Electrical Injury

• • 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

Epidemiology

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

Symptoms and Signs

• • 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

Laboratory Findings

• • Myoglobinuria

  • Rapid drop in Hct (lysis)

Rule Out

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

When to Refer

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

• • 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

Surgery

Indications

• • Dead or devitalized tissue

Complications

• • Acute tubular necrosis

Prognosis

• • Related to voltage, path, type

Prevention

• • Public education

References