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Oxford Textbook of Medicine$
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Oxford Textbook of Medicine (5 ed.)

Edited by David A. Warrell, Timothy M. Cox, John D. Firth

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Latest update

The November 2012 update sees updates to over 70 chapters, focusing on Neurology and Gastroenterology. This update also incorporates a selection of 29 Case Histories taken from related titles in the Oxford Case Histories series, linked to from related chapters. Each case includes several questions followed by detailed answers and discussion to enhance diagnostic and clinical understanding.

Neurology updates include substantial updates to key chapters and new material on a wide range of topics including spinal cord injury, autonomic nervous system disorders, and inherited neurodegenerative diseases. 

Gastroenterology updates include extensive revisions of key chapters on liver failure and acute pancreatitis and new material on a wide range of matters, ranging from the common to the rare: including surgical treatments for colonic diverticular disease, antibody tests for immune disorders, and a revised treatment algorithm for small bowel bacterial overgrowth.

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Publisher:
Oxford University Press
Print Publication Date:
May 2010
Print ISBN-13:
9780199204854
Published to Oxford Medicine:
May 2012
DOI:
10.1093/med/9780199204854.001.1

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Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Contents

Lightning and electrical injuries

Chapter:
Lightning and electrical injuries
Author(s):

Chris Andrews

DOI:
10.1093/med/9780199204854.003.090507

Lightning

Lightning strikes are rare accidents but carry a 10% case fatality, killing 0.1 to 0.3 per million population each year. During thunderstorms, the risk is increased by sheltering under trees or by being on open water, on tractors, or in open fields or golf courses.

Lightning causes instant asystole. It is suspected clinically if someone is found collapsed in the open with linear or feathered burns, exploded clothing, and ruptured eardrums. Victims are safe to handle, with most victims showing keraunoparalysis (cold, pulseless, mottled extremities). Immediate cardiopulmonary resuscitation (CPR) is mandatory. Survivors may develop complications including pain syndromes and psychological sequelae.

Electrocution

Electrocution is the fifth commonest cause of workplace death, mainly affecting utilities, mining, and construction labourers. Contact with power lines and power tools are the commonest causes, with metal ladders and antennae being particularly dangerous. Prevention is by implementing codes of safe practice.

Victims of electrocution may suffer prolonged attachment to the source of electric current and must be removed or disconnected from the source before resuscitation. Clinical presentations include (1) ventricular fibrillation, sometimes leading to persistent cardiac dysfunction; (2) neurological and muscular manifestations, both early and late, including paraesthesiae, pareses, and generalized convulsions, also tetanic spasm causing respiratory embarrassment and rhabdomyolysis; (3) burns, which may be severe and require expert surgical attention. Electroporation (cell membrane disruption) contributes to cell death; delineation using polaxamers may direct the extent of surgical debridement.

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