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An unusual presentation of inhalation injury in a patient with high voltage electrical injury: A case report.

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Citation: International Journal of Surgery Case Reports. 77:357-361, 2020 Nov 04.PMID: 33217653Institution: MedStar Health Research Institute | MedStar Washington Hospital CenterDepartment: Firefighters' Burn and Surgical Research Laboratory | Surgery/Burn ServicesForm of publication: Journal ArticleMedline article type(s): Case ReportsSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2020 ISSN:

2210-2612

Name of journal: International journal of surgery case reportsAbstract: 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: 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: 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. Copyright (c) 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.All authors: Johnson LS, Keyloun JW, Shupp JW, Travis TEFiscal year: FY2021Digital Object Identifier:

https://dx.doi.org/10.1016/j.ijscr.2020.10.139

Date added to catalog: 2020-12-31

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	33217653	Available		33217653

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: 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: 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. Copyright (c) 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

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