A 55year old male was harvesting coconuts on the occasion of festival. When he lifted a bamboo stick, he was electrocuted and his left hand and his body burnt up to 50%. He didn’t notice that bamboo stick and electrical pole were in contact. The incident resulted in shock and burn injury extending to both the upper limbs, front and back of the trunk and parts of the back. The patient was seeking admission in all the corporate and established hospitals in Kakinada but no hospital could admit him due to lack of 24 hrs qualified medical personnel. No hospital in the region was equipped with the required experts and the system to treat second degree electrical burns
Though Medicover at Kakinada was established recently, we decided to take up this challenging case. We were required to meet the high standards needed to treat 50% Types 2 burns case, which carries high mortality even under fully equipped Burns ward.
The patient is a known case of hypertensive for the past 10 years on regular medication. On arrival at ER, he was immediately resuscitated with IV fluids and stabilized after the initial assessment. A Plastic surgeon was requested to see this patient and he diagnosed 2-degree Deep burns and 50% involvement. He was conscious, coherent with stable vitals. GCS-15/15.
Within 45 minutes, patient was shifted to OR and the major debridement and dressing was done. Post operatively he was kept in ICU separately from the other patients with adequate medical care with separate nurse.
Proper isolation methods ensured that he would not contract Infections. Counselling sessions were conducted daily and feedback was taken from the patient’s attendant. After one week of stay, surgeon identified that gangrene developed on little finger of his left hand and amputation was done. Major dressings were done regularly. He stayed in hospital for more than 15 days with proper nursing care. Two gratings were performed on him; first graft at Medicover Kakinada and second graft at Vizag after few weeks.
Patient recovered from such high degree of deep burns only with the collaborative work of plastic surgeon, critical care team and nursing staff. This case gave us ample opportunity to streamline CSSD and critical care services. The patient received multiple debridement and dressings in both ICU and room. The patient recovered well and discharged home after 20 days stay at hospital.
Electrical burns are different from other types of burns in that they typically affect less surface area. However, Complications and risks are much higher due to internal organ injury. Damaged tissue can cause complications like gaseous gangrene, ischaemic necrosis and loss of blood flow to limbs. The damaged body parts may need to be amputated. Repeated removal of the damaged tissue with dressings and debridement are common in the management. Limbs and fingers amputation rates reach as high as 75%. Burns treatment for severe wounds may require skin grafting, debridement, excision of dead tissue, and repair of damaged organs.
Contributors
(M. Ch-Plastic and Reconstructive Surgery) Consultant Plastic Surgeon
News Letter
Medicover Hospitals Impact Newsletter November 2022
