Keyloun John W, Travis Taryn E, Johnson Laura S, Shupp Jeffrey W
Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA; The Burn Center, MedStar Washington Hospital Center, Washington, DC, USA; Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA.
Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA; The Burn Center, MedStar Washington Hospital Center, Washington, DC, USA; Departments of Surgery and Biochemistry, Georgetown University School of Medicine, Washington, DC, USA.
Int J Surg Case Rep. 2020;77:357-361. doi: 10.1016/j.ijscr.2020.10.139. Epub 2020 Nov 4.
Electrical injuries comprise a minority of burn center admissions but are associated with significant morbidity and mortality. This is a case of a patient who suffered high-voltage electrical injury who survived despite developing several sequalae, who had an unusual presentation of inhalation injury complicated by the aspiration of metal screws.
This is a 20-year-old male who suffered electrical contact injury, and 45.5% total body surface area (TBSA) burns from electrothermal discharge and subsequent ignition of clothing, whose hospital course was complicated by rhabdomyolysis, compartment syndrome, renal failure, and inhalation injury. After cardiac arrest with successful defibrillation and intubation in the field, he was found to have metallic foreign bodies in his airway. Metal screws were retrieved using rigid bronchoscopy and lower extremity escharotomy was performed for compartment syndrome. He was placed on renal replacement therapy for persistent acidosis and severe rhabdomyolysis. On post-burn day (PBD) 3 he developed severe hypoxia and bronchoscopy showed evidence of inhalation injury. This was treated with protocolized nebulizer treatments, prone-positioning, early tracheostomy, and frequent bronchoscopy. Over his hospital course he required lower extremity amputation and numerous excision and grafting procedures. Ultimately, he exhibited renal and respiratory recovery. He was discharged on PBD 75 to a rehabilitation hospital.
This case highlights that electrical injuries are associated with serious sequelae that can be overt or occult. Clinicians must maintain a high index of suspicion for comorbid conditions with electrically injured patients given variable presentations and the need for prompt, aggressive, and complex management.
电击伤在烧伤中心收治的病例中占少数，但却与显著的发病率和死亡率相关。本文报道了一例高压电击伤患者，尽管出现了多种后遗症，但仍存活下来，该患者吸入性损伤的表现不寻常，且伴有金属螺丝钉误吸。
这是一名20岁男性，因电接触伤以及电热放电和随后衣物着火导致全身45.5%体表面积（TBSA）烧伤，其住院过程因横纹肌溶解、骨筋膜室综合征、肾衰竭和吸入性损伤而复杂化。在现场心脏骤停后成功除颤和插管，发现他气道内有金属异物。使用硬支气管镜取出金属螺丝钉，并对下肢进行了焦痂切开术以治疗骨筋膜室综合征。因持续酸中毒和严重横纹肌溶解，他接受了肾脏替代治疗。烧伤后第3天（PBD 3），他出现严重缺氧，支气管镜检查显示有吸入性损伤的证据。通过标准化的雾化治疗、俯卧位、早期气管切开和频繁的支气管镜检查进行治疗。在整个住院过程中，他需要进行下肢截肢以及多次切除和植皮手术。最终，他的肾脏和呼吸功能得以恢复。他于烧伤后第75天出院，转至康复医院。
本病例突出表明，电击伤会伴有严重的后遗症，这些后遗症可能明显或隐匿。鉴于临床表现多样，且需要迅速、积极和复杂的治疗，临床医生对电击伤患者的合并症必须保持高度的怀疑指数。
