An unusual presentation of inhalation injury in a patient with high voltage electrical injury: A case report.
Burns
Case report
Compartment syndrome
Electrical injury
Foreign body aspiration
Inhalation injury
Journal
International journal of surgery case reports
ISSN: 2210-2612
Titre abrégé: Int J Surg Case Rep
Pays: Netherlands
ID NLM: 101529872
Informations de publication
Date de publication:
2020
2020
Historique:
received:
21
09
2020
revised:
28
10
2020
accepted:
29
10
2020
pubmed:
21
11
2020
medline:
21
11
2020
entrez:
20
11
2020
Statut:
ppublish
Résumé
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.
Sections du résumé
BACKGROUND
BACKGROUND
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.
CASE PRESENTATION
METHODS
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.
CONCLUSIONS
CONCLUSIONS
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.
Identifiants
pubmed: 33217653
pii: S2210-2612(20)31026-9
doi: 10.1016/j.ijscr.2020.10.139
pmc: PMC7683282
pii:
doi:
Types de publication
Case Reports
Langues
eng
Pagination
357-361Informations de copyright
Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.
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