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  • • 3 kinds of electrical injuries

    • 1. Current injury

      2. Electrothermal burns from arcing current

      3. Flame burns from ignited clothing

    • Damage from electrical current is directly proportional to its intensity (Ohm's law): Amperage = Voltage/Resistance

    • Voltages > 40 V are dangerous

    • Current path through body depends on resistances: bone>fat>tendon>skin>muscle>blood>nerve

    • Pathway of current determines survival

    • Type of current also relates to severity of injury (AC>DC)

    • Electrical injuries are often more than just burns (thrombosis, hemorrhage, fractures, dislocations, etc.)

    • Deep destruction not initially evident

    • Flame burns (clothing) often most significant injury

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Epidemiology

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  • • House current (AC) particularly dangerous (cardiac arrest common)

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Symptoms and Signs

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  • • Skin burn usually depressed gray or yellow area of full-thickness burn with surrounding hyperemia

    • Charring may be present if arc injury coexists

    • Deep destruction not initially evident

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Laboratory Findings

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  • • Myoglobinuria

    • Rapid drop in Hct (lysis)

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Rule Out

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  • • Must evaluate for associated injuries, such as from blunt trauma (falls)

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When to Refer

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  • • Always transfer significant electrical injuries to specialized centers after initial resuscitation

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  • • All dead and devitalized tissue must be debrided

    • Second debridement often indicated 24-48 hrs after the injury

    • Referral to specialized center after initial resuscitation

    • Alkalinization of urine and osmotic diuresis if myoglobinuria present

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Surgery

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Indications

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  • • Dead or devitalized tissue

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Complications

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  • • Acute tubular necrosis

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Prognosis

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  • • Related to voltage, path, type

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Prevention

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  • • Public education

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References

Haberal M. An eleven year survey of electrical burn injuries. J Burn Care Rehabil. 1995;16:43.  [PubMed: 7721908]
Kendrick D. et al. Home safety education and provision of safety equipment for injury prevention. Cochrane Database of Systematic Reviews. 2007 (1):CD005014.

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