3. Electric Burn:
• Electrical burns and injuries are the result of
electrical currents passing through the body.
Temporary or permanent damage can occur to
the skin, tissues, and major organs.
4. Causes:
Accidental contact with exposed parts of electrical appliances, wiring, or
lightning strikes. May occur when:
• Children bite on electrical cords
• Utensils or other metal objects are
poked into electrical outlets or appliances.
5. Causes:
• The power supply is not shut down before making home repairs or
installation.
• A plugged-in appliance is dropped into water.
• Occupational accident.
6. Types of electrical injury:
1. Low voltage electric burn (<1000V):
May cause blisters and local tissue damage and may
or may not cause deep tissue damage. It may cause
cardiac arrest.
Example : home electrical appliances, car batteries
7. Types of electrical injury:
2. High voltage electric burn (>1000V):
It causes deep tissue damage. Due to deep muscle damage,
limbs become very swollen and tense on palpation which
eventually causes decrease in peripheral circulation and loss of
pulses, called compartment syndrome. Death can be caused by
respiratory arrest
8. Types of electric burn:
• Lightening : Burn injuries from lightening is
due to ultra high tension energy. When
lightening strikes the victim, chances of
mortality is very high. Cardio-respiratory
9. Symptoms:
• Numbness or tingling
• Weakness
• Headache
• Pain
• Feeling disoriented
• Lightheadedness because of low blood pressure
• Seizures
• Unconsciousness
• Visible burn on skin
10. Symptoms:
• Cardiac arrest
• Arrythmias : Many of them die of asystole at the site of injury due to
passage of electric current through the conducting system of the heart. If
they survive, they can have arrhythmia within the next 24 hours especially
if the patient has preexisting heart disease.
• Respiratory failure
• AC causes tetany of muscles of hand
11.
12. Diagnosis:
• First-degree burns —Injury is only to the outer layer of skin.
They are red and painful, and may cause some swelling. The
skin turns white when touched.
13. • Second-degree burns —These burns are deeper and
more severe. They cause blisters and the skin is very
red or splotchy. There may be more significant
swelling.
14. • Third-degree burns —These cause damage to all layers
of the skin down to the tissue underneath. The burned
skin looks white or charred. These burns may cause
little or no pain because the nerves in the skin are
destroyed.
15. Test:
1. 12-lead ECG
- initial ECG must be done in all the patients to look for any cardiac
changes
- if ECG of any patient shows changes in ECG, continuous monitoring must
be done for at least 24 hrs.
16. 2. Blood tests : cardiac enzymes
3. Urine output
• damaged muscles release myoglobin release myoglobin High load of
myoglobin is presented to glomeruli in the kidney blocks the glomeruli and
causes renal failure
17. . Urine may be brick colored or dark red depending on the
concentration of myoglobin.
4. CT or MRI
18. Management:
• The source of power must be cut. Patient must be
taken to Emergency department of the hospital right
away.
19. Management:
• Severe symptoms require immediate care:
a loss of consciousness
seizures
difficulty in breathing or severe injury will need
emergency help. Those may be:
• Airway and breathing support
• Cardiopulmonary resuscitation (CPR).
• IV fluids to restore balance in the body
20. Fluid management:
• Fluid management must be especially be monitored because
of myoglobinuria:
The quantity of fluid administration must be titrated to
maintain an adequate urinary output.
21. • In adults, Ringer lactate solution is administered at a rate
sufficient to maintain a urinary output of 100 mL/hr.
In children: 2ml/kg/hr
• Mannitol is given 25gm 6 hourly for adults or 1gm/kg/day
• Alkalization of the urine :
Adding sodium bicarbonate to the IV fluid increases the
solubility and clearance rate of myoglobin in the urine .
22. Surgical management:
• Fasciotomy to salvage the limbs in case compartment
syndrome is developed.
• Amputation of the affected limb to save the patient’s
lives
• Several surgical debridement of the wound
• Eventually coverage of the defect or wound with skin
graft or various kinds of flap.
Trainer can also tell little bit about arc burn and flash burn.
Trainer can ask what other burn might result from electrical burn (flame burn because of sparks)
Ask some symptoms to the trainees.
(preventing the victim from releasing his/her grasp)
- trainer must explain symptoms of electric burns will depend on 7 factors: (1) type of current, (2) amount of current, (3) pathway of current, (4) duration of contact, (5) area of contact, (6) resistance of the body, and (7) voltage.
Fractures, dislocation are also common as the person can be thrown away from the source of electricity or due to fall
Therefore proper history is very important
Like other burns, electrical burns have 3 degrees of severity, each with distinctive symptoms:
Trainer can tell/ask the participants about entry and exit wound
Muscle damage is not evident from outside because it may be hidden from the intact skin. This problem can be tackled by increasing the urine output (2 ml/kg/hour as opposed to 1 ml/kg/hour with other types of burns). This can be achieved by either giving plenty of intravenous fluids or mannitol in dire cases. Diuresis can be done when the blood pressure is within normal limits. It is also helpful to alkalinize urine by giving intravenous sodium bicarbonate to increase the solubility of myoglobin.
Treatment will depend on the extent of injuries.
Less severe symptoms may only require observation.
What do you see in this picture? One should keep oneself safe while helping the victim
As, in electric burns the magnitude of damage to the underlying tissue often is grossly underestimated. Neither the percentage of burn can ne estimated with Rule of 9 nor Lund and Browder formula. Therefore even fluid calculation may not be accurate and sufficient. So titration of fluid according to urine output is important.
Mannitol is given 25gm 6 hourly for adults or 1gm/kg/day
This is to increase diuresis and reduce kidney damage. Contraindicated in case of oliguria.
trainees can be asked first what are the different surgical management for electrical burn
