ELECTROCUTION

BY
ANGELIE OROPILLA, MD
ELECTROCUTION
Almost always due to alternating current (35-150 Hz)
Human beings are 4-6x more sensitive to alternating
current (AC) than direct current (DC)
Amperage is the most important factor
Current is directly related to voltage and inversely
related to resistance
Greater the voltage, the higher the current
Greater the resistance, the lower the current
FACTORS DETERMINING SEVERITY OF
ELECTRICAL INJURY
Nature of the current
Voltage involved
If alternating current, frequency involved
Amount of current
Length of time the victim is in contact with the
current
Condition of the earth (dry or wet), if the earth is
part of the circuit
Resistance of the body
The path of the current through the body
LOW VOLTAGE DEATH
Voltage less than 1.000
volts
Cause of death not always
obvious
Direct contact between
victim and the electrical
circuit
Death primarily due to
ventricular fibrillation
If low current but great
contact time= death may
still occur but mechanism
of death is by muscle
paralysis with secondary
asphyxia
HIGH VOLTAGE DEATH
Voltage more than 1,000
volts
Direct contact not
necessary as current may
arc to victim
Electric arc can generte
high temp. (4000C)
Death due to respiratory
arrest or electrothermal
injuries caused by heat
generated by current
RESISTANCE & CURRENT FLOW
Since voltage is fairly constant, changes in
resistance becomes an important factor in
determining amount of current that will flow
through the body
Blood and body fluids offer the least
resistance
RESISTANCE & CURRENT FLOW
Human skin provides the greatest degree of
resistance
Type of Skin Resistance (ohms)
Dry,calloused,thickened 1 million ohms
Dry, non-calloused 100,000
Moist 1,000
Moist, thin 100
RESISTANCE & CURRENT FLOW
Also dependent on
type of clothing
Rubber boots and
gloves
CURRENT FLOW THROUGH BODY
Current flow through the body follow the
shortest path and not necessarily the path of
least resistance
Current may take different paths through the
body depending upon and entry and exit sites
Paths the includes heart or brain = fatal
outcome
Current
(mA)
Effect on Body
1 Threshold of perception, tingle
5 Muscle tremor
15 Muscle contraction, w/c prevents release
of line
40 Possible loss of consciousness
75-100 Ventricular fibrillation
2000
(2 Amps)
Ventricular arrest
ELECTRICAL BURN
OF THE SKIN
LOW VOLTAGE
Electrical burns in about
50% of cases
If victim remains in contact
with the electrical source,
severe burns may be seen
Electrical burns may be
hidden (mouth)



ELECTRICAL BURN
OF THE SKIN
HIGH VOLTAGE
Electrical burns are seen
in virtually all cases
Burns produced may be
severe with charring of
tissue
Distinctive odor = burnt
cork
Multiple small pitted
burns may occur as
current arcs across body
Flash burns large
areas of the skin


ELECTRICAL BURN
OF THE SKIN
HIGH VOLTAGE
May cause explosive
injuries
Loss of extremities
Rupture of organs
If burns produced by
contact:
Fingertips or palms
Soles of the feet

ELECTRICAL BURN
OF THE SKIN
HIGH VOLTAGE
Typical burn
Chalky white or
yellow/tan with central
crater and raised pale
border
May have focal, small
areas of blackening
May be surrounded by a
zone of erythema
Punctate to 1-2 cm
Lightning strike
Virtually all discharges are negative
Direct current (1000 million volts or more)

Lightning strike
Direct strike
Contact- contact with object hit by lightning
Side flash- bolt strikes an object then jumps to
the individual nearby
Ground current- electrical energy from the
bolt move towards the ground and results in
injuries


Lightning strike
Lightning strike
Lightning strike
Arborescent marks
Lichtenberg bodies
Filigree burns
Lightning strike
Cardiopulmonary arrest
Electrothermal trauma
Paralysis of the nervous system
Complications of burns

THERMAL & FIRE INJURY
CLASSIFICATION OF BURNS
ACCORDING TO
DEPTH OF INJURY
FIRST DEGREE
Limited to superficial
epidermis
Erythema & edema
Blistering not present
Painful
No scarring
Ex. Mild sun burn

CLASSIFICATION OF BURNS
ACCORDING TO
DEPTH OF INJURY
SECOND DEGREE
Partial thickness burns
Involve all of epidermis &
some of dermis
Sparing of skin appendages
Blister
Senses intact, with some
associated pain
Heal without scarring
except in deep burns which
may scar
CLASSIFICATION OF BURNS
ACCORDING TO
DEPTH OF INJURY
THIRD DEGREE
Full thickness
Necrosis of all skin
layers including skin
appendages
Burned area appears
white
Sensation is lost
Severe scarring

CLASSIFICATION OF BURNS
ACCORDING TO
DEPTH OF INJURY
FOURTH DEGREE
Charring injury
Incineration of tissues
Complete destruction
of the skin and
subcutaneous tissue
Complete or partial
charring of the bone

CHARRED BODIES
Charring may:
Produce large splits in the
skin or muscle
Occur parallel to muscle
fibers
Not due to to antemortem
trauma
Pugilistic attitude
Flexion of the upper
extremities similar to a
boxer holding hands in
front of his face
Flexures develop as body
cools, not a reflexion of
position of body prior to
burning
CHARRED
BODIES
Charring may:
Complete absence of
fingers, toes and
portions of
extremities
Heat fractures
heat epidural
form as the blood
boils out of the venous
sinuses
Chocolate brown,
spongy or crumbly
Located over frontal,
temporal or parietal
areas of brain
CHARRED BODIES
May be charred on
outside but internal
organs are usually well
preserved

BURN SEVERITY FACTORS
INTENSITY OF THE HEAT
Ordinary house fires = less than 1200-1600 F
industrial fuel fires = greater than 1900-2100 F
DURATION OF EXPOSURE
Skin exposed to heat for 2 hrs
Hyperemic without loss of epidermis
Skin exposed to heat for 3 hours
Complete epidermal necrosis occurs

Cremation 1500 F for 1-1 hrs
EXTENT AND PATTERN OF BURN
FACTOR AFFECTING BURN SURVIVAL
AGE
DEGREE OF THE BURN
PERCENTAGE OF TOTAL BODY SURFACE AREA
CLOTHING & BURNS
MATERIAL
Cotton fabrics
less protection
Ignite easily
Nylon, polyester, wool
produce less severe burns
Ignite less readily
TYPE / DESIGN OF GARMENT
Close fitting clothes are safer than long loose garments
(i.e. nightgowns)

CLASSIFICATION OF BURNS
ACCORDING TO AGENT
FLAME BURNS
CONTACT BURNS
RADIANT BURNS
SCALDING BURNS
Immersion burns
Splash or spill burns
Steam burns
MICROWAVE BURNS
CLASSIFICATION OF BURNS
ACCORDING TO AGENT
FLAME BURNS
Due to direct contact
with a flame
Severity depends upon
the length of time the
flame is applied


CLASSIFICATION OF BURNS
ACCORDING TO AGENT
FLASH BURNS
Variant of flame burn
Caused by sudden
ignition or explosion of
fine particulate matter
or gas
Produces a uniform
burn (1
st
or 2
nd
degree)
of all exposed areas of
the skin, singes hair


CLASSIFICATION OF BURNS
ACCORDING TO AGENT
CONTACT BURNS
Occur when skin is in
contact with a hot
object such as hot iron
May have
configuration or shape
of hot object that was
applied to the skin
CLASSIFICATION OF BURNS
ACCORDING TO AGENT
RADIANT BURNS
Occur when skin is
exposed to heat waves
Contact with heat
source is not necessary
for a burn to occur
May produce blisters &
erythema
Prolonged exposure
may result in charring
CLASSIFICATION OF BURNS
ACCORDING TO AGENT
SCALDING BURNS
When the skin is
contacted by a hot
liquid
Water at 70 C
Produce 3
rd
degree
burns in about one
second of contact
Water at 55 C
Almost 25 seconds to
produce same burn
CLASSIFICATION OF BURNS
ACCORDING TO AGENT
IMMERSION BURNS
Accidental / homicidal
Homicidal example
Child abuse
Immersion of child in
tub full of scalding
water
Burns with sparing of
knees, popliteal fossae
and inguinal regions
CLASSIFICATION OF BURNS
ACCORDING TO AGENT
SPLASH BURNS
Usually accidental
Caused by spilling hot liquid over the body
STEAM BURNS
Usually accidental
Superheated vapor can cause severe injury to the mucosa
of the airway
Massive laryngeal edema may occur
CLASSIFICATION OF BURNS
ACCORDING TO AGENT
MICROWAVE BURNS
Most are accidental
Occur as an individual reaches into a microwave which has not
turned off completely or by ingestion of scalding hot liquid
heated in a microwave

CLASSIFICATION OF BURNS
ACCORDING TO AGENT
CHEMICAL BURNS
Strong acids and alkalis
Phosphorus, phenols
Burns produced slower
than by thermal agents

Extent of injury depend
on:
The chemical agent
Strength or
concentration of agent
Duration of contact with
the agent
CLASSIFICATION OF BURNS
ACCORDING TO AGENT
Alkaline agents
Tend to cause more
severe injury than acid
agents
Produce burns generally
have a pH greater than
11.5
Frequent produce full
thickness injury
Produce burns that
appear pale and feel
leathery and slippery

CLASSIFICATION OF BURNS
ACCORDING TO AGENT
Acid agents
Produce only partial
thickness burns
May be accompanied
by erythema and
superficial erosion
Death due to burn injury
Immediate death
Within minutes to hours of the injury
Delayed death
Occur as result of numerous possible complications
Death due to burn injury
Immediate death may result
from
Neurogenic shock
Direct thermal injury
Large amount of fluid
loss=hypovolemia = shock, acute
renal failure
Inhalation injury
Soot in nares or mouth
Externsive thermal injury of
airway mucosa = mucosal
necrosis & edema =
bronchospasm or upper airway
obstruction due to laryngeal
edema
Carbon monoxide poisoning

Death due to burn injury
Inhalation injury
Other noxious agents
Cyanide
Acrolein
Reactive aldehyde produced by burning wood & petroleum products
Injury by protein denaturation
Hydrochloric acid
Due to combustion of plastsics, furnishings building components
Pulmonary edema may be delayed for 2-12 hours after exposure
Tolouene diisocyanate
Nitrogen dioxide
Death due to burn injury
Inhalation injury
Other noxious agents
Tolouene diisocyanate
Produced by burning polyurethane
May cause severe bronchospasm

Nitrogen dioxide
Produced in fires involving automobiles or agricultural wastes
Even brief exposure could cause broncho/larungeal spasm and
pulmonary edema
Chronic interstitial lung disease may be a late complicataion
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