Skip to main content
Log in

Elektrotrauma

Besonderheiten und Behandlung

Electrical trauma

Characteristics and treatment

  • Standards in der Unfallchirurgie
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Eine Unterteilung der Elektrotraumen in Nieder- und Hochspannungsunfälle ist sinnvoll. Während bei Ersteren (<1000 V) die Herzrhythmusstörungen im Vordergrund stehen, wird das Ausmaß der Schädigung durch einen Hochspannungsunfall (>1000 V) oft unterschätzt. Bei diesem führt der Stromfluss häufig direkt durch den Körper, sodass das wahre Ausmaß der Schädigung von außen nicht sichtbar ist. So kommt zu der Brandverletzung an der Oberfläche der in der Tiefe gesetzte Schaden mit Muskelnekrosen, Verletzung von Nerven und Gefäßen, gelegentlich auch Schädigung innerer Organe hinzu. Die Lokalisation der tiefen Muskelnekrosen kann dabei erhebliche diagnostische Schwierigkeiten bereiten. Mosaikartige Muster — bestehend aus Muskelnekrosen umgeben von gesunder Muskulatur — können sich zeitlich deutlich verzögert demarkieren, sodass ein mehrzeitiges operatives Vorgehen mit radikalem Débridement erforderlich wird. In Einzelfällen ist bei ausgedehntem Gewebeschaden eine frühzeitige Indikation zur Extremitätenamputation als lebenserhaltende Maßnahme zu stellen. Aufgrund der Komplexität der Verletzung müssen Starkstromverletzte in einem Zentrum für Schwerbrandverletzte behandelt werden.

Abstract

Classification of electrical traumata into subgroups of accidents involving either low or high voltage is judicious. While in the first instance (<1000 V) arrhythmias are conspicuous, the extent of damage caused by a high-voltage accident (>1000 V) is often underestimated. In this case the current flow passes directly through the body so that the actual extent of the damage is not visible from the outside. Thus, the burn injury on the surface is joined by the internal damage in the form of muscle necroses, injury to nerves and tissues, and sometimes even damage to the inner organs. Identifying the site of the deep muscle necrosis can pose considerable difficulty in the diagnosis. Mosaic-like patterns — consisting of muscle necroses surrounded by healthy musculature — can become demarcated with substantial delay necessitating a multistage surgical approach with radical débridement. In individual cases when tissue damage is extensive, early indication for amputation of the extremity is a life-preserving measure. Due to the complexity of the injury, victims of high-voltage trauma must be treated in a specialized burn center.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5a,b

Literatur

  1. Arnoldo BD, Purdue GF, Kowalske K et al. (2004) Electrical injuries: a 20 year review. J Burn Care Rehabil 25: 479–484

    Google Scholar 

  2. Arrowsmith J, Usgaocar RP, Dickinson WA (1997) Electrical injury and the frequence of cardiac complications. Burns 23: 576–578

    Google Scholar 

  3. Baumeister S, Koller M, Dragu A et al. (2005) Principles of microvascular reconstruction in burn and electrical burn injuries. Burns 31: 92–98

    Google Scholar 

  4. Baxter ChR (1970) Present concepts in the management of major electrical injury. Surg Clin Am 50: 1402–1418

    Google Scholar 

  5. Büttemeyer R (2002) Das Elektrotrauma. Handbuch der Verbrennungstherapie. Landsberg, ecomed, 5.2: 464–474

  6. Büttemeyer R, Bruck JC, Plogmeier K (1970) Hautersatz nach Elektroverbrennungen. Langenbecks Arch Chir 1970: 628–631

    Google Scholar 

  7. Carter EA, Tompkins RG, Hsu H et al. (1997) Metabolic alterations in muscle of thermally injured rabbits, measured by positron emission tomography. Life Sci 61: 39–44

    Google Scholar 

  8. Cole L, Bellomo R, Davenport P et al. (2004) Cytokine removal during continuous renal replacement therapy: an ex vivo comparison of convection and diffusion. Int J Artif Org 27: 388–397

    Google Scholar 

  9. Di Vincenti F, Moncrief JA, Pruitt BA Jr (1969) Electrical injuries: a review of 65 cases. J Trauma 9: 497–507

    Google Scholar 

  10. Hamumadass ML, Voora SB, Kaga RJ et al. (1986) Acute electrical burns: 10-year clinical experience. Burns 12: 427–431

    Google Scholar 

  11. Holliman CJ, Saffle JR, Kravitz M et al. (1982) Early surgical decompression in the management of electrical injuries. Am J Surg 144: 733–739

    Google Scholar 

  12. Hülsbergen-Krüger S, Pitzler D, Partecke B-D (1995) Hochspannungsunfälle, Besonderheiten und Behandlung. Unfallchirurg 98: 218–223

    Google Scholar 

  13. Hunt JL, Mason AD, Masterson T et al. (1976) The pathophysiology of acute electric injuries. J Trauma 16: 335–340

    Google Scholar 

  14. Hussmann J, Kucan JO, Russell RC et al. (1995) Electrical injuries — morbidity, outcome and treatment rationale. Burns 21: 530–535

    Google Scholar 

  15. Hussmann J, Zamboni WA, Russell RC (1995) A model for recording the microcirculatory changes associated with standardized electrical injury of skeletal muscle. J Surg Res 59: 725–732

    Google Scholar 

  16. Jiang F, Xu T (2000) Morphological changes in canine heart after electrical injury. Chin J Burns 16: 334–335

    Google Scholar 

  17. Kulier A, Kiesling A, Semu J (1990) Hämofiltration bei akutem Nierenversagen; Erfahrungen einer operativen Intensivstation. Anästhesist 39: 540–546

  18. Lee RC, Camady DY, Hammer SM (1993) Transient and stable ionic permeabilization of isolated skeletal muscle cells after electrical shock. J Burn Care Rehabil 14: 528–540

    Google Scholar 

  19. Lee JW, Jang YC, Oh SJ (2004) Paediatric electrical burn: outlet injury caused by steel chopstick misuse. Burns 30: 244–247

    Google Scholar 

  20. Le Orme RM, Pigott DW, Mihm FG (2004) Measurement of cardiac output by transpulmonary arterial thermodilution using a long radial artery catheter. A comparison with intermittent pulmonary artery thermodilution. Anaesthesia 59: 590–594

    Google Scholar 

  21. Martinez JA, Nguyen T (200) Electrical injury. South Med J 93: 1165–1168

    Google Scholar 

  22. Mutlu FM, Dumann H, Cil Y (2004) Early-onset unilateral electric cataract: a rare clinical entity. J Burn Care Rehabil 25: 363–365

    Google Scholar 

  23. Ohashi M, Koizumi J, Hosada Y et al. (1998) Correlation between magnetic resonance imaging and histopathology of an amputated forearm after an electrical injury. Burns 24: 362–368

    Google Scholar 

  24. Petty PG, Parkin G (1986) Electrical injuries in children. J Dis Child 137: 231–235

    Google Scholar 

  25. Skoog T (1970) Electrical injuries. J Trauma 10: 816–830

    Google Scholar 

  26. Spilker G, Horch RE (2004) Correlation between serum creatinine kinase levels and extent of muscle damage in electrical burns. Burns 30: 680–683

    Google Scholar 

  27. Thomson JC, Ashwal S (1983) Electrical injuries in children. J Dis Child 137: 231–235

    Google Scholar 

  28. Wong L, Spencer RJ (200) Escharotomy and fasciotomy of the burned upper extremity. Hand Clin 16: 165–174

    Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. Möller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Möller, M., Bisgwa, F. & Partecke, B.D. Elektrotrauma. Trauma Berufskrankh 7, 310–313 (2005). https://doi.org/10.1007/s10039-005-1028-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10039-005-1028-4

Schlüsselwörter

Keywords

Navigation