These are usually caused by the passage through the body of an electric current of high voltage owing to accidental contact with a live wire or to a discharge of lightning. The general effects produced are included under the term electric shock, but vary greatly in degree. The local effects include spasmodic contraction of muscles, fracture of bones, and in severe cases more or less widespread destruction of tissues which may amount simply to burns of the skin or may include necrosis of masses of muscle and internal organs. Fright due to the unexpectedness of the shock, and pain due to the sudden cramp of muscles, are the most common symptoms and in most cases pass o? within a few minutes. In more severe cases – especially when the person has remained in contact with a live wire for some time, or has been unable to let go of the electrical contact owing to spasmodic contraction of the muscles – the effects are more pronounced and may include concussion or compression of the brain (see BRAIN, DISEASES OF). In still more severe cases, death may ensue either from paralysis of the respiration or stoppage of the heart’s action. If prompt measures are taken for treatment, the victim can often be resuscitated.
In Britain there are an average of 110 deaths a year from electrocution, half of these occurring in the home.
Treatment No electrical apparatus or switch should be touched by anyone who is in metallic contact with the ground, such as through a metal pipe, especially, for example, from a bath. The ?rst action is to break the current. This can sometimes be done by turning o? a switch. If the victim is grasping or in contact with a live wire, the contact may be severed with safety only by someone wearing rubber gloves or rubber boots; but as these are not likely to be immediately available, the rescuer’s hands may be protected by a thick wrapping of dry cloth, or the live wire may be hooked or pushed out of the way with a long wooden stick such as a broom-handle. If the injured person is unconscious, and especially if breathing has stopped, arti?cial respiration should be applied as described in APPENDIX 1: BASIC FIRST AID – Electrocution. When the patient begins to breathe again, he or she must be treated for shock and professional help obtained urgently.
Most blows to the head cause no loss of consciousness and no brain injury. If someone is knocked out for a minute or two, there has been a brief disturbance of the brain cells (concussion); usually there are no after-effects. Most patients so affected leave hospital within 1–3 days, have no organic signs, and recover and return quickly to work without further complaints.
Severe head injuries cause unconsciousness for hours or many days, followed by loss of memory before and after that period of unconsciousness. The skull may be fractured; there may be ?ts in the ?rst week; and there may develop a blood clot in the brain (intracerebral haematoma) or within the membranes covering the brain (extradural and subdural haematomata). These clots compress the brain, and the pressure inside the skull – intracranial pressure – rises with urgent, life-threatening consequences. They are identi?ed by neurologists and neurosurgeons, con?rmed by brain scans (see COMPUTED TOMOGRAPHY; MRI), and require urgent surgical removal. Recovery may be complete, or in very severe cases can be marred by physical disabilities, EPILEPSY, and by changes in intelligence, rational judgement and behaviour. Symptoms generally improve in the ?rst two years.
A minority of those with minor head injuries have complaints and disabilities which seem disproportionate to the injury sustained. Referred to as the post-traumatic syndrome, this is not a diagnostic entity. The complaints are headaches, forgetfulness, irritability, slowness, poor concentration, fatigue, dizziness (usually not vertigo), intolerance of alcohol, light and noise, loss of interests and initiative, DEPRESSION, anxiety, and impaired LIBIDO. Reassurance and return to light work help these symptoms to disappear, in most cases within three months. Psychological illness and unresolved compensation-claims feature in many with implacable complaints.
People who have had brain injuries, and their relatives, can obtain help and advice from Headwat and from www.neuro.pmr.vcu.edu and www.biausa.org... brain injuries
A method of electrical stimulation that is being used for the relief of PAIN, including that of MIGRAINE, NEURALGIA and phantom limbs (see AMPUTATION). Known as TENS, its mode of action appears to have some resemblance to that of ACUPUNCTURE. Several controlled trials suggest that it provides at least a modicum of relief of pain after operations, thereby reducing the amount of ANALGESICS that may be called for.... transcutaneous electrical nerve stimulation (tens)
The Industrial Injuries Scheme provides money for people who have suffered injury or illness because of their work. Bene?ts for employment-related disability (selfemployment is excluded) have been altered many times since they were introduced in 1948. There is now a mix of bene?ts, eligibility for which depends on several factors: the date, onset and type of disability are among the most important. ‘Industrial’ includes almost all forms of employment. In addition to accidents, there is a long list of prescribed industrial diseases ranging from BURSITIS, hearing loss, ASTHMA and viral HEPATITIS to unusual ones such as ORF. Psychological as well as physical disablement may attract bene?t, which is calculated on a percentage basis according to the extent of disability. The onus is on the individual to claim, and trade unions and representative organisations can advise on procedures. Injured employees should always report details of an accident to their employer and record it in the accident book promptly: even seemingly minor injuries may subsequently lead to some disability. Relevant information lea?ets are available – for example, from local bene?t agencies, local-authority advice centres and public libraries.... industrial injuries benefit
(electromechanical dissociation) the appearance of normal-looking complexes on the electrocardiogram that are, however, associated with a state of *cardiac arrest. It is usually caused by large pulmonary emboli (see pulmonary embolism), *cardiac tamponade, tension *pneumothorax, severe disturbance of body salt levels, severe haemorrhage, or hypothermia causing severe lack of oxygen to the heart muscle.... pulseless electrical activity
Scoliosis A condition where the spine is curved to one side (the spine is normally straight when seen from behind). The deformity may be mobile and reversible, or ?xed; if ?xed it is accompanied by vertebral rotation and does not disappear with changes in posture. Fixed scoliosis is idiopathic (of unknown cause) in 65–80 per cent of cases. There are three main types: the infantile type occurs in boys under three and in 90 per cent of cases resolves spontaneously; the juvenile type affects 4–9 year olds and tends to be progressive. The most common type is adolescent idiopathic scoliosis; girls are affected in 90 per cent of cases and the incidence is 4 per cent. Treatment may be conservative with a ?xed brace, or surgical fusion may be needed if the curve is greater than 45 degrees. Scoliosis can occur as a congenital condition and in neuromuscular diseases where there is muscle imbalance, such as in FRIEDREICH’S ATAXIA.
Kyphosis is a backward curvature of the spine causing a hump back. It may be postural and reversible in obese people and tall adolescent girls who stoop, but it may also be ?xed. Scheuermann’s disease is the term applied to adolescent kyphosis. It is more common in girls. Senile kyphosis occurs in elderly people who probably have osteoporosis (bone weakening) and vertebral collapse.
Disc degeneration is a normal consequence of AGEING. The disc loses its resiliance and becomes unable to withstand pressure. Rupture (prolapse) of the disc may occur with physical stress. The disc between the fourth and ?fth lumbar vertebrae is most commonly involved. The jelly-like central nucleus pulposus is usually pushed out backwards, forcing the annulus ?brosus to put pressure on the nerves as they leave the spinal canal. (See PROLAPSED INTERVERTEBRAL DISC.)
Ankylosing spondylitis is an arthritic disorder of the spine in young adults, mostly men. It is a familial condition which starts with lumbar pain and sti?ness which progresses to involve the whole spine. The discs and ligaments are replaced by ?brous tissue, making the spine rigid. Treatment is physiotherapy and anti-in?ammatory drugs to try to keep the spine supple for as long as possible.
A National Association for Ankylosing Spondylitis has been formed which is open to those with the disease, their families, friends and doctors.
Spondylosis is a term which covers disc degeneration and joint degeneration in the back. OSTEOARTHRITIS is usually implicated. Pain is commonly felt in the neck and lumbar regions and in these areas the joints may become unstable. This may put pressure on the nerves leaving the spinal canal, and in the lumbar region, pain is generally felt in the distribution of the sciatic nerve – down the back of the leg. In the neck the pain may be felt down the arm. Treatment is physiotherapy; often a neck collar or lumbar support helps. Rarely surgery is needed to remove the pressure from the nerves.
Spondylolisthesis means that the spine is shifted forward. This is nearly always in the lower lumbar region and may be familial, or due to degeneration in the joints. Pressure may be put on the cauda equina. The usual complaint is of pain after exercise. Treatment is bed rest in a bad attack with surgery indicated only if there are worrying signs of cord compression.
Spinal stenosis is due to a narrowing of the spinal canal which means that the nerves become squashed together. This causes numbness with pins and needles (paraesthia) in the legs. COMPUTED TOMOGRAPHY and nuclear magnetic resonance imaging scans can show the amount of cord compression. If improving posture does not help, surgical decompression may be needed.
Whiplash injuries occur to the neck, usually as the result of a car accident when the head and neck are thrown backwards and then forwards rapidly. This causes pain and sti?ness in the neck; the arm and shoulder may feel numb. Often a support collar relieves the pain but recovery commonly takes between 18 months to three years.
Transection of the cord occurs usually as a result of trauma when the vertebral column protecting the spinal cord is fractured and becomes unstable. The cord may be concussed or it may have become sheared by the trauma and not recover (transected). Spinal concussion usually recovers after 12 hours. If the cord is transected the patient remains paralysed. (See PARALYSIS.)... spine and spinal cord, diseases and injuries of
a state benefit payable to a person disabled by injury or a prescribed industrial disease sustained or contracted in the course of employment (see occupational disease; prescribed disease). The benefit is payable as a weekly amount. The amount of the benefit depends on the degree of disablement as determined following assessment by a specialist. To be entitled to benefit, the disablement must be assessed as being at least 20% of total disability (1% in the case of pneumoconiosis, byssinosis, and diffuse mesothelioma). The benefit is payable if the claimant is still suffering disability two months or more after the date of the accident or onset of the disease. It is payable for a period assessed as the time for which the claimant is likely to suffer the disability. The assessment can be reviewed if the claimant’s condition deteriorates or if he or she is still disabled at the end of the period of assessment.... industrial injuries disablement benefit
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