Description

Abrasions have occurred when the outer layers of the skin have been scraped away or roughed up and deeper layers are exposed.

Symptoms and Signs

The injured area appears raw and reddened, is painful, and has a small amount of bleeding (Figure 15-1, A and B). E15-1 The exposure of sensitive nerve endings causes a burning type of pain in the injured area; it may be embedded with small foreign particles.

Patient Screening

Abrasions require prompt cleansing. Current tetanus prophylaxis should be confirmed.

Etiology

Abrasions are caused by the friction created when a rough, hard surface comes in contact with skin as a consequence of a scraping or sliding type of motion, often the result of a fall or scrape. Such injuries are often referred to as friction burns, floor burns, rug burns, or road rash.

Diagnosis

Diagnosis is made by subjective information (what the patient says), history, and visual inspection.

Treatment

Treatment consists of gentle washing and irrigation of the area with a germicidal soap and water to remove any bacteria and contamination. Any foreign particles, such as gravel and dirt that have not been removed by cleansing, should be removed carefully with forceps. Failure to remove foreign particles left in the skin stain the epidermis and cause scars or a tattoo. Next, a germicidal ointment or cream may be applied. A dressing may be applied as well, depending on the size and location of the abrasion. Prophylaxis with tetanus toxoid is confirmed or administered if necessary.

Prognosis

The prognosis for healing is good once cleansing to remove any foreign bodies or bacteria is accomplished. The extent of scarring depends on the depth and extent of the insult.

Prevention

Prevention is difficult, especially for active individuals. Protective gear or leather clothing worn sometimes by cyclists helps prevent extensive “road rash” abrasions.

Patient Teaching

Instruct the patient regarding appropriate wound care and the importance of keeping the wound clean and dry. Reinforce the value of maintaining up-to-date tetanus prophylaxis. Instruct the patient to avoid direct sunlight and to protect the new fragile skin with sunscreen or clothing for 6 months to prevent pigment changes in the skin. Written instructions regarding signs and symptoms of infection and when to report concerns are helpful to the patient. Generate print-on-demand electronic materials explaining or depicting proper applications of dressings when possible as teaching tools.

Description

With avulsion injuries, a portion of the skin and possibly underlying tissue is torn away, either completely or partially (Figure 15-2, A and B). E15-2, A and B

Symptoms and Signs

An avulsion injury can involve a limb, an appendage, or any soft tissue area anywhere on the surface of the body. The patient usually has severe pain in the area, and bleeding from the wound is common. When the avulsion is partial, the avulsed tissue is still partially attached to the injured area. Larger avulsed areas are considered a serious injury and may require split-thickness grafting. One type of severe avulsion is a “degloving” injury, in which the full thickness of skin is peeled away from the body, such as the hand or foot.

Patient Screening

Avulsion injuries require prompt cleansing and closure of the open wound. When the avulsed tissue is available (i.e., still partially attached to the body or retrieved from the accident site, as for example, in the case of a severed finger tip) and reattachment is possible, the surgical procedure is performed as quickly as possible. Current tetanus prophylaxis should be confirmed.

Etiology

The mechanism of this kind of injury is usually one in which the affected body part becomes entangled in machinery, clothing, or some other means of entrapment, causing the skin, tissue, and possibly bone to be torn and pulled away from the body. If the limb or appendage is severed completely from the body, it is termed an amputation.

Diagnosis

Diagnosis is made by visual inspection of the affected part and by history of the mechanism of injury.

Treatment

Treatment consists of controlling the bleeding, cleansing the area, and surgically repairing the tissue. If an amputation has occurred, the stump or remaining area must be cleansed and surgically repaired. The patient probably will be treated prophylactically with antibiotics to prevent infection. Obtain information on the patient’s history of medicine allergies. A sterile dressing is applied to the repaired wound. Tetanus prophylaxis is confirmed or administered if necessary. Pain medication is prescribed and administered when necessary.

Prognosis

Prognosis depends on the extent of the insult. Prompt intervention helps promote the healing process.

Prevention

Prevention is difficult and the likelihood of injury is unpredictable. Following safety guidelines when operating machinery, especially that of not wearing loose clothing while operating machinery, is a prudent practice.

Patient Teaching

Reinforce the importance of following safety guidelines. Instruct the patient on wound care and the importance of keeping the wound clean and dry. Reinforce the value of maintaining up-to-date tetanus prophylaxis. Provide the patient written instructions regarding signs and symptoms of infection. Encourage patients to keep any follow-up appointments as scheduled. Generate print-on-demand electronic materials when possible as teaching tools regarding treatment of wound.

Description

Crushing injuries occur when a part of the body is compressed with extreme force between two surfaces.

Symptoms and Signs

A crushing injury may involve any body part, but most often, a finger, hand, toe, or foot is the involved part. The patient experiences pain and may not be able to move the injured part. Soft tissue is compressed or crushed, and depending on the amount of pressure involved in the mechanism of injury, bone, nerves, and vessels also may be crushed.

Patient Screening

Crushing injuries require prompt assessment and intervention. Many individuals that sustain such an injury will be transported to an emergency facility. If not, schedule them to be seen as soon as possible on the day of the injury or refer them to an emergency facility.

Etiology

The crushing injury occurs when the affected body part becomes pressed between two hard surfaces. Examples of such injuries are fingers shut in doors, hands or fingers caught in presses, heavy objects being dropped on feet or toes, and compression of any body part as a result of a motor vehicle accident. Falling debris, such as building parts broken loose in a storm or earthquake, also can cause crushing injuries.

Diagnosis

Diagnosis is made from history, visual inspection of the body area, and physical examination. Radiographic studies of the injured part also aid in the diagnosis.

Treatment

Treatment depends on the severity and location of the injury. When an open wound is present, the area is cleansed, irrigated, and débrided if necessary. Immobilization of the affected limb or appendage follows any surgical repair that is indicated. Sterile dressings will probably be applied to any open wound or surgical area. If the crushing injury involves the head or trunk of the body, appropriate triage of the patient, monitoring of vital signs, and surgical intervention is undertaken. Tetanus prophylaxis is confirmed or administered if necessary, and antibiotics may be prescribed as an additional prophylactic measure.

Prognosis

Prognosis depends on the extent of the insult. Prompt intervention helps hasten the healing process.

Prevention

Prevention is difficult and the likelihood of injury is unpredictable. Following safety guidelines when operating machinery, especially that of not wearing loose clothing while operating machinery, is a prudent practice. Other such Occupational Safety and Health Administration (OSHA) guidelines should be followed whenever engaging in risky activities.

Patient Teaching

Reinforce safety guidelines. Instruct the patient on wound care and the importance of keeping the wound clean and dry. Reinforce the value of maintaining up-to-date tetanus prophylaxis. Encourage patients to keep any follow-up appointments as scheduled.

Description

Puncture wounds result when a pointed or sharp foreign object penetrates the soft tissue (Figure 15-3, A and B). Animals bites, discussed later in this chapter, also may be considered puncture wounds.

Symptoms and Signs

Puncture wounds cause pain and usually very little bleeding. Redness at the site may be noted, or there may be no indication of the wound other than the pain. A puncture wound may not have a dramatic appearance, therefore meticulous inspection of the area and underlying structures should be carefully performed. If the foreign body that caused the injury is protruding out of the wound, it is described as an impaled object (Figure 15-4).

Patient Screening

Puncture wounds require prompt assessment and cleansing. Tetanus prophylaxis needs to be confirmed. Impaled objects require stabilization until assessment and treatment are accomplished.

Etiology

A puncture wound occurs when a sharp, pointed object penetrates the skin and underlying soft tissue. The offending object may be a needle, a nail, a splinter of glass, wood, or metal, a knife, or even a bullet. The object first penetrates the skin and then the skin closes around the object or point of entry. As a result, bleeding is minimal. In some situations, bleeding will occur as the penetrating object is removed. Puncture wounds near joints are at risk for bacterial infection, and wounds on the bottom of the foot are at risk for cellulitis.

Diagnosis

Diagnosis is made by visual examination, history, and sometimes radiographic studies (if the object can be visualized by imaging). An embedded organic object, such as a small twig, can be visualized only by using magnetic resonance imaging. An impaled object is easily observed because it protrudes from the injured site.

Treatment

Treatment involves removal of the foreign body, along with copious irrigation of the wound with sterile fluid. A sterile dressing is applied. Tetanus prophylaxis is confirmed or administered if necessary, and antibiotics may be prescribed as an additional prophylactic measure. Impaled objects are stabilized until they can be removed by the physician.

Prognosis

Prognosis varies depending on the extent and depth of the puncture wound.

Prevention

Prevention is difficult. Health care providers should practice OSHA guidelines when handling sharps and needles. Construction workers are encouraged to use air tools with great caution and wear recommended safety devices, such as steel-toed safety shoes, hard hats, and safety goggles.

Patient Teaching

Instruct the patient on wound care and on keeping the wound clean and dry. Provide the patient with instructions on signs and symptoms of infection. Reinforce the importance of tetanus prophylaxis. Encourage enforcement of OSHA guidelines when appropriate.

Description

Lacerations result when a sharp object cuts the skin and possibly underlying soft tissue.

Symptoms and Signs

Lacerations result when a sharp object cuts the skin and possibly the underlying soft tissue as well. They cause pain and moderate to severe bleeding. The edges of the cut may be smooth, or they may be jagged, depending on what object did the cutting. The bleeding is generally proportionate to the depth and length of the laceration.

Patient Screening

Lacerations require prompt cleansing and repair.

Etiology

Lacerations occur when a sharp instrument, such as a knife or sharp piece of glass or metal, cuts the skin and underlying soft tissue (Figure 15-5, A and B). E15-4, A and B

Diagnosis

Diagnosis is made by visual examination. History may reveal the type of sharp object that caused the injury. A laceration with smooth edges that can be approximated cleanly is termed an incision (Figure 15-6).

Treatment

Lacerations should be cleansed gently with germicidal soap and water. If the laceration is not too deep and bleeding is controlled, approximating and securing the edges with tape, a butterfly dressing, or sterile adhesive strips (Steri-Strips) may be the only intervention necessary other than a sterile dressing application. In some cases, a new type of “glue” is used to hold the edges together, thereby eliminating the need for sutures. Lacerations that are deep, have jagged edges, or continue to bleed need to be débrided and have the edges trimmed to facilitate good approximation. Bleeding should be controlled by either coagulation or suture. Suturing of the wound will probably be necessary. If the laceration is over a movable joint, immobilization of the area is indicated. A sterile dressing should be applied. Tetanus prophylaxis is confirmed and administered if necessary, and antibiotics may be prescribed as an additional prophylactic measure.

Prognosis

Prognosis varies depending on the location, length, depth, and condition of the laceration. The degree of approximation of the edges of the wound may determine the extent of the scarring.

Prevention

Prevention is difficult. Care when using knives should be stressed. Following OSHA guidelines when using power tools is a prudent practice.

Patient Teaching

Instruct the patient on wound care and the importance of tetanus prophylaxis. When sutures have been used for closure, instruct the patient regarding when to return for suture removal, and that signs and symptoms of infection should be reported promptly.

Description

Foreign bodies (FB) in the ear typically range from bugs, pebbles, and bits of cotton to anything small enough to fit in the ear canal. E15-5

Symptoms and Signs

The patient will complain of feeling stuffiness and something in the ear. If the foreign object is a bug, the patient also may complain of a buzzing sound in the ear. Complaints of pain in the ear canal and decreased hearing capability may be expressed. Anything small enough to fit in the ear could be the offending foreign body. Visualization of the ear canal usually shows an apparent object.

Patient Screening

Although not a life-threatening condition, individuals with foreign bodies in the ear require prompt assessment and intervention.

Etiology

Flying insects may enter the ear canal accidentally in the course of flight, and instances of a bug crawling into the ear when an individual is lying down have been reported. Children have a tendency to place small objects in their ear canals and typically do not report the event in a timely manner. Small toys, cereal, grapes, peas, beans, and pebbles are examples of some of the objects commonly found in the ear canals of children. Vegetative foreign bodies, such as wood or thorns, may lead to infection and may require a computed tomography (CT) scan. Foreign bodies in the ear should be removed as quickly as possible. Cotton from cotton-tipped applicators also may be the offending object; the cotton inadvertently comes off of the applicator stick during a cleaning process. Anything small enough to be placed into the ear canal could be the problem, especially in the case of children.

Diagnosis

Diagnosis is made by history and visual and/or otoscopic inspection of the ear canal.

Treatment

The goal of treatment is removal of the offending object without damaging the ear canal or tympanic membrane. Many times the object simply may be grasped by forceps and removed. Food and cereal can absorb moisture from the ear canal and swell to the point of being compressed against the walls of the ear canal. Such objects may require removal by a physician using gentle controlled suctioning. The individual with a live bug in the ear should be placed in a dark room and have a flashlight shone in the ear. Bugs that are alive will crawl out of the ear toward the light. Bugs that are not responsive to the light technique may have to be washed out of the ear. In that case, the ear canal is gently irrigated with a warm solution of 50% water and 50% hydrogen peroxide or mineral oil; the bug usually flows out with the solution. If this is not successful, then gentle suction may be necessary to remove the FB. Caution is taken not to scratch or damage the ear canal or the tympanic membrane.

Prognosis

Prognosis is good with prompt removal of the FB and no consequential damage to the ear canal or tympanic membrane.

Prevention

Prevention includes working with children to educate them about not putting anything in their ears. A good rule to teach them is “never place anything in your ears that is smaller than your elbow.” Keep cotton-tipped applicators out of the reach of children, and use extreme caution when attempting to cleanse the ears with them.

Patient Teaching

Stress the dangers of putting small objects in the ears. Encourage parents to seek medical intervention when a child has a FB in the ear canal.

Description

Foreign bodies in the eye are objects that would not normally be found in the eye. Common offenders are bugs, rust, dust, sand, hair, small pieces of metal, or small pieces of brush or tree branches. Chemicals may be accidentally splashed in the eye.

Symptoms and Signs

The individual complains of scratching or irritation of the eye. The patient may experience pain in the eye and report blurred or compromised vision. Tearing is usually present.

Patient Screening

Foreign objects in the eye require prompt evaluation and intervention. If the injury involves splashed chemicals, advise immediate irrigation of the eye. If an immediate appointment is not available, refer the individual to an emergency facility. Encourage patients to have someone else provide their transportation because they should not attempt to drive. If the object is impaled and sticking out of the eye, the Emergency Medical System (EMS) is the recommended mode of transportation after stabilization of the impaled object has been accomplished.

Etiology

Foreign bodies in the eyes can result from a number of sources and routes of entry. A common source of rust and metal particles in the eye is the undercarriage of a car; the person working under a car may inadvertently knock loose rust particles or minute scraps of metal that then fall into the eye. Industrial accidents involving objects that have been propelled through the air, possibly as the result of an explosion, also can result in a foreign body entering the unprotected eye. Foreign objects also may be propelled into the eye as a result of a motor vehicle accident. Dust and other debris in the environment may be blown into open unprotected eyes. A bug flying into the eye is a common occurrence. Occasionally, just rubbing the eyes with dirty hands can be the source of entry for dirt or a chemical. Working with caustic liquids without wearing eye protection is another source of foreign substances in the eye resulting from splashing.

Diagnosis

Diagnosis is made by visual and ophthalmoscopic examination of the eye. A history of feeling something in the eye combined with the circumstance of possible exposure to foreign bodies is helpful. Staining the eye with fluorescein to visualize a corneal abrasion will confirm the presence or previous presence of a foreign body. Refer to Chapter 5 for discussion on corneal abrasion.

Treatment

Treatment involves removal of the offending material. Many times gentle irrigation of the eye with normal saline will flush dust, bugs, or debris out of the eye. E15-6 When the FB is embedded in the eye, the physician may attempt removal with surgical instruments or an eye spud. If these procedures are unsuccessful, immediate referral to an ophthalmologist or emergency department is made. Ophthalmic antibacterial drops or ointments may be placed in the eye, and the eye is usually covered with a patch.

Prognosis

Prognosis varies depending on the offending material and the depth and involvement of the eye structures. Many injuries caused by bugs and dust will resolve after cleansing irrigation. Extensive corneal abrasions may result in residual scarring and compromised vision. Chemical burns may result in blindness.

Prevention

The best prevention for occupational and other possible insults by foreign objects to the eye is wearing approved eye protection. Many accidental incidents can be prevented in that way.

Patient Teaching

Encourage the use of eye protection whenever any possible hazard to the eye is anticipated. When a foreign object other than minute dust particles enters the eye and is not removed successfully by gentle irrigation, encourage the individual to seek professional treatment. When one eye is patched or covered with a bandage, make the patient aware that depth perception will be absent and encourage care in navigating steps.

Description

Any object or foreign material that is causing an obstruction in the nares should be considered a foreign body in the nose, and medical intervention for removal should be sought. Foreign bodies often found wedged in the nares of children are cereals, dried peas or beans, grapes, Styrofoam particles, pebbles, and cotton.

Symptoms and Signs

Children have the most occurrences of foreign bodies wedged or stuck in the nares. Parents usually note mucus running from one of the nares and congested breathing. Upon investigation they are able to confirm that one of the nares is constricted and air is not moving through the affected side.

Patient Screening

Foreign bodies in the nose require prompt assessment and treatment.

Etiology

Children have a tendency to insert foreign objects into their noses. These foreign bodies include but are not limited to cereals, dried peas or beans, grapes, Styrofoam particles, pebbles, toys, and anything else small enough to fit in the nares. Dry materials, such as dried peas, beans, and cereal, have a tendency to absorb moisture from the mucous membrane and then swell, creating an obstruction.

Diagnosis

Diagnosis is made by history and visualization of the foreign body in the nares. Often mucus is dripping from the unobstructed nares and may be foul smelling.

Treatment

The child is encouraged to blow the nose, hopefully expelling the object. If the offending foreign substance is cereal, squeezing the nose usually will crush the cereal bit and permit it to be expelled by blowing the nose. A physician may need to grasp the object with forceps for removal.

Prognosis

Prognosis is good when removal of the offending object is uncomplicated and complete.

Prevention

Prevention is difficult because children often have a tendency to insert small objects into their noses.

Patient Teaching

Counsel children not to place any objects in their noses. Emphasize that dried objects will swell and that medical intervention may be needed to correct the situation.

Description

Burns are the result of thermal insults to tissue. The insults may be caused by heat, chemical sources, electrical sources, or radiation. Heat sources that cause injury may be in the form of dry heat, steam, or hot substances; sun rays are also capable of causing a burn.

Symptoms and Signs

The patient who has experienced a burn usually has pain. The extent of the burn, along with the percent of body surface involved, usually is related proportionately to the degree of pain. Depending on the depth and nature of the burn, the skin surface may be reddened, blistered, or charred (Figure 15-7). E15-8, A and B

Patient Screening

Burns require prompt assessment and intervention. After evaluation and stabilization, patients with major burns are referred to burn centers for treatment. Knowing the mechanics of the injury is important in determining the type of treatment intervention required; this includes assessment of respiratory status, wound contamination, eye involvement, and fluid management.

Etiology

Burns can be caused by flame, dry heat, liquid scalds, radiation, chemicals, or electricity. The exposure of the skin to any of these sources can cause destruction of the skin. The injury to the underlying soft tissue is proportionate to the duration of the exposure and the intensity of the thermal source.

Diagnosis

Diagnosis is made by visual examination and history. In a flame type of burn, it is necessary to determine whether the burn occurred inside an enclosed space or out in the open. The respiratory state of any patient with a flame type of burn must be assessed. The status of the eyebrows, eyelashes, and nasal hair must be determined. Any singeing of these hairs indicates that the patient inhaled the flame or superheated air and that the respiratory status may be in grave danger.

Determination of the depth (Figure 15-8) and extent (Figure 15-9) of a burn is important. Pain intensity depends on the amount of nerve tissue that is involved or destroyed. Superficial burns involve only the outer layers of the skin, which usually appear only reddened, and yet these burns are painful. Partial-thickness burns involve all layers of the skin; they produce blisters and are quite painful. Full-thickness burns involve both the skin and the underlying subcutaneous tissue. Resultant destruction of nerve endings often results in minimal pain in that particular area; however, pain may be reported in areas around the periphery of the burn site. Prompt assessment of the percent of skin surface area involved in the burn injury is achieved by applying the rule of nines. The rule of nines provides a fast and fairly accurate calculation of the body surface involved. Percentages used to ascertain the burned tissue area in the adult are as follows: head, 9%; anterior trunk, 18%; posterior trunk, 18%; entire right arm, 9%; entire left arm, 9%; anterior surface right leg, 9%; posterior surface right leg, 9%; anterior surface left leg, 9%; posterior surface left leg, 9%; and perineum, 1%. Percentages in children and infants are slightly different. Another method of designating a percentage of body surface involvement is used by the ICD-9-CM and ICD-10-CM code books. Refer to the current edition of the ICD-9-CM and ICD-10-CM code books for these percentages.

Treatment

Treatment depends on the source of the burns. Heat burns (from flame, liquid scalds, or superheated air) should be cooled with cool water and covered with dry sterile dressings until seen by a physician. Sunburns should be treated with the application of cool water, and the damaged skin may be sprayed with antiseptic and analgesic sprays (Figure 15-10). OTC medications including aspirin, ibuprofen, and naproxen may be used for relief of sunburn pain. Cool compresses applied to the areas of sunburned skin may also provide pain relief.

Skin burned with chemicals other than lime, which must first be brushed away, should be flushed with cool water for at least 15 minutes, covered with a sterile dressing, and treated by a physician. Electrical burns should be examined for points of entry (rings, belts, necklaces) and exit (knees, toes) (Figure 15-11). These areas should be covered with dry sterile dressings and treated by a physician.

Analgesics are given to treat the pain. Minor burns usually are treated with an antibacterial cream or ointment. Severe burns require specialized treatment, with surgical débridement of the burned tissue and skin grafts if necessary.

Patients with severe large area burns, the elderly and the very young, and those with severe burns to the face, hands, feet, or perineal area usually are admitted to a burn center, where they receive specialized burn care. Respiratory status (if the respiratory tract is involved), fluid and electrolyte balance, and vital signs are monitored. Pain control is accomplished with narcotic analgesics. Tetanus prophylaxis is confirmed or administered if necessary, and antibiotics may be prescribed as an additional prophylactic measure. Obtain a list of the patient’s medicine allergies. Skin grafting, including the use of cloned skin and the use of autografts and adjacent tissue grafts, is used for treatment of extensive destruction of tissue.

Prognosis

Prognosis varies depending on the cause and extent of the burned tissue and other organ or system involvement. Prompt intervention helps promote a positive outcome. Scarring is typical (refer to the Enrichment box on radiation).

Prevention

Prevention is difficult. Prudent use of fire or combustible materials is helpful. Being proactive to avoid situations where burns may occur is wise. Application of sunscreens when exposure to sun rays is anticipated is strongly recommended.

Patient Teaching

Stress the importance of keeping follow-up appointments and compliance with prescribed therapy. Provide instruction on wound care and the signs and symptoms of infection. Emphasize the importance of current tetanus prophylaxis.

 Enrichment

Sunburn

Exposure to the ultraviolet α- and β-rays from the sun can cause sunburn, ranging from mild to severe. The person who has experienced at least three severe sunburns with blistering is at risk for the development of skin cancer. Prevention of sunburn includes avoiding exposure from 10 am to 2 pm, when the sun’s rays are the strongest, applying a sunscreen to exposed skin areas, and wearing a hat to protect the scalp and eyes. Those at greatest risk have light or fair skin and freckles and blond or red hair

Sun protection factor (SPF) is the technical name for measurement of UVB protection provided by sunscreen. The numbers assigned to a product designate the length of time it takes to redden the skin as compared with no protection. SPFs of at least 15 are recommended by the Skin Cancer Foundation as a protection against the sun’s harmful rays or UVB.

 Enrichment

Radiation Exposure

Exposure to radioactive material is another threat to society. “Dirty bombs” may contain radioactive particles that can be released into the environment upon explosion of the bomb. The three main types of exposure to ionizing radiation are slow, cumulative whole body exposure; sudden whole body exposure; and high-dose localized exposure. Sudden whole body exposure is the most likely form of ionizing radiation exposure for the general public in a terrorist type of event. The body’s exposure to radiation may be external irradiation of all or part of the body from an external source, including radiation therapy for cancer treatment, contamination by radioactive material in gases, liquids, or solids that have been released into the environment causing external, internal, or both types of contamination, or by incorporation of the radioactive material as a sequela to other contamination. Symptoms of radiation exposure include nausea, vomiting, and diarrhea; redness and blistering of skin burns; dehydration; weakness, fatigue, exhaustion, and fainting; hair loss, ulceration of oral mucosa, esophagus, and gastrointestinal (GI) tract; vomiting blood and experiencing bloody stools; bruising; sloughing of the skin; and bleeding from nose, mouth, and gums. The extent of the toxicity of ionizing radiation depends on the dose, the distance from the source of radiation, and the length of time of the exposure. Body responses and long-term effects as an overview of major morphologic consequences are presented in Figures 15-13 and 15-14.

Description

Electrical shock is an injury that occurs as the result of exposure to or contact with electricity.

Symptoms and Signs

Patients who have experienced electrical shock may be in cardiac or respiratory failure. They have a visible burn at the entrance wound and at the exit wound. If conscious, they experience pain at these sites. Charred tissue may be noted.

Patient Screening

Individuals who have suffered electrical shock constitute a life-threatening emergency. They need to be entered into the Emergency Medical System (EMS) for transport to an emergency care facility. Resuscitation and life support may be required during transport.

Etiology

The person who has sustained electrical shock experiences tissue damage from the point of entry of the electricity to the point of exit. The electrical current follows the path of least resistance through the body, usually along nerve routes. The current enters the body at the point of contact with the electrical source and exits at the point of grounding (see Figure 15-11) E15-9. As the alternating current passes through the body, it may produce muscle contractions, causing the person to be thrown from the source. This can result in lacerations, fractures, or head trauma. One major concern with electrical shock injuries is the development of cardiac dysrhythmias.

Diagnosis

Diagnosis is made by visual examination and history.

Treatment

Treatment consists of maintaining the cardiac and respiratory status. If indicated, cardiopulmonary resuscitation (CPR) must be administered after the patient has been removed from the electrical source. The patient’s neurologic and vascular status is assessed for the extent of tissue destruction. Any fractures, lacerations, and head injuries are treated. The burned areas are débrided and dressed with sterile dressings. Pain management is accomplished with narcotic analgesics. Tetanus prophylaxis is confirmed or administered if necessary, and antibiotics may be prescribed as an additional prophylactic measure.

Prognosis

Prognosis varies depending on the extent of the insult and damage to organs and body systems. When cardiac arrest has occurred, prognosis may not be favorable, even with prompt resuscitative efforts. It is important to realize that electrical energy will follow nerves on its path through the body and therefore has the potential to cause damage in the peripheral nervous system (PNS).

Prevention

Extreme care should be taken in situations that involve repair of or close proximity to electrical power, and people should be alert for possible electrical accidents at all times. Use electrical outlet covers when the outlets are not in use. Avoid standing in water when it is possible that nearby electrical wires could come in contact with the water.

Patient Teaching

Advise patients to follow OSHA guidelines when working with electricity. Encourage them to be aware of potential sources of electrocution in the workplace and home environment.