Cover

Half-title

Title

Copyright

Contents

Contributors

Acknowledgements

Preface

Part I: Introduction

1 Electrical burns: a historical review

History

Electrical terminology

The electric arc

Electrical shock parameters

The 60 Hz transmission and distribution system

The 60 Hz, 120/240 V electrical system

Lightning

General references

2 Industrial electrical accidents and their complications observed by Electricite de France

General characteristics of electrical accidents

Immediately caused death

Apparent death: intensive care

Initial lesions

Clinical course - delayed-onset fatalities

Sequelae

Permanent disabilities (PD)

References

3 The pathophysiology and clinical management of electrical injury

Introduction

Relevant biophysics and physiology

Dielectric breakdown: 'arcing'

Sensory and neuromuscular responses

Joule heating

Cellular response to supraphysiological temperatures

Electroporation

Induced transmembrane potential by electric fields

Pathogenesis of tissue injury

The relative role of thermal versus nonthermal effects

Duration of contact

Clinical manifestations and treatment guidelines

Classification of injury

General considerations

Cutaneous injury

Nerve injury

Skeletal muscle injury

Skeletal injury

Rehabilitation

Horizons in management

Summary and conclusions

Acknowledgements

References

Part II: Clinical manifestations and management

4 Soft tissue patterns in acute electric burns

References

5 The spectrum of electrical injuries

History

Initial assessment and resuscitation

Specific areas

The scalp and skull

Trunk, perineum

Extremities

Summary

References

6 Electrical trauma: pathophysiology and clinical management R.H. Demling

Electrical current tissue damage

Cutaneous injury

Muscle necrosis

Cardiovascular

Renal

Pulmonary

Neurological

Abdominal viscera

Orthopaedic

Ocular-otic

Hematological

Infection

Hypermetabolism

General treatment principles

Fluid management

Infection control

Escharotomy-fasciotomy

Wound management

Nutritional support

Managing contact sites

Thermal burns to the skin

Blunt trauma (free falls)

7 Acute and delayed neurological sequelae of electrical injury

Introduction

Review of literature

Low voltage

High voltage

Cerebral syndromes

Delayed peripheral lesions

Spinal cord syndromes

Histopathology

Thesis: What are the neurologic sequelae after electrical injury?

Material and methods

Results

High voltage

Loss of consciousness

Acute peripheral neuropathy

Delayed peripheral neuropathy

Summary

Pathophysiology of electrical injury

The laws of physics

Resistance

Current path

Biophysical mechanisms for neurological sequelae from electricity

Thermal destruction -joule heat

Uniform resistance volume conductor model

Inhomogeneous resistance composite tissue model

Nonthermal tissue destruction by electricity

Electric field hypothesis

Inflammatory mediator model

Conclusions

References

8 Paediatric electrical burns

Introduction

The injury

High-tension injuries

Treatment

The wound - low-tension injury

Outcome

Conclusion

References

9 Surgical technique for salvage of elecrically damaged tissue

Discussion

References

Part III: Tissue responses

10 The role of arachidonic acid metabolism in the pathogenesis of electrical trauma

References

11 Thermal damage: mechanisms, patterns and detection in electrical burns

Thermal damage in electrical burns

Mechanisms of hyperthermic cell death

Systemic factors: per fusion

Heat dose: thermal death equation

Patterns of thermal damage in a primate model of electricalaccidents

Macroscopic patterns

Detection of thermal damage by electrical impedancespectroscopy

Automated techniques

Tissue specificity and interspecies similarity

Pathology

References

12 Evaluation of electrical burn injury using an electrical impedance technique

Introduction

Theory

Clinical aspects

Experimental studies of resistance and impedance

Results

Discussion

Conclusions

Acknowledgements

References

13 Impedance spectroscopy: the measurement of electrical impedance of biological materials

Introduction

Electrodes

Current distribution

Measuring instruments

Conclusion

Acknowledgements

References

14 Analysis of heat injury to the upper extremity of electrical shock victims: a theoretical model

Introduction

Thermotolerance of cells

Theoretical model formulation

Results

Discussion

Acknowledgements

References

Part IV: Biophysical mechanisms of cellular injury

15 Response of cells to supraphysiological temperatures: experimental measurements and kinetic models

Introduction

Background

Thermal injury in skeletal muscle cells: membrane permeability

Thermal injury in skeletal muscle cells: mechanical damage

Thermal injury in skeletal muscle cells: applications

Conclusion

References

16 Cell membrane rupture by strong electric fields: prompt and delayed processes

Introduction

Electroporation background

Brief description of electroporation events in an isolated cell

Electroporation of artificial planar bilayer membranes

Electrical behaviour: rupture in planar bilayer membranes

Electrical behaviour associated with reversible electricalbreakdown

Electrical behaviour: comparison of experiment and theory

Electroporation involves pores of many sizes

Molecular transport associated with electroporation

Membrane recovery after electroporation

Recovery from cell stress: death or surviva

Tissue electroporation

Summary

Acknowledgements

References

17 An anisotropic, elastomechanical instability theory for electropermeabilization of bilayer-lipid membranes

Introduction

The base state

Linear stability analysis

The first-order electric field and Maxwell stresses

Membrane elasticity

Marginal curves and stability maps

Comparisons of the anisotropic model results with experimentsand concluding remarks

References

18 Electrical injury to heart muscle cells

Introduction

19 Skeletal muscle cell membrane electrical breakdown in electrical trauma

Experimental observations

In vitro muscle strip

Enzymatically isolated single cell

Cell membrane

Theoretical models

Distribution of electric field in the heart

Effect of external electric field on cardiac cell potential

Electroporation

Discussion

Alterations in cellular homeostasis

Future directions

Acknowledgements

References

20 Theory of nonlinear conduction in cell membranes under strong electric fields

Introduction

Distribution of pores in bilayer-lipid membranes

Conductivity of a single pore in a bilayer-lipid membrane

Estimation of the Born energy

Current density through an aqueous cylindrical channel

Bilayer-lipid membrane conductivity

References

Index