Electrical Burn Injuries

Electrical Burn Injuries are a complex form of injuries that are associated with high rate of morbidity and mortality. The severity of electric injuries depends upon the type of current, the voltage, and the resistance.

Electrical injury damage to tissues is caused by electrical current passing through the body. Symptoms range from skin burns to internal organ damage, soft tissue damage, cardiac arrhythmias, and respiratory arrest.

Diagnosis is based on history, clinical criteria, and selective laboratory testing. Treatment is supportive, with aggressive care for severe injuries.

Etiology:

Accidental electrical burn injuries may be encountered at:

  • Domestic level (eg, touching an electrical outlet or getting shocked by a small home appliance), Children may experience a low-voltage injury by biting or chewing on an electrical cord
  • Occupational injuries occur as a result of contact with power lines, electrical machines or tools.

Types of Electrical Burn Injuries:

  • Low voltage electric injury ( domestic level electricity 110- 120 volts)
  • High voltage electric injury ( greater than 1000 Volts)
  • Flash burn injury

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Pathophysiology of Electrical Injuries:

The severity of electrical current injury depends on following factors:

  • Type of electric current (direct [DC] or alternating [AC])
  • Voltage and amperage (strength of electric current)
  • Duration of exposure (longer exposure increases severity of injury)
  • Body resistance
  • Pathway of current (determines the specific tissue damaged)

The Pathology of tissue Damage caused by electric current include:

  • Hemolysis
  • Protein coagulation
  • Coagulation necrosis of muscle and other tissues
  • Thrombosis
  • Dehydration

Signs and Symptoms of Electrical Burn Injuries:

It includes:

  • Skin damage due to electric current penetration into deeper tissues
  • Severe involuntary muscular contractions or tetany,
  • Fits & seizures,
  • Cardiac arrhythmias or Ventricular fibrillation,
  • Respiratory arrest due to central nervous system (CNS) damage,
  • muscle paralysis,
  • Brain, spinal cord, and peripheral nerve damage may result in various neurologic deficits.
  • Cardiac arrest

Young children who bit on electric extension wires can burn their mouth and lips. And may result in impair growth of the teeth, jaws, and middle face.

An electrical shock can cause powerful muscle contractions leading to falls (eg, from a ladder or roof), resulting in dislocations or fractures, injuries to internal organs, and other blunt injuries.

Late sequelae include neurologic, psychologic, and physical injuries, which develop 1 to 5 years later e.g. cataract, fits and seizures, contracture & bony deformities.

Diagnosis of Electrical Injuries:

  • Detailed history
  • Head-to-toe examination
  • Initial resuscitation
  • Investigations: Sometimes complete blood count, ECG, cardiac enzyme measurement, and urinalysis (to check for myoglobin). Patients with impaired consciousness may require CT or MRI.

Treatment of Electrical Injuries

  • Shutting off current source to stop the process of damage.
  • Resuscitation: Shock may result from trauma or massive burns, is treated. Fluids are titrated to maintain adequate urine output (about 1-2 mL/kg/h). To prevent acute renal failure due to myoglobinuria, maintaining adequate urine output is particularly important.
  • Analgesia
  • Sometimes cardiac monitoring for 6 to 12 hours: is indicated for patients with the following conditions:
    1. Arrhythmias
    2. Chest pain
  • Any suggestion of cardiac damage.
    1. Known heart disorders.
  • Surgical debridement and Wound care.

All patients with significant electrical burn injuries should be referred to a specialized burn unit for acute burn wound management and wound healing.

Deterrence and Patient Education

To help prevent domestic electrical burn injuries, the following precautions should be taken:

  • Put child-safety covers on all electrical outlets.
  • Keep electrical cords out of the reach of children.
  • Follow the directions when using electrical appliances.
  • Avoid using electrical appliances in wet places.
  • Turn off the circuit breaker when you are working with electricity.