Mary Capelli-Schellpfeffer

Neuropsychological Symptom Presentation after Electrical Injury

OBJECTIVE This study explored the relationship of neuropsychological complaints to accident- and injury-related characteristics, affective state, and work status in a group of electrical injury (EI) patients. METHODS Sixty-three EI patients and 22 electricians with no history of electrical shock completed the Neuropsychological Symptom Checklist and the Beck Depression Inventory as part of an extensive neuropsychological evaluation. RESULTS The EI group endorsed significantly more physical, cognitive, and emotional symptoms than did the controls. Symptom complaints were not related to injury parameters or litigation status. Only the time interval between injury and assessment accounted for differences in symptom presentation, with patients in the postacute stages of recovery showing the most cognitive and emotional complaints. CONCLUSION The neuropsychological syndrome of electrical injury survival includes physical, cognitive, and emotional complaints. Considering that most electrically injured patients are treated within the acute medical setting, greater attention needs to be directed early in the course of treatment toward addressing neuropsychologic and psychiatric issues.

The Neuropsychological Effects of Electrical Injury: New Insights

Although electricity has been used for commercial purposes since the 19th century, surprisingly little is known about the pathogenesis of neuropsychological and psychiatric changes following electrical injury (EI). As first noted in our review of this area, there primarily have been single case studies and retrospective investigations of EI patients that have been limited by small sample sizes, lack of appropriate control group comparisons, nonrandom selection procedures, and methodological variability.1 Yet, these studies seem to suggest that EI patients can have diverse clinical presentations in both type of symptoms (i.e., ranging from significant cognitive and/or emotional) and time of onset (i.e., immediate vs. delayed). Since our review of the neuropsychological effects of electrical injury first published in this book series in 1994, several new case reports have appeared in the literature that have documented posttraumatic stress disorder following electric shock2 and the presence of parasomnia as a neuropsychiatric complication of electrical injury.3 Additionally, one study surveyed a large support group of lightning and electrical injury survivors for behavioral symptoms4 and several retrospective neuropsychological studies have been published by a group of University of Iowa neuroscientists based on their series of electrical injury patients.5,6 Unfortunately, in our view, the critical factors that influence the neurocognitive and psychiatric consequences of exposure to electricity have not been clearly identified. However, many assumptions about EI are made by mental health professionals despite the lack of empirical evidence. These assumptions include the following: (1) the worse the visible burn, the worse the psychological difficulties that someone will have; (2) low voltage exposures will not cause significant neuropsychological problems; (3) EI patients who experience changes are not premorbidly psychologically stable; or (4) electrically injured patients are faking their difficulties for secondary gain. The purpose of this article is to summarize the new insights gained into the neuropsychological effects of electrical injury based on a series of studies conducted by the University of Chicago Electrical Trauma Program over the past five years,7–11 emphasizing that much more work still needs to be done. The goals of our research program continue to be the clarification of the central nervous system effects of electrical injury as reflected by postinjury neurocognitive and psychiatric functioning as

Advances in the evaluation and treatment of electrical and thermal injury emergencies

Advances in the evaluation and treatment of electrical and thermal injuries suggest that the mechanism of injury in electrical trauma is more complex than once thought. Thermal and nonthermal tissue damage can cause extensive destruction which may result in amputation rates as high as 65 percent for accident survivors. This paper discusses the terminology around electrical trauma and reviews current understanding of the mechanisms of injury when an employee is exposed to electrical hazards. Building on the classical analysis of electrical arc blast burns, the use of burn models as predictors of injury is considered. Finally, electrical injury concepts and their implications for treatment in the emergency and hospital settings are presented.<<ETX>>

Correlation between electrical accident parameters and sustained injury

While there has been a substantial reduction in major electrical injuries as a result of safe work practice guidelines and engineering advances, considerable improvement is still possible to reduce the incidence and severity of electrical trauma. Here the correlation of how an electrical accident occurs, the exposures at the accident scene and the possible injuries and outcomes provides information to support consideration of safe work practices.

Radiotracers for Imaging Electroporationa

Radiotracer imaging can be used to assess the extent of soft tissue damage in victims of electrical trauma; for over 20 years, this has been done.1–5 Radiotracer imaging can also be used with in vivo animal models to develop methods for the investigation of electrical injury and for the assessment of therapeutic agents for electrical injuries. We have applied radiotracer imaging techniques involving a high-resolution small-field-of-view gamma camera to the in vivo study of electrical injury. Specifically, we have used radiotracer imaging and an animal model of electroporation injury in skeletal muscle to examine the effects of novel therapies for the treatment of the electroporation component of electrical injury. Detailed here is our investigation of four radiotracers that might be used for assessment of such therapies.

Management and Coordination of Postacute Medical Care for Electrical Trauma Survivors

ABSTRACT: The clinical spectrum of electrical injury ranges from the absence of any external physical signs to severe multiple trauma. Reported neuropsychiatric sequelae can vary from vague complaints, which may seem unrelated to the injury in their occurrence over time or by their apparent severity, to sequelae consistent with brain injury accompanying an electrical trauma. In this report, a case study and discussion are presented on the management and coordination of postacute care of an electrical trauma survivor. Expertise and a multi‐disciplinary team are essential to cohesive patient care. Patient monitoring for progressive changes and prompt intervention are needed to address the potential difficulties experienced by trauma survivors as they rehabilitate to return to their work and their activities of daily living.

Signaling Safety [Electrical Safety]

A red light indicates “stop” at a busy intersection, “alert” on amotor control monitor, or “now charging” for a mobile telephone plugged into a power source. The light triggers an electrochemical reaction in our eye, initiating an event cascade that ultimately transmits electrical forces through our nervous system to our brain.

Engineering the art of safety [Electrical Safety]

Based on the 2007 edition of the National Electrical Safety Code (NESC), utilities and contractors are acting to comply with new work rules that become effective 1 January 2009. The standard, approved by the American National Standards Institute on 16 June 2006, is applicable across the United States for the construction, operation, and maintenance of electric supply and communication lines.

Partnerships for electrical safety

The authors present a case study of the successful development of an educational partnership between industrial collaborators and university researchers to promote electrical safety. For industrial and academic organisations considering a similar approach, we identify a development methodology to align people and resources to implement electrical safety education. Educational partnerships offer a bridge to speed the movement of technologies and concepts between different communities like those represented by a plant and a local hospital. This case study reviews the development of a direct RD to identify the best process and best practice; to facilitate the availability of the best care/treatment for those injured on the job through rapid technology transfer; and to specifically move electrical safety principles to a higher level of awareness for individuals, their workplaces, and their communities.

Current research in radiotracer imaging of electroporation injury

High-voltage electrical shock can produce minimal external signs of damage with widespread damage to the skeletal muscle. The injury can be thermally mediated or the result of electroporation of cell membranes. Radiotracer imaging is one method for assessing the extent of damage in skeletal muscle. The authors are using radiotracer imaging in an in vivo animal model to investigate the effects of novel therapies, such as surfactants, for repairing electroporation damage. In this work, the authors report the results of region-of-interest (ROI) analysis and principal component analysis (PCA) of the data collected from the animal model. These analytical methods may provide a tool to assist in clinical monitoring of electrical injury victims.