电击伤紧急求助

LDF值小于2.5，微血管扩张值小于0.5为深II度烧伤；LDF值小于1.5，微血管不扩张为III度烧伤）后两种方法较客观、准确，但需一定的设备和条件，一般不轻易实现；相对来说，美蓝染色临床应用较多，便宜、方便，若组织尚存活力，可再此手术时应用。此引入一相对简单的图像判定法CASEREPORTLichtenbergfigures:cutaneousmanifestationofphoneelectrocutionfromlightning*AjayLMahajana,b,*,RuchikaRajanb,PadraicJReganaaDepartmentofPlastic,Reconstructive&HandSurgery,UniversityCollegeHospital,Galway,IrelandbDepartmentofPlasticandReconstructiveSurgery,DerrifordHospital,Plymouth,UKReceived29November2006;accepted19June2007SummaryIntroduction:Lichtenbergfiguresarereddish,fern-likepatternsthatappearontheskinwhenapatientisstruckbylightning.Theseappeartobearesultofaninflammatoryresponseascurrentspreadsoutcausingionisationandheateffectsanddamagetothesmallsubcutaneouscapillaries.CasereportA30-year-oldladywasbroughttoouraccidentandemergencydepartmentwithahistoryofmomentarylossofconsciousness.Onarrival,thepatientwasfullyconsciouswithaGlasgowcomascaleof15.Shewascomplainingofaheadacheandtinnitusinherrightear.Shealsohadparaesthesiaontherightsideofherface,neck,chest,bothhandsandrightleg.Shewasveryanxiousandwasexperiencingpalpitations.Allthatthepatientcouldrecollectwasthatshehadbeenonthephonewhensheheardaloudbangfollowingwhichshe‘blackedout’.Whensheregainedconsciousness,shefoundherselflyingonthefloor,afewfeetawayfromthetelephone.Shefeltaburningsensationandparaesthesia,mainlyontherightsideofherbody.Theburningsensationhadresolvedbythetimeshehadpresentedtous,1haftertheincident.Theweatherhadbeenquitestormyonthedayandoninspectionofthepatient,therewerecharacteristicerythematousLichtenbergfiguresontherightsideofherneck,chest,abdomen,bothupperlimbsandrightlowerlimb（Figs.1and2）.Theserevealedthetruediagnosisofalightningstrikeconductedthroughthephonelineintothepatient.Thepatientwasfoundtohaveanincreasedrespiratoryrateandpulserate.Anelectrocardiogramexaminationshowednoevidenceofarrhythmia.Neurologicalexaminationwasnormalwithfullpowerinallthelimbs.Therewasnoevidenceofanexitburnwound.Examinationoftheearsshowedaperforationintherighttympanicmembraneandtestsconfirmedasensorineuraldeafnessonthatside.Examinationoftheeyeswasnormal.Thepatienthadnootherassociatedinjuries.Shewasadmittedforobservationanddischargedthefollowingday.TheLichtenbergfiguresresolvedwithin24h.Shewasquitetraumatisedbytheeventandreceivedpsychiatriccareasshewasemotionallyverylabile.Theperforatedtympanumhealedwithconservativemanagementinafewweeksandthepatienthadsomedegreeofresidualsensorineuraldeafnessather6monthfollowup.DiscussionInjuryfromalightningstrikecanoccureitherbyadirectstrike,sidesplash（whenlightningsplashesontosomeonestandingclosetoanobjectstruckbylightning）orbystepvoltage（whencurrentflowingintheground,followingalightningstrike,goesuponelegandconductsbackdowntheother!）.1CutaneousmanifestationsrangefromsimpleLichtenbergfigurestofullthicknessburns.Lichtenbergfiguresarefern-likepatternsduetohighvoltagedischarges,firstdescribedbytheGermanphysicistGeorgChristophLichtenberginthelate1700s.2Thesearesaidtooccurduetoaninflammatoryresponseascurrentspreadsoutcausingionisationandheateffects.3Injurytothesubcutaneouscapillariesisthoughttooccur.Thesesignsgenerallyresolvewithin24hbutcanoccasionallybeassociatedwithdeeppigmentation.Dependingontheamperageofthecurrentpassingthrough,thepatientmayhavemildeffectssuchasparaesthesiaatlowamperages,whichcanprogresstotetany,respiratoryarrestorcardiacarrestfollowingventricularfibrillationsathigheramperage.4Adirectlightningstrikecanexposethepatienttocurrentsrangingfrom3kAtoover100kA.5Whenthecurrentpassesthroughthebody,thepathwayofleastresistanceappearstobethetympanicmembraneandoftenthetympanicmembraneisfoundtoberuptured.6Damagetothemiddleearmayresultinthepatientexperiencingtinnitus,ataxia,vertigoandnystagmus.Visuallosscanoccurforvaryingdurations,occasionallyfromformationofcataracts.Injuriestothecentralnervoussystemcanresultinhaemorrhage,infarction,oedemaandnecrosisofthebrainleadingtomotorandsensorydysfunctionanddelayedprogressiveneurologicaldamage.7Charcot’sparalysisorkeraunoparalysis,whichischaracteristicoflightninginjuries,canaffectallthelimbstemporarilyandresolvesgradually.8Dependingonthedegreeoftheassault,patientsmaysufferfromretrogradeamnesia,confusion,anxiety,andpsychoticbehaviour,oftenneedingpsychiatrichelp.