electric burn

1. Department of Plastic Surgery
Patna Medical College & Hospital
Electric Burn Management
Presenter: Soni Kumari
MCh 1st year Resident,
Dept. of Plastic Surgery,
PMCH, Patna

2. INTRODUCTION
• Commercial use of electricity has been one of the most potentially
dangerous commodities in our society.
• A/c statistical data, 0.8-1% of accidental deaths caused by electric
injury, with approx. one quarter caused by natural lightning.

3. Definition
• Electric injury is damage to the skin or internal organs when
a person comes into contact with an electrical current
• Electrical injuries have become a more common form of
trauma with a unique pathophysiology and with high
morbidity and mortality.

4. Classification
Four classes of electrical injuries are as follows :
• True electrical injuries - person becomes part of the electrical circuit
and has an entrance and exit
• Flash injuries - Superficial burns caused by arcs that burn the skin;
no electrical energy travels through the skin
• Flame injuries - Caused by ignition of the persons clothing by arc;
electricity may or may not travel through the person’s body
• Lightning injuries - unique type of injury that occurs at extremely high
voltages for the shortest duration; the majority of electrical flow
occurs over the body, with characteristic feature being ‘Lichtenberg
Flowers’.

6. Etiology
• 20% of all electrical injuries--in children At home, with extension
cords (60-70%) and wall outlets (10-15%)
• Adults: 4th leading cause of work-related traumatic death
• 50% of these occupational electrocutions result from power line
contact (5-6% of all work-related deaths), and 25% result from using
electrical tools or machines
• Male to female ratio is 17:1

8. Low Voltage <1000 V High Voltage >1000 V

9. Types of Circuit
• One of the factors affecting the nature and severity of electrical injury
is the type of circuit involved, either direct current (DC) or alternating
current (AC).
• 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.
Brief contact with a DC source can also result in disturbances in
cardiac rhythm, depending on the phase of the cardiac cycle affected.
• 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.

11. Body Tissue Resistance
• In electric burn, electricity travels along the path of least resistance,
which in human tissue corresponds directly with the water content of
tissue.
• Heat generated according to resistance of various tissues:
Bone has highest resistance, followed by Fat, tendon, Skin, Muscle,
Blood vessel, nerve
• Area with low cross section high bony content such as wrist and ankle
are particularly susceptible to severe injuries
• In electrical burn external injury doesn’t give proper idea of burn, it
depends upon electrical path within the body
• All electrical burns are considered as severe grade

12. Associated injuries
• Respiratory System
Suffocation secondary to tetanic muscle contractions
Respiratory arrest secondary to direct injury.
• Cardiovascular System
Asystole (more likely if DC or high V)
Arrhythmias (more likely AC) (~15% pts)
Ventricular fibrillation most common fatal arrhythmia
Myocardial necrosis (thermal effect)
Anoxic injury secondary to respiratory arrest
• Neurological System
Direct effects include LOC, autonomic dysfunction, amnesia, temp paralysis
(keraunoparalysis (clear within hours))
Spinal Cord injury secondary to spine fracture secondary to muscle contractions
Peripheral motor/sensory losses (long-term sequel)

13. • Skin
(~57% low V fatalities; ~96% high V fatalities)*
Superficial, partial or full thickness thermal burns
Degree of external injury can underestimate internal injury & vice-versa. One
should not attempt to predict the amount of underlying tissue damage from
the amount of cutaneous involvement
• Muscle
Necrosis secondary to severe contraction or thermal injury ,C0MPARTMENT
syndrome secondary to edema from deep injury & 3rd
spacing,Rhabdomyolysis and Myoglobinuria….
• Skeletal
Osteonecrosis secondary to thermal injury
Fracture secondary to muscle contraction or blunt trauma

14. Contd..
• GI Tract
Curling ulcers
Abdominal Compartment Syndrome
• Eye
Cataract can develop even 2 yrs after the burn
• ENT
Hearing Loss
• Scalp

16. Management

17. ATLS Protocol
Immediately life threatening conditions are identified and emergency
management begun:
• A. Airway maintenance with cervical spine control
• B. Breathing and ventilation
• C. Circulation with haemorrhage control
• D. Disability - neurological status
• E. Exposure + environmental control

20. Treatment
Fluid resuscitation
• Aggressive replacement if soft tissue injury
• Prevent Heme pigment-induced AKI
• Administer fluids till
Normal blood pressure
UOP (0.5-1 mL/kg/h if +ve Myoglobin // 1-2 mL/kg/h if-ve Myoglobin)
CK < 5000 U/L
negative urine for hematuria
• Not estimated from skin injury degree (Parkland formula)
• Normal Saline = best solution
• Monitor K level (released from damaged muscles)
• Over correction may lead to Abdominal Compartment Syndrome

22. Nutritional Support
• Aggressive nutritional support to counterbalance the effect of
Hypermetabolism and Protein catabolism following Burns
• ENTERAL feeding is preferred over PARENTERAL feeding
• Burns patient is hypercatabolic - up to 150- 200% above baseline.
• Nutrition needed for burns >20% TBSA.

24. Escharotomy
• Circumferencial Full thickness burn of limb and trunk requires
emergency surgery

26. Fasciotomy
• Done in cases of deep burn of limbs with Compartment Syndrome
which is characterised by severe pain, pain on passive movement,
decreased sensation along with pulselessness
• Involves incising the deep muscle fascia and is best carried out via
longitudinal incision of skin, fat and fascia

28. Abdominal Electrocution
• IAP b/w 25 & 35 mm Hg needs Decompression
• If > 35 Abdominal Decompression and Exploration needed

29. Wound Debridement
• Enzymatic Debridement
Application of commercially prepared proteolytic & fibrinolytic enzyme
to the burn wound e.g. Papain
• Surgical Debridement
Tangential Excision- Very thin layers of devitalised tissue are
subsequently until viable tissue is reached

36. Flaps
• A skin flap is a segment of tissue which transferred from its original
position in the body to another site while maintaining its own
inherent blood supply for nourishmnent

39. Thank You