Although electrical burns constitute a small percentage of burns patients admitted, they are an important subset because of high morbidity caused and active management required. The purpose of the study was to analyse the clinical and epidemiological features of electrical burns patients admitted in Safdarjang Hospital during the year 1998. A total of 110 patients were admitted. There was low mortality but high morbidity characterized by multiple surgeries for debridement, amputation, and flaps cover and split skin grafting. Almost all of the admitted patients had high-tension burns, construction workers being the most commonly affected. It is suggested that more emphasis should be paid on preventive measures like stringent building bylaws and safety precautions since even after aggressive treatment few patients are able to return to their original occupation.

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The aim of the present work is to study the viscosity of blood and its serum afflicted with Gram-negative bacterial infection in case of thermal burn injuries ranges from 0≤A_b≤70. To understand the flow of blood in the circulatory system the alterations in the viscous behavior of the blood in the human physiology resulting due to severe burn trauma is studied. We have taken into account three forms of burn injuries: (a) thermal (6) Electrical (c) Chemical. It is concluded that the biochemical alterations following thermal injury rise the viscosity with the penetration of infection and increases with the percentage of hematocrit. It decreases with the increase in temperature.

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Sudden and unexpected deaths in burn patients have occasionally been reported in the literature. Sometimes due to stormy course it is difficult to ascertain the exact cause of death. A retrospective. study of all deaths occuring at Burns Center of Kasturba Hospital, Man!pal during past two years was done to document the incidence of unexpected and sudden deaths. Of the 206 patients admitted during this period 68 patients (33%) died. In four patients death was unexpected andlor sudden. This constituted 5.9% (4/68) of all deaths. Out of four sudden and unexpected deaths two (2.9%) were due to septicemia, one (1.5%) was due to saddle pulmonary embolus and one (1.5%) was due to tracheal necrosis following endotracheal intubation.

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Severe growth retardation and reduced thickness of bones and joints is a common finding resulting from burn contracture which persists even after the release of contracture. Cutaneous scar contracture alone is not responsible for these skeletal changes but reduced blood supply to bones and joints due to trauma or scar tissue leads to restriction of growth. Wherever there has been continuous pull from scar, it leads to increased flow of blood. At these sites there was excessive new bone formation and hyperplasia of the bone, but in our study it was seen that the thickness of the bone was reduced in all the cases. Burn scar contracture did not always led to growth retardation as it was observed in just six cases. It was observed that these changes i.e. growth retardation and thinning oi bone could not be reversed when the pulling force of scar tissue was removed by release and split skin grafting as studied in fourteen cases. Encouraged by this observation we tried to find out the cause of bone atrophy and we found in our study that these effects are reversed when by any means along with the release of pulling force vascularity of the part is increased, though there was not much change in the length of the bone. The effects are normally unpredictable but they are seen maximum when scar formation is seen during infancy and remain uncorrected for more than five years.

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The various problems seen in the cases of electric burns are skin loss, muscle necrosis, and nerve damage, thrombosis of vessels, exposure of neurovascular bundles and gangrene of extremities. Of these one of the most fatal is the exposed vessels which can present as a blowout leading to life-threatening hemorrhage, virtually uncontrollable. As the prevention is better than cure, it is wise to provide a proper cover to any exposed vessel frequently by a muscle. It is seen that a vascularized muscle cover improves the vascularity of the vessel walls, controls the infection and hence prevents the vessel walls from sloughing out.

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After the release of post burn contracture and split thickness skin grafting, a nasogastric tube is commonly used in the postoperative period. This study compares a group of patients in which no nasogastric tube was used with patients in which it was used. Results revealed that patients without nasogastric tube were more comfortable while there was almost similar incidence of graft loss in both groups. Thus we feel that the use of nasogastric tube after release of post burn neck contracture is unnecessary.

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Although patients with electrical burns constitute only about 5 % of the patients admitted with burns, the injury is often devastating for the patient. Because of injury to vital structures like nerves and tendons, there is a very high incidence of loss of function apart from a high rate of amputation. Various theories have been given to explain the pathophysiology and the typical pattern of injury seen in the electric burn. Our experience of large number of patients at Safdarjang hospital shows that the blood vessels show the least resistance to electrical current and the typical distribution of injury in the wrist, elbow and axilla can be explained on this. The progression of injury is due to venous and arterial thrombosis and early intervention must be aimed at augmenting it by flap cover.

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Development of various degrees of organ failures in severely burned patients is extremely high and often fatal. A studv was conducted to elucidate the etiology and clinical significance of Multiple Organ Failure (MOF) in burn patients. Fifty patients admitted with extensive burns more than 40% Total Body Surface Area (TBSA) involved were studied for the development of failure of vital organs especially the lungs, heart, kidneys, blood coagulation system, liver and pancreas. Thirty-five patients developed MO F and the most frequently involved organs were the lungs, followed by kidneys, heart, blood coagulation system, pancreas and liver. The mortality was 84% and inhalation injury along with shock were the common contributory factors to the morbidity and mortality. It was also elucidated that MOF can develop even without any focus of infection.

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This study was undertaken to compare the rate [MRSA] Methicillin resistant Staph aureus infection in our Burn Unit during the period 1995-1997. MRSA is a common cause of infection in Burns patients and is spread by hand and airborne particles, resulting in significant implications for patient nursing, treatment and recovery, providing a reservoir of MRSA within the burn unit and increasing the risk of infection for other patients. The percentage positivity of MRSA which was 20.5% in 1995 increased to 28.5% in 1996 and dropped to 13.6% in 1997. Judicious use of antibiotics coupled with strict nursing barrier seems to have contributed to this decrease in MRSA infection.

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