1. Electrical burns occur when electrical current passes through the body, causing cellular damage through heat production. The extent of injury depends on factors like voltage, current pathway, and contact duration.
2. Treatment for electrical burns involves stabilizing the airway, breathing, and circulation. Additional evaluation is needed to identify occult injuries like fractures or internal bleeding. Wound management may require escharotomy, debridement, and eventual flap closure for exposed tissue.
3. Long term complications can include central nervous system issues, contractures, bone problems, and increased cancer risk depending on the location and severity of the electrical injury. Special considerations are given to burns on the head, extremities, and in pediatric patients.
Answer AThere are two modes of tissue injury in electrical contact.pdfanokhilalmobile
Answer A
There are two modes of tissue injury in electrical contacts: thermal injury and
electroporation.Thermal injury, resultant from resistive heating of tissues, is a proportional
response to tissue resistance, current density and duration of contact. Thermal injury occurs only
along the current pathway. Given the energy requirements to heat tissue and the time constraints
for heat diffusion, remote injury from tissue heating is often very limited
High voltage, short pulsed electric fields (PEF) is a non-thermal ablation method, in which
defined PEF irreversibly destabilize cell membranes, while preserving other tissue components
such as the extracellular matrix (ECM)
Tissue damage after electrical injury is mediated either thermally or electrically.When electricity
passes through a solid conductor, heat is generated in proportion to the current strength, the
duration of the current flow, and the resistance of the conductor. The greatest resistance
encountered by the flow of current through the body is across the skin; this accounts for the
burns and local coagulative tissue injury often seen at the points of electrical entry and exit.
When electrical contact is brief, thermal injury and burns may be minimal but non-thermal injury
may still cause damage by direct electrical effects causing electroconformational changes in
membrane proteins, and the formation of pores in the cell membrane—electroporation.The
vulnerability of a cell to non-thermal electrical damage is particularly related to its length in the
direction of the electrical field, larger transmembrane potentials being induced in longer cells.
Skeletal muscle cells and, particularly, nerve axons are thus especially susceptible to this type of
non-thermal damage, which may disrupt peripheral nerve axons in isolation and in the absence of
significant damage to surrounding tissue.The remarkable degree of peripheral nerve regeneration
and recovery seen in this patient suggests that the axons were selectively injured, leaving the
surrounding tissue including the Schwann cells intact to enable subsequent regeneration. This
pattern of injury is consistent with acute non-thermal electrical injury.
Answer B
pH change is completely neutralized by the tissue buffer.
Tissue injuries are evidenced as light red halos surrounding central red spots in the mucosa
(corresponding to points where electrodes were placed). These injury halos can be the
consequence, at least partially, of the extreme pH changes induced by the electric pulses applied.
Answer C
The severity of electrical injuiry depends on the type of source, the intensity of the current, the
pathway through the body and the duration of the contact. Other factors are the applied current
frequency , the phase of the heart cycle when the shock occurs and the general health ststus of
the person.
The effect of electrical shock decreases with applied signal frequency. High frequency currents
donot exite muscles and do not cause cardiac arrhy.
Answer AThere are two modes of tissue injury in electrical contact.pdfanokhilalmobile
Answer A
There are two modes of tissue injury in electrical contacts: thermal injury and
electroporation.Thermal injury, resultant from resistive heating of tissues, is a proportional
response to tissue resistance, current density and duration of contact. Thermal injury occurs only
along the current pathway. Given the energy requirements to heat tissue and the time constraints
for heat diffusion, remote injury from tissue heating is often very limited
High voltage, short pulsed electric fields (PEF) is a non-thermal ablation method, in which
defined PEF irreversibly destabilize cell membranes, while preserving other tissue components
such as the extracellular matrix (ECM)
Tissue damage after electrical injury is mediated either thermally or electrically.When electricity
passes through a solid conductor, heat is generated in proportion to the current strength, the
duration of the current flow, and the resistance of the conductor. The greatest resistance
encountered by the flow of current through the body is across the skin; this accounts for the
burns and local coagulative tissue injury often seen at the points of electrical entry and exit.
When electrical contact is brief, thermal injury and burns may be minimal but non-thermal injury
may still cause damage by direct electrical effects causing electroconformational changes in
membrane proteins, and the formation of pores in the cell membrane—electroporation.The
vulnerability of a cell to non-thermal electrical damage is particularly related to its length in the
direction of the electrical field, larger transmembrane potentials being induced in longer cells.
Skeletal muscle cells and, particularly, nerve axons are thus especially susceptible to this type of
non-thermal damage, which may disrupt peripheral nerve axons in isolation and in the absence of
significant damage to surrounding tissue.The remarkable degree of peripheral nerve regeneration
and recovery seen in this patient suggests that the axons were selectively injured, leaving the
surrounding tissue including the Schwann cells intact to enable subsequent regeneration. This
pattern of injury is consistent with acute non-thermal electrical injury.
Answer B
pH change is completely neutralized by the tissue buffer.
Tissue injuries are evidenced as light red halos surrounding central red spots in the mucosa
(corresponding to points where electrodes were placed). These injury halos can be the
consequence, at least partially, of the extreme pH changes induced by the electric pulses applied.
Answer C
The severity of electrical injuiry depends on the type of source, the intensity of the current, the
pathway through the body and the duration of the contact. Other factors are the applied current
frequency , the phase of the heart cycle when the shock occurs and the general health ststus of
the person.
The effect of electrical shock decreases with applied signal frequency. High frequency currents
donot exite muscles and do not cause cardiac arrhy.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
3. Electrical Burns - Pathophysiology
Joule Effect:
Passage of current through a solid conductor results in
conversion of electrical energy to heat
Ohm’s Law:
I = V / R
Intensity of the current (amperage) is directly
proportional to the potential flow (voltage) and
inversely proportional to the resistance
4. Electrical Burns - Pathophysiology
Joule’s Law:
J = 0.24 • I2 • R • T
J = Heat Production
I = Current
R = Resistance
T = Time
5. Electrical Burns - Pathophysiology
Resistance of body tissues
Nerves and Blood Vessels
Good to excellent conduction
Muscle
Bone and Skin
Resistant to passage of electricity
6. Electrical Burns - Pathophysiology
Extent of injury depends on:
Type of current (alternating vs direct)
Pathway of flow
Local tissue resistance
Duration of contact
7. Electrical Burns - Pathophysiology
Mortality of electrical burns
Low-voltage injuries
Alter the cardiac cycle
High-voltage injuries
Cause concomitant tissue damage
Survival of contact with voltage greater than
70,000 volts uncommon
8. Electrical Burns - Acute Care
A - Airway
B - Breathing
C - Circulation
D - Disability
E - Expose the patient
Look for occult injuries
9. Electrical Burns - Acute Care
Airway / Breathing
Always examine for airway patency
Think of pneumothorax
Not uncommon with high-tension injuries
Circulation
? History of cardiac arrest
ECG and ECG monitoring
10. Electrical Burns - Acute Care
Circulation
Assess peripheral circulation
? Need for escharotomy / fasciotomy
May measure muscle compartment pressures
Disability
Neurological status
Assess for focal motor and sensory deficits
11. Electrical Burns - Acute Care
Skin damage from electrical burns
Contact Burns
Entry and exit points
Arc Burns
Current exiting and entering adjacent parts in
close proximity
Thermal Burns
Ignition of clothing
12. Electrical Burns - Acute Care
Detailed evaluation
Look for other causes of shock
Large fluid loss from muscle damage
Possibility of associated hemorrhage
• Vascular injury from associated fractures
• Chest or abdominal trauma
Perforation of intra-abdominal viscus
13. Electrical Burns - Acute Care
Detailed evaluation
Nervous System
Respiratory / extremity paralysis
Hemiplegia, aphasia, cerebellar dysfunction, and
epilepsy
Physiologic spinal cord transection
• Up to 25% of high voltage injuries
14. Electrical Burns - Acute Care
Laboratory - Urinalysis
Presence of hemoglobin and myoglobin
Lysis of RBC’s
Destruction of muscle
Cardiac enzymes
Damage to cardiac muscle
15. Electrical Burns - Acute Care
Radiology
Chest X-Ray
Rule of pneumothorax
Cervical, thoracic, and lumbar Spine
Limbs
Fractures and dislocations from tetanic
contractions
16. Electrical Burns - Treatment
Immediate first aid
Protect yourself
Cardiopulmonary resuscitation
ECG abnormalities
Continued cardiac monitoring
Pharmacologic treatment of dysrhythmia
19. Electrical Burns - Parkland formula
IV fluid - Lactated Ringer's Solution
4 x BW in kg x % TBSA burn
Give 1/2 of that volume in the first 8 hours
Give other 1/2 in next 16 hours
Warning: fluid rate should be gradually reduced throughout the
resuscitation to maintain the targeted urine output
20. Electrical Burns - Treatment
Wound management
Early escharotomy and fasciotomy
Damage around peri-osseous Core
Debride obviously necrotic material early
Local wound care
Silver sulfadiazene vs. sulfamylon
Definitive closure frequently requires flap closure
Needed to salvage exposed bone
21.
22. Electrical Burns - Treatment
Complete excision vs. cautious debridement
Progressive necrosis after the injury
Due To Delayed Vascular Occlusion
23. Electrical Burns - Scalp And Skull
Common entry site
Devitalized / exposed bone source of infection
Osteomyelitis
Epidural abscess
Approach depends on depth of injury
24. Electrical Burns - Scalp And Skull
Partial-thickness bone injury
Remove outer table
Skin graft acutely
Dress until granulation tissue develops
Downside
Infected diploic cavity - if undue delay before
skin grafting
Unstable graft with frequent breakdown
25. Electrical Burns - Scalp And Skull
Full thickness bone injury
Coverage obtained with flap closure
1 Excise cranial bone
• Carries associated risks of cranial procedure
2 Flap closure over exposed bone
• Assume devitalized bone is “bone graft”
• Assume bone is not osteomyelitic - delay in
procedure can result in bone colonization
26. Electrical Burns - Extremities
Commonly involved in electrical burns
Often grasp source with hand
Lower extremity often exit point
Periosseous tissues can harbor areas of
myonecrosis
Often more proximal than the cutaneous component
27. Electrical Burns - Long Term
Complications
Central Nervous System
Late onset of paraplegia or quadriplegia
Problems with gait / balance
Difficulties with speech
Seizures
Personality changes
Commonly associated with entrance or exit wounds of the skull
28. Electrical Burns - Long Term
Complications
Eyes
Increased risk of cataract development
Onset up to one year later
Skeletal
Contractures
Bone cysts
Heterotopic bone formation
Cause - forced passive mobilization
29. Electrical Burns - Lightening Injuries
Mechanism
Direct strike
Side flash
Flow of current between person and nearby object struck
by lightening
Current often travels over surface of the body
Not through
31. Electrical Burns - Lightening Injuries
Management
Resuscitation
Increased fluid requirements due to underlying muscle
damage
Foley catheter
Analyze urine for myoglobin
Maintenance of peripheral circulation
Frequent monitoring
Decompress with escharotomy or fasciotomy
32. Electrical Burns - Pediatric Patient
Low voltage common
Usually minimal cutaneous injury
No muscle damage
Injuries to oral commissure
Look worse than they really are
No immediate debridement
Watch for delayed bleed with eschar separation
33.
34. Pediatric Burns
Scald burns most common under age 3 years
Flame burns more commonly seen over 3 years
Always be Aware of child abuse
Large surface area
Increased fluid requirements
Affects temperature regulation
Thin dermal layer results in increased tissue
destruction
