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
- 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 contact 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
Initial treatment of an electrical burn depends on what injuries were caused and the individual's response to the electric shock. These initial steps should be taken with safety in mind so that no one else is injured:
- Ensure that electrical power is off before touching the patient
- Ensure patient is removed from the source
- Start CPR if needed
- Remove all clothing and jewelry
- Document pulses
- Monitor for dysrhythmias
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.
The following are body tissues ranked from highest to lowest tissue resistance:
- Bone - Highest Tissue Resistance
- 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?
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. Side flash is when current discharges through the air from object to victim. Arcing is the ionization of particles between two conductors. Additionally, it can cause heat that reaches 4000 degrees Celsius. Arcing may cause clothing to ignite, resulting in thermal burns. It can also vaporize metal. Forms of explosion can dissipate excess energy
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)
- 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 seen, such as 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 occurs because of increased compartment pressure due to edema. This causes less 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 Intevention 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 the 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. The lower limb is particularly susceptible to injury because the muscle between bones and the tight intermuscular septum.
For more information on electrical burns or how to treat them, contact Burn and Reconstructive Centers of America at 855-863-9595. If you’re a healthcare provider looking to refer a patient, check out our referral process and how we’re able to assess and create a care plan in minutes.