

Electrical Trauma Clinic

The victim complains about burning pain, convulsive muscle contraction. After the current stops, weakness, a feeling of heaviness, fear, depression or excitement of consciousness occur.

Clinical picture due to the severity of the electrical injury. Changes in the cardiovascular, respiratory and central nervous system.

There are four degrees general reaction body to electrical trauma:

I - convulsive muscle contraction without loss of consciousness;

II - convulsive muscle contraction with loss of consciousness;

III - convulsive muscle contraction with loss of consciousness and impaired cardiac activity or breathing;

IV - clinical death.

With a general reaction of degrees I and II, symptoms of increased intracranial pressure, neurological and mental disorders. In a third degree reaction, dullness of heart sounds, weakening of the pulse, tachycardia, and sometimes arrhythmia are observed.

More severe and persistent changes are observed after high-voltage injury cardiovascular systems s (extrasystole, increased blood pressure, systolic murmur, diffuse or focal changes in the myocardium).

Disruption of the processes of membrane polarization, formation and conduction of the action potential in the conduction system of the heart leads to changes in conductivity, disruption of the rhythm of contractions up to

ventricular fibrillation, which corresponds to the cessation of blood circulation and the onset of clinical death.

Electrical burns of the head are accompanied by changes in the outer and sometimes inner plate of the bones of the cranial vault. Damage to the brain and the entire nervous system can lead to severe disorders of its function (spasms of the muscles of the larynx and respiratory muscles, convulsions, paresis and paralysis, visual impairment, etc.).

With convulsive contraction of muscles, their ruptures, as well as compression and avulsion fractures of bones, are possible. IN late period Possible development of liver and kidney failure.

Reason sudden death Electric shock causes ventricular fibrillation, asystole and respiratory arrest.

Death may not occur immediately, but several hours after the injury.

In some cases, the so-called “imaginary death” develops - a condition in which there is no consciousness, heart contractions are rare and difficult to detect, breathing is shallow and rare. This condition is not clinical death, and the observed symptoms can be restored even after a long period of time. In case of electrical injury, it is customary to provide assistance until the appearance of cadaveric spots and rigor mortis.

Possible after electrical injury asthenic conditions, in which psychogenic symptoms are often observed. Differentiation of these syndromes, sometimes externally similar, requires a detailed clinical examination.

First aid for electrical injury. Emergency assistance to a victim of electric shock involves quickly taking the following measures.

It should be remembered that you can touch the victim only after turning off the power electrical network or in a special isolation suit (rubber gloves and rubber boots), otherwise the first aid provider may receive an electric shock. For safety, it is recommended to remove the wires from the victim’s body with a dry wooden stick and pull the body away by grabbing it by the edges of the clothing.

If the victim has signs of clinical death, carry out artificial ventilation lungs, indoor massage heart and defibrillation.

1. Deliver the patient to a hospital (emergency hospital, burn center). Treatment of electrical trauma is carried out in accordance with the depth and nature of tissue damage.

2. If breathing stops, carry out artificial respiration(mouth to mouth or mouth to nose), administer cardiac and cardiovascular drugs (0.1% solution of adrenaline - 1 ml, 10% solution of caffeine sodium benzoate - 1 ml subcutaneously), respiratory stimulants (1% solution of lobeline hydrochloride, 1 ml intravenously slowly or intramuscularly).

3. In case of sudden excitation of the central nervous system, sedatives are prescribed.

4. If intracranial pressure increases, dehydration therapy and sometimes spinal puncture are performed.

5. When functional disorders nervous system are prescribed sleeping pills.

6. To accelerate the rejection of necrotic tissue in small-area burns, baths with a solution of potassium permanganate (1:1000), UV irradiation, and balsamic oil dressings are recommended.

7. Rehabilitation treatment electrical injuries include, according to indications, massage, exercise therapy, physiotherapeutic procedures, etc.

General overheating of the body. Thermal and sunstroke. Clinic, urgent Care on prehospital stage.

Sunstroke is defined as a pathological syndrome manifested by damage to the central nervous system during long-term exposure direct sun rays to the head area.

Clinic. Headache, general malaise, dizziness, feeling of weakness, nausea, vomiting.

Objectively, facial hyperemia, shortness of breath, tachycardia, fever, profuse sweating. Sometimes nosebleeds, loss of consciousness, and convulsions may occur.

Urgent Care. The patient must be placed in the shade, in a cool room. Lay horizontally, legs raised. Unfasten your clothes and trouser belt. Sprinkle cold water on the face. Cool your head, for which you can use the cooling thermal pack available in a standard car first aid kit. Wipe off wet towel whole body. A good effect is achieved by inhaling ammonia vapor. If conscious, give cold water to drink. The issue of hospitalization is decided individually.

HEAT STROKE

Heatstroke is defined as a pathological syndrome that occurs as a result of exposure to external thermal factors or as a result of a violation of heat transfer.

Etiology. Prolonged stay in rooms with high temperature and high humidity, especially when performing heavy and prolonged physical work. Heatstroke due to impaired heat transfer is most often observed in children infancy as a result of excessive wrapping or in military personnel, long time wearing chemical protective suits.

Pathogenesis. The leading pathological changes are a disorder of water-electrolyte metabolism with subsequent disturbances in the macro- and microcirculation system.

Clinical picture and emergency care is similar to treatment measures for sunstroke.

Treatment in a hospital.

In the hospital, general and local warming continues. For this they can be used warm baths with a gradual increase in water temperature from 20 to 40 °C over 40 minutes. Warmed solutions of rheopolyglucin and glucose are administered intravenously.

Drugs that improve blood circulation and relieve vasospasm are used: nicotinic acid, papaverine, no-spa.

Antibiotics for the prevention of pneumonia.

Local treatment of frostbite depends on the depth of the lesion and is carried out according to the principles of treatment of burns.

Electrical injury- this is an electric shock or lightning discharge, accompanied by profound changes in the central nervous system, respiratory and cardiovascular systems in combination with local damage.

There are low voltage injuries and high voltage injuries.

Low voltage currents Typically used in household electrical appliances.

General effect of low voltage current consists of convulsive contraction of muscles, as a result of which the victim is unable to free himself from the source of tension.

Loss of consciousness, disturbances in cardiac activity and breathing may occur.

Local action low voltage current Brushes are usually exposed. The skin of the hands is often moist and becomes good conductors of electricity. Usually deep burns of Shb-1U degrees occur.

As a result of such a burn, you can lose your fingers.

Most life-threatening high voltage currents. Such injuries are possible when contacting wires carrying high voltage technical current, when entering transformer booths, when carrying out earthworks in the area where high voltage cables pass and in other places specially marked with a “high voltage” sign.

As a result general action high voltage currents death can occur instantly or several hours after the current stops.

The cause of death on the spot is most often: respiratory arrest or fibrillation (random contractions) of the ventricles of the heart.

Long-term causes of death may be electric shock, which develops against the background of depression of brain function or late violations cardiac activity arising against the background of myocardial hypoxia due to spasm coronary arteries(infarction-like changes).

Due to local exposure to high voltage victims lose limbs.

The severity of electrical injury can be:

- light, when convulsions were observed without loss of consciousness and without disturbances in breathing and cardiac activity;

- moderate severity, when, against the background of convulsions, there was a loss of consciousness, but without disturbances in breathing or cardiac activity;

- heavy, when, against the background of convulsions and loss of consciousness, respiratory and cardiac disturbances were noted;

- extremely severe when, under the influence of current, a state of clinical death instantly develops.

When examining victims, current entry and exit marks are found on the body.

Algorithm for emergency care for electrical injury. ( Rice. 15)

1. De-energize the victim, always observing personal safety precautions. You should protect yourself with non-conductive materials - rubber, dry wood, dry cotton clothing, several thick sheets of paper. Give the command to those around you to move to a safe distance. Turn off the switch or circuit breaker, cut the wire with an ax, knife or other sharp object, throw the exposed wire off the victim with a dry stick, and pull him away from the power source by his clothes. (Fig. 14)

2. In case of clinical death - basic cardiopulmonary resuscitation, oxygen therapy.

3. With extrasystole- lidocaine 2.% solution - 2 ml per 10 ml of 40% glucose solution intravenously at the rate of 1 mg of dry matter lidocaine per kilogram of body weight (one ampoule per 40 kg of patient’s body weight).

4. For convulsions, psychomotor agitation: seduxen (analogue 0.5% solution 2 ml intramuscularly (intravenously), or sodium hydroxybutyrate 20% solution 10 ml intravenously, or magnesium sulf, 25% solution 10 ml intramuscularly.

5. For hypotension - glucose 5% solution (reopolyglucin\ 400 ml with dopamine 0.5% solution 5 ml intravenous drip at a rate ensuring the maintenance of systolic blood pressure at the level of 100 mm Hg in a volume determined by the time of delivery to the hospital.

6. When anginal pain(angina) - nitroglycerin in tablets under the tongue, analgin.

7. To prevent cerebral edema - Lasix.

8. For electrical burns - aseptic dry dressings locally.

9. In case of extensive injuries to the limbs or their separation transport immobilization after temporary stop bleeding and application of aseptic dressings.

10. Warm the victim, cold to the head.

Tactical decision- delivery to the hospital on a stretcher lying down, under the control of the state of life support functions.

All victims who seek medical help must be transported to the hospital within 6 days. after electrical trauma, regardless of the presence and severity of pathological symptoms due to the danger of sudden development of late life-threatening conditions.

ELECTRICAL TRAUMA is understood as a complex of changes in the victim’s body when exposed to an electric field.

Depending on the character developing disorders It is customary to divide electric shock into local (electrical burns) and general (electrical trauma) symptoms. These disorders are very often combined.

LOCAL SYMPTOMS

The current signs that appear during electric shock are characterized by the following signs.

“There are usually small (up to 2-3 cm in diameter) areas of dry necrosis of a round or linear shape, and sometimes in the form of a conductor imprint. There is retraction in the center, the edges are raised. Hair is curled.

There is practically no hyperemia around.

¦No pain.

Metallization of the affected areas may occur due to the splashing of small particles of the conductor.

Electrical burns are almost always deep. Rejection continues for a long time, both due to the depth of the lesion and due to disruption of the blood supply as a result of spasm and thrombosis of blood vessels.

A complication of electrical burns is secondary tissue necrosis due to thrombosis of the great vessels up to the development of gangrene.

When struck by lightning, lightning marks are formed - tree-like branches and stripes of hyperemia on the skin (a consequence of damage to the walls of skin vessels - paralysis and stasis). They disappear after a few days.

GENERAL SYMPTOMS

The clinical picture is determined by the severity of the electrical injury. Changes in the cardiovascular, respiratory and central nervous systems prevail.

The heart rate is usually reduced (bradycardia), the pulse is tense, the heart sounds are muffled, and arrhythmia is possible. In severe cases, cardiac fibrillation develops with cessation of blood circulation.

Spastic damage to the muscles of the larynx and respiratory muscles leads to disruption of the rhythm and depth of breathing and to the development of asphyxia.

Disorders of the central nervous system manifest themselves in weakness, dizziness, blurred vision, fatigue, and sometimes agitation. The presence of paresis, paralysis and neuritis is characteristic. With convulsive contraction of muscles, their ruptures, as well as compression and avulsion fractures of bones, are possible. With severe lesions, loss of consciousness is noted. In the later period, insufficiency of liver and kidney function may develop.

Sudden death due to electric shock is caused by ventricular fibrillation and respiratory arrest. Death may not occur immediately, but several hours after the injury.

In some cases, the so-called “imaginary death” develops - a condition in which there is no consciousness, heart contractions are rare and difficult to determine, breathing is shallow and infrequent - that is, there is extreme depression of the basic vital functions. important functions. Despite the external similarity, this condition is not clinical death, and the observed symptoms may reverse development even after a fairly long period of time. Therefore, in case of electrical injury, it is customary to provide assistance (including resuscitation measures) until the appearance of cadaveric spots and rigor mortis.

In case of electrical injury great value has timeliness of events. The success of treatment is largely determined by the quality of first aid.

FIRST AID

When providing first aid, the following measures must be taken:

1. Stop exposure to electric current (free from contact with the current carrier). It should be remembered that you can touch the victim only after the electrical network has been de-energized or while wearing a special insulating suit (rubber gloves, etc.), otherwise the first aid provider may be electrocuted. For safety, it is recommended to throw the wires off the victim’s body with a wooden object (board) and pull the body away, holding it by the edges of the clothing.

2. Carry out resuscitation measures if there are indications for them (signs of clinical death).

3.Apply dry aseptic dressings to the burn area.

4. Deliver the patient to a hospital (emergency hospital, burn center).

LOCAL TREATMENT

Treatment of electrical trauma is carried out in accordance with the depth and nature of tissue damage. Necrosis most often develops, the peculiarity of which is prolonged rejection of the scab and low reparative abilities. Therefore, the method of choice is early necrectomy. Sometimes this operation is performed in several stages. If the limbs are charred, amputation may be performed.

After necrectomy, dressings with antiseptics and proteolytic enzymes are used.

Skin grafting is rarely performed, since extensive necrosis practically does not occur. It is usually produced in late dates, after complete rejection of necrotic tissue.

GENERAL TREATMENT

After providing first aid, careful monitoring of the patient is necessary; if shock develops, antishock therapy(pain relief, transfusion of blood replacement solutions, cardiac medications). Otherwise, treatment methods for electrical and thermal burns fundamentally similar.

Electrical trauma is a set of traumatic disorders that appear in the human body as a result of exposure to industrial, household or natural electric current. Electrical injury may have serious complications. In some cases it leads to death.

The main causes of electrical injuries in children and adults

Both children and adults can suffer electrical injury either as a result of exposure to electric current at home or at work, or from a lightning strike. Lightning damage should be considered as a natural, force majeure factor, from which a person cannot always protect himself. In other cases, electric shock injury occurs for the following main reasons:

1. Psychophysiological.
2. Technical.
3. Organizational.

Reasons related to the human psyche and physiology include weakening of attention, stressful situation, excessive fatigue, health status of an adult or child, a person being under the influence of drugs or alcohol, and various other reasons.

Technical reasons mean:

Organizational causes of electrical injuries include:

• Negligence when handling live objects electrical installations when left without proper supervision.
• Neglect of basic safety rules as usual, everyday life, and in the workplace.
• Carrying out work on electrical equipment without first checking that there is no voltage on it.

People who deal with electricity professionally are the most likely to suffer electrical injuries!

These include electricians, assemblers of high-voltage structures, builders, and other specialist workers.

Electrical injuries usually occur when:

• Presence of dangerous electrical voltage and current.
• Features of the body and the specific health status of the victim.
• Environmental conditions.

Severity of electrical injuries

Depending on the nature of the injury, injuries may include:

• General , in which the current passes through the entire human body, so they suffer various groups muscles, convulsions, paralysis of the heart and breathing occur.
• Local when, as a result of a short circuit, the integrity of the skin and fabrics. The victim receives an electric shock.

According to the severity of injuries resulting from the action of electric current, they are divided into 4 degrees:

• For first degree injury The victim is conscious and exhibits the following symptoms:

When the impact of the traumatic factor stops, a person often begins to experience pain!

• Second degree characterized by loss of consciousness of the victim and severe tonic convulsions. At the same time blood pressure the patient has low, slight respiratory disorders. Often at this stage, cardiac arrhythmia already appears and shock occurs. The consequence of trauma can be memory loss.

• At the third stage The patient's condition can be described as severe with the following symptoms:

1. Severe respiratory distress and convulsions. Laryngospasm may occur.
2. Ruptures of blood vessels in the lungs.
3. Disruption of the heart and, as a consequence, the entire blood circulation. Blood pressure drops significantly, the rhythm of cardiac activity is disturbed.
4. Damage to internal parenchymal organs up to the appearance of necrotic foci in the liver, kidneys, lungs, spleen, as well as in the thyroid and pancreas.
5. Retinal detachment.
6. Edema of the brain and lungs.

At this stage, the patient may fall into a coma!

• Fourth degree - complete cessation of breathing as a result of paralysis respiratory center and ventricular fibrillation, leading to clinical death of the patient.

Respiratory paralysis is most common for injuries in which an electric current passes through a person's head!

There is also a division of electrical injuries, depending on the nature of the impact of the current, into:

• Instant when a person receives a very strong electrical discharge in a few seconds, exceeding the permissible level.
• Chronic . This type of injury is typical for people who have constant and long-term contact with sources high current. In a state of chronic electrical trauma, a person experiences memory and sleep disturbances, he often has a headache, he gets tired quickly, and experiences a feeling of persistent fatigue.

How is the disease diagnosed?

The characteristic signs that appear in him will help you understand that a person has suffered from an electric shock.

In case of a mild electrical injury, the victim experiences:

• Dizziness.
• Fainting.
• Impaired vision, smell and hearing.
• Frustration, lack of strength, or, conversely, an excited state.
• Neurotic reactions.

Severe electrical injury can be recognized by the following signs:

When injured by a lightning strike, the following symptoms are observed:

• Blindness.
• Temporary muteness and deafness.
• Feeling of fear.
• Headache.
• Photophobia.
• Cardiac and respiratory paralysis.
• "Imaginary" death.

The more serious the injury, the more pronounced the specific symptoms appear.

In some cases, electric shocks lead to instant death of the patient!

Providing emergency first aid for electrical injuries

• In order to competently help a person exposed to electric current, you must first take personal safety measures. They consist of wearing thick rubber shoes and gloves, since there may be a high voltage wire nearby that has fallen to the ground.

Do not come closer than ten meters to a live wire!

If there is no rubber uniform nearby, you can protect yourself in this way: start moving towards the victim in the so-called “duck step”. Steps should be very small, take them in such a way that the feet do not leave the ground, and during each next step the toe of one foot and the heel of the other were on the same line.

• Next, you should stop contacting the victim with the current source.

It should be remembered that water is an excellent conductor of electricity, and dry wood is an excellent insulating material!

To stop the electric discharge, you need to unplug the electrical cord from the outlet or turn off the switch. If this is not possible, you should throw the wire to the side with a long wooden or any non-metallic stick. You can cut or cut the electrical wire with an insulated tool.

If a person who is under voltage is on high altitude, before turning off the current, measures should be taken to ensure that the victim does not break if he falls!

• Then you need to drag the person who received the electrical injury away from the current zone by about 10-15 meters, holding him by the edges of his clothing.

Do not touch the exposed parts of the victim’s body!

• After this, you need to check whether the person is conscious and has breathing and a heartbeat. If they are absent, you must immediately begin giving the person indirect cardiac massage and artificial respiration.

You can start cardiopulmonary resuscitation only after making sure that the effect of the current on the human body has stopped!

If the victim did not lose consciousness, you need to give him any sedative, for example, Corvalol in the amount of 50-100 drops.

• Cold should be applied to the patient's head. In the cold season, it is enough to simply remove your hat.

• If there are wounds or burns on the body, they need to be bandaged with a clean, preferably sterile, cloth. If fractures are suspected, secure the limbs with splints.

First aid to the victim in the video:

Measures to maintain vital functions during burns

After rendering necessary assistance a person who has received an electrical injury of the 2nd, 3rd or 4th degree of severity should be immediately taken to a trauma center or surgical department hospital. There the patient will receive qualified medical care. In case of electrical injury of the 1st degree of severity, hospitalization is not always necessary.

Every person who has received an electrical injury must be vaccinated against tetanus!

Therapeutic inpatient care for a victim of electrical injury includes:

• Local treatment of burned areas of the body.
• General treatment aimed at maintaining and restoring all disturbed systems and functions of the body.

As a local anti-burn measure, sterile bandages soaked in disinfectant solutions are applied to the entry and exit points of electrical discharges.

Subsequently, burns on the skin are exposed to ultraviolet irradiation to facilitate the process of death of tissues susceptible to necrosis and accelerate the restoration of healthy epithelium. Patients are also prescribed baths with a solution of potassium permanganate, and medicinal regenerating bandages are applied to the burned areas.

If the resulting skin defect requires correction, the patient undergoes plastic surgery!

In parallel with local treatment burns are treated intensively infusion therapy to normalize cardiac activity and restore both central and peripheral hemodynamics. Doctors also prescribe anti-shock and oxygen therapy, sedatives and antihypertensive drugs to patients.

Basically, all drugs are introduced into the patient’s body through intravenous or intramuscular injections, and also through IVs!

On the first day, the amount of drugs administered intravenously, taking into account the severity of the shock, is from 30 to 80 milliliters per kilogram of the patient’s body weight. In this case, urination is monitored hourly. Normally, the victim should produce about 1.5 -2.0 ml/kg of urine.

On the second and third days, the volume of drugs infused by infusion is reduced by approximately 30 percent. Among other drugs, the victim must be given heparin, vitamins, painkillers and heart medications, drugs to reduce arrhythmia, antispasmodics and adrenergic blockers. The most commonly used electric shocks are:

If the patient has wounds in the skull and has experienced prolonged loss of consciousness, he requires enhanced dehydration therapy!

In the presence of lesions of the extremities, use nicotinic acid and papaverine with novocaine solution.

Amputation of limbs is done as a last resort - in case of irreversible tissue necrosis!

In case of electrical injury with deep lesions muscle fascia is often required surgery in the form of necrotomy, dissection and drainage of tissue.