ELECTRICAL INJURY

By:
Mohd Khairul Izzati Omar
 PATHOPHYSIOLOGY
• The nature and severity of electrical burn injury are
directly proportional to the current strength, resistance,
and duration of current flow
• Based on Ohm’s Law
• Damage depends on:
- voltage
- resistance of tissue
- amperage
- type of circuit
- current pathway
- duration of contact
• VOLTAGE
high voltage results in greater current flow and
therefore has a greater potential for tissue
destruction

• TISSUE RESISTANCE
The higher the resistance of a tissue to the flow
of current, the greater the potential for
transformation of electrical energy to thermal
energy at any given current
Skin Resistivity
Least Nerves
Blood
Mucous membranes
Muscle
Intermediate Dry skin
Tendon
Fat
Most Bone
• AMPERAGE
• A very narrow range exists between the threshold
of perception of current (0.2to 0.4 mA) and let-go
current (6 to 9 mA)
• Let-go current = the level above which a person
becomes unable to release the current source
because of muscular tetany.
• Thoracic tetany can occur at levels just above this
let-go current and result in respiratory arrest
owing to paralysis of the muscles of respiration
1 mAmp Threshold of perception
5 mA Maximum harmless current
10 mA “Let-go” current
20 mA Possible tetany of resp muscles
100 mA VF threshold
6A Defibrillation
20 A Household circuit breaker opens
• TYPE OF CIRCUIT
• High-voltage DC contact tends to cause a single muscle
spasm, often throwing the victim from the source. This
results in a shorter duration of exposure but increases
the likelihood of traumatic blunt injury
• AC exposure to the same voltage tends to be three
times more dangerous than DC. Continuous muscle
contraction, or tetany, can occur when the muscle fibers
are stimulated at between 40 and 110 times per second
• entry and exit points – source and ground point
• DURATION
the longer the duration of contact with high-
voltage current, the greater the electrothermal
heating and degree of tissue destruction

• PATHWAY
pathway that a current takes determines the tissues
at risk, the type of injury seen, and the degree of
conversion of electrical energy to heat
 Low vs High Voltage
Low voltage injury High voltage injury
Voltage Less 1000 More 1000
Type of current AC AC/DC
Duration of contact Prolonged Brief (if DC)
Cause of cardiac arrest VF Asystole
Cause of respiratory arrest Thoracic muscle tetany Thoracic muscle tetany or
indirect trauma
Muscle contraction Tetanic Tetanic (if AC)
Single (if DC)
Burns Superficial Deep
Rhabdomyolysis Less common More common
Blunt injury Does not usually occur Cause by falls and violent
muscle contractions
Clinical presentation of electrical injury
1. Direct trauma from the electric coursing
through the body
2. Trauma from the conversion of the electrical
energy
3. Mechanical effects of the electric current
System Presentation

Skin Cutaneous burns

Cardiac Arrhythmias, cardiac arrest

Respiratory Respiratory arrest due to muscle tetany or central

nervous system causes

Vascular Aneurysm formation, tissue ischaemia

Neurologic Loss of consciousness, transient paralysis or

paraesthesia, peripheral neuropathy, spinal cord injury

Musculoskeletal Fractures or dislocations secondary to muscle spasm or

falls, muscle necrosis, compartment sysndrome

Renal Myoglobinuria leading to renal failure

Other Cataracts, neurophysiological effects

 MANAGEMENT
DANGER
RESPONSE
AIRWAYS + C SPINE
BREATHING
CIRCULATION
DISABILITY
EXPOSURE
• PREHOSPITAL:
- ensure the safety of the medical personnel
- aggressive and persistent CPR, even if the
victims appear dead
- in case of defibrillation or cardioversion
needed, no adjustment of the voltage is
needed
- immobilized with cervical collar and spinal
board.
• EMERGENCY DEPARTMENT:
- maintaining airway with cervical collar
- difficult airway evaluation should be made
(burns involving the face, mouth or neck)
- aggressive fluid resusscitation (especially if
heme pigment present in the urine)
- physical examination (size of burns,
neurovascular check – compartment syndrome)
 Diagnostic Studies
• ECG
- all patients receive an initial ECG to assess
for cardiac injury
Characteristics Cardiac monitoring Cardiac monitoring
NOT required if ALL IS requird if ANY of
the following the following
present present
ECG Normal Arrhthmias or
evidence of
ischaemia
History loss of No Yes
consciousness
Type of injury Low voltage High voltage
( <1000 volts) ( >1000 volts)
 Cardiac Monitoring
List of Indications for Electrocardiographic Monitoring
• Cardiac arrest
• Documented loss of consciousness
• Abnormal ECG
• Dysrhythmia observed in prehospital or ED setting
• History of cardiac disease
• Presence of significant risk factors for cardiac disease
• Concomitant injury severe enough to warrant admission
• Suspicion of conductive injury
• Hypoxia
• Chest pain
• Radiology
- c spine
- any area that patient has pain, obvious
deformity or decreased range of movement
 Treatment
• Cutaneous injury
- burns should be cleaned and covered with
sterile dressings
- mafenide acetate: localised full thicness
burns
- sulfadiazine silver: extensive burns
- may need transfer to burn center
• Injury to the extremities
- electrothermal burns affect upper extremity,
limb should be splinted in ‘Z’ position,
elevated above the heart level
- neurovascular check for compartment
syndrome (progressive neurological
dysfunction, vascular compromise)
• Myoglobinuria
- do urine analysis (patients with electrical
injuries has risk of renal failure due to
myoglobinuria)
- fluid resuscitation (aim for 1.0 – 1.5 mls/kg/hr
till urine clear of myoglobin)
• Pain management
- pethidine (50 – 75 mg)
- diclofenac sodium (75 mg)
 Special Situations
• Paediatrics
- oral commissure burn
• Obstetrics
- fetal injury depends on the flow of current
through the mother’s body
- need fetal monitoring
 Disposition
• Admission
- high voltage injury
- specific organ system involvement
- neurovascular compromise to the
extremities
- oral commissure burns
- deep hand burn
• Discharge
- low voltage injury, no evidence of burns
- normal ECG
- no history loss of consciousness
 Summary
• ECG for all patients
• Cardiac monitoring when indicated
• Fluid resuscitations to prevent hypovolaemia
and renal failure
• Frequent neurovascular checks – for
compartment syndrome
Thank You