Electrical Burns
Electrical burns and injuries can cause temporary or permanent damage to the skin, tissues, and major organs. Caused by contact with exposed parts of electrical appliances, wiring, or lightning strikes, electrical burns and injuries can range in seriousness. Still, even short contact with an electrical current can cause injuries. For example, an electrical shock from a household current can cause fatal heart dysrhythmias. In addition, small surface electrical injuries may be associated with devastating internal injuries. These injuries are often work-related and have significant public health and economic impact.
Signs and symptoms of an electrical burn:
- Visible burns on the skin
- Headache
- Weakness
- Numbness
- Tingling
- Lightheadedness
- Heart arrhythmias
Electrical burn injuries can include:
- Entrance wounds
- Exit wounds
- Arc wounds
- Thermal wounds
- Hidden wounds
The severity of an electrical burn depends on the amount of electricity you come into contact with and how long your body is connected with the current. Similar to other burns, electrical burns have three degrees of severity, with tissue damage depending on:
- The voltage of the source
- The amperage of current passing through the tissues
- Resistance of tissue traversed by current
- Duration of contact
- Pathway of the current
HOW TO TREAT ELECTRICAL BURNS
A major concern with electrical burns is whether or not the victim has suffered injuries as a result of the electrical current, so any odd sensations, feelings or pains, even remote from the burn, need to be evaluated urgently. Electrical injuries can sometimes be contained to thermal (electricity can create heat and cause a thermal burn or in addition, can be conducted through the body to cause a wide variety of internal injuries).
The guidelines on how to treat an electrical burn depend on the degree of the burn. Mild burns like first-degree and minor second-degree burns can sometimes be treated at home—although it’s always advisable to seek the opinion of a healthcare professional. Severe burns from a more extensive second-degree electrical injury or third-degree burn require immediate intervention and emergency treatment.
Mild Burns
For minor or mild burns, follow these first aid steps:
- If symptoms persist or there is any doubt about the severity of a burn, consult your physician, call 911 or head to the nearest hospital with an emergency department.
- Remove clothing from the affected area.
- Avoid popping blisters, as this can lead to infection.
- Do not use ice or attempt to disinfect the skin with iodine, alcohol or other cleansers. Instead, soak the affected area, apply a cold, wet compress or run under cool water for at least 20 minutes.
- Cover the affected area with a clean, dry and sterile non-stick dressing.
- Never apply oily substances, home remedies like butter, mayonnaise or egg whites, or medicine from your bathroom cabinet directly to the wound.
- Administer over-the-counter pain relievers like ibuprofen or acetaminophen to reduce pain and swelling.
- Apply moisturizing lotion or petroleum jelly to hydrate the skin and retain moisture to prevent dryness and itching as the burn heals.
Severe Burns
For more severe injuries, electrical burns treatment may include resuscitation and recovery can include surgery and skin grafts. So, it is vital to seek professional assistance as soon as possible. Call 911 or head to the nearest hospital with an emergency department. While you are waiting for help to arrive, follow these first aid steps:
- Make sure the electrical source has been turned off.
- Check for breathing and provide CPR if needed.
- For an electrical burn on hands, arms, legs or feet, raise the burned limb above heart level.
- Cover the victim with warm, dry clothes or blankets.
- Keep checking their breathing and pulse rate until medical personnel arrives.
When to Seek Emergency Care for Your Electrical Burns
The danger posed by electrocution burns depends on the current, voltage, how the electricity travels through the patient’s body and the victim’s overall health. However, even a small amount of electricity can be fatal. For example, an electrical burn on the hand may not leave a visible mark but could still cause significant internal damage and possibly even cardiac arrest. That’s why it’s essential to get properly checked as soon as possible.
While milder burns may not be quite as time-sensitive, you should call 911 immediately if you notice any of the following symptoms:
- Confusion
- Difficulty breathing
- Pain and contractions
- Seizures
- Heart rhythm problems (arrhythmias)
- Cardiac arrest
- Loss of consciousness
If you are helping someone else who has been burned, be sure to secure your safety and secure the scene:
- Turn off the source of electricity.
- Don’t touch an injured person if they are still in contact with a live electricity source.
- Don't use your bare hands to move an electricity source.
- Don't move someone with an electrical injury unless they are in immediate danger.
Electricity Burns - Tissue Resistance
Tissue resistance is an integral part of electrical burn injury physiology. Once resistance is overcome, current flows through the underlying tissue. The body acts as volume conduct, and the current flows through the involved body part. Bone has high tissue resistance. However, the heat generated from current washing along the bone surface may damage adjacent muscles. As a result, serious muscle injury may occur from electrical burns even when superficial muscle appears normal.
Your body tissues rank from highest to lowest tissue resistance as follows:
- Bone - Highest Tissue Resistance
- Fat
- Tendon
- Skin
- Muscle
- Vessel
- Nerve - Lowest Tissue Resistance
Questions to Ask:
- What was the voltage from the source?
- What was the amperage of current passing through the tissues?
- What was the resistance of the tissue traversed by the current?
- What was the pathway of the current?
- What was the duration of contact?
- Was the patient thrown, or did the patient fall?
- What was the estimated voltage?
- Was there a loss of consciousness?
- Was CPR administered?
How Long Does It Take for Electrical Burns to Heal?
The time it takes to recover from electrocution burns will depend on the severity of the damage and how soon after an accident a patient receives the proper electrical burn treatment. Like any other burn, an electric burn has three degrees of severity. Each type has different symptoms and will vary in healing time.
First-degree electric burn - Only the epidermis, the outermost and most superficial layer of skin, is damaged. First-degree burns usually heal in around 7-10 days.
Second-degree electric burn – Both the epidermis and the next layer of skin underneath, known as the dermis, is damaged. Symptoms include pain, redness and blistering, with possible oozing or bleeding. The healing process can take 1-3 weeks.
Third-degree electric burn - Extends through the epidermis and dermis to the deepest layers of tissue and nerves. Sometimes the muscle and fat beneath an electric burn are visible. However, pain is rare because the sensory nerve endings are usually destroyed. After the appropriate medical intervention, healing can take a few weeks.
Preventing Electrical Burns and Additional Injuries
The good news is there are many precautions you can take around your home to avoid an electrical burn.
Hands are a common first point of contact for electrical injuries, so many effective techniques involve nothing more than being mindful about what you touch and pick up.
- Never insert foreign objects into an electric socket. Instead, use proper childproof plug covers (these are widely available in hardware stores).
- Do not use electrical appliances near a standing or running water source.
- Only plug one appliance into an outlet at a time.
- Do not stick metal cutlery like knives and forks into toasters or other electric appliances.
- Check electrical cords often and replace them as soon as you notice signs of wear, cracking or fraying.
- Hold the plug rather than pulling on the cord when removing an appliance from a socket.
- Immediately replace any appliances that give off excess heat, smoke, sparks or causing small shocks.
- Always unplug appliances before attempting to repair them.
- Never allow children to play with electrical appliances and teach them about electrical safety at a young age.
- Never leave appliances like hair dryers or other heat sources unattended near children.
- Don’t run extension cables underneath rugs.
- Try to leave three feet between combustible appliances and flammable objects like curtains and wooden furniture.
- Contact your local fire department and electrical groups for more tips and resources.
By applying these basic electrical safety rules, you can reduce the chances of an electrical injury. However, if you are ever in doubt, it’s good to call a professional electrician to check your home. It’s also recommended that your family’s tetanus shots/boosters are up to date to protect against additional injuries and infection should an accident happen.
Types of Electrical Current:
- Alternating Current (AC) - Marked by reversal of electron flow every half cycle. Most commercial applications use alternating current. Alternating currents are more dangerous because they can cause tetany, cardiac fibrillation, and respiratory muscle paralysis. Alternating currents have contact points but no actual entrance or exit points. Additionally, alternating currents can cause cardiac dysrhythmia.
- Direct Current (DC) - Current generated from lightning, car batteries, and medical devices. Direct current travels in one direction, and entrance and exit sites may be seen in individuals who suffer from an electrical burn.
Electrical Burns from Lightning Strike
Electrical burns resulting from a lightning strike are not typically associated with deep burns. However, monitoring any potential resulting cardiac and neurological damage is essential. The presentation of electrical burns from a lightning strike can vary widely. The most common injury results from side flash and arcing. Side flash is when current discharges through the air from object to victim. Arcing is the ionization of particles between two conductors. Side flash and arcing can cause heat that reaches 4000 degrees Celsius. Arcing may also cause clothing to ignite, resulting in thermal burns. It can also vaporize metal.
Indicators of High-Voltage Electrical Burn Injury
- Loss of consciousness
- Paralysis or mummified extremity
- Loss of peripheral pulse
- Flexor surface burns (antecubital, axillary, inguinal, popliteal)
- Myoglobinuria
- Serum CK above 1,000 IU
- Cardiac or pulmonary arrest at the scene
Because electrical burn injuries often involve areas below the skin that cannot be see (like bones or tendons that can act as conduits for the current) there are special considerations for such injuries:
- Lethal dysrhythmias
- Vascular compromise
- Compartment syndrome
- Renal dysfunction or failure
Compartment Syndrome
Compartment syndrome occurs because of increased compartment pressure due to edema. This causes reduced blood flow to the muscle. The key to prevention is not allowing the pressure to exceed capillary pressure. The symptoms of compartment syndrome include numbness or tingling in the extremities, decreased or absent pulses, pain when flexing or extending muscles within the compartment, and pallor.
Surgical Intervention for Vascular Compromise
Escharotomy is the proper treatment for circumferential and cutaneous burns. Fasciotomy is required in the case of sub-fascial edema or muscle compartment pressure elevation. In an upper limb, an incision should be made through the skin, subcutaneous tissue, into the underlying fascia if needed. The carpal and or cubital tunnel may need to be released. There must be ensured protection of the ulnar and brachial nerve. Lower limbs are particularly susceptible to injury because of the muscle between bones and the tight intermuscular septum.
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