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Electrical burns in children

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What is your knowledge regarding electrical burn in children,types of electrical burns in children.,characteristic features of each type ,minor electrical burn , high -voltage electrical burn ,lightning electrical burn what are the clinical presentations and management ,cardiac complication of electrical burn,neurological complication of electrical burn , cutaneous and oral complication ,masculoskeletal complication and ocular and renal complications

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Electrical burns in children

  1. 1. Prof. Dr. Saad S Al Ani Senior pediatric consultant Head of Pediatric Department Khorfakkan Hospital Sharjah , UAE anahbaghdad@gmail.com Electrical Burns in children 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 1
  2. 2. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 2 https://www.networx.com/article/electrical-safety-quiz
  3. 3.  Q1.How does electricity move from one place to another? a. Electricity travels through the air. b. Electricity travels through conductors. c. Electricity only travels through electrical wires. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 3 An electrical safety quiz?
  4. 4. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 4 http://clipart-library.com/clipart/1839625.htm
  5. 5. True or false:  Q2.Low voltage = Low hazard a. True b. False 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 5
  6. 6. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 6 https://www.canstockphoto.com/do-not-leave-kids-alone-4636702.html
  7. 7. True or false:  Q3. You are more likely to experience an electric shock if you touch an electrical object with wet hands. a. True b. False 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 7
  8. 8. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 8 https://twitter.com/singletrackelec
  9. 9. True or false:  Q4. Is it safe to run an extension cord under a carpet or along a baseboard for permanent use? a. True b. False 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 9
  10. 10. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 10 http://www.thinkstockphotos.in/image/stock-illustration-vector-illustration-of-kid-with/935702422
  11. 11.  Q5. If a friend receives a severe electric shock from an electrical appliance in your home, what should your first response be? a. Grab the appliance and throw it aside so that you can tend to your friend. b. Run to the circuit breaker and turn off the main switch. c. Use a wooden broomstick to push the appliance away safely. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 11
  12. 12. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 12 http://www.bipps.org/now-admit-no-electric-circuit-coverage-nextgen-science-standards/
  13. 13.  Q6. If you are doing an outdoor painting or roofing project and there are power lines nearby, how much space should there be between you and the power lines in order for you to stay safe? a. You, your tools and ladders should be at least 10 feet away from the power lines. b. You, your tools and ladders should be at least 20 feet away from the power lines. c. You don’t have to worry about it because power lines are insulated, so you won’t get shocked. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 13
  14. 14. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 14 https://www.dreamstime.com/stock-photos-man-electrocuted-image20443763
  15. 15. Introduction 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 15 3 Types of electrical burns 1.Minor electrical burns 2.Electrical wire burns 3.Lightning burns
  16. 16. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 16 Minor electrical burns Usually occur as a result of biting on an extension cord Produce localized burns to the mouth
  17. 17. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 17 https://www.healthline.com/health/electric-shock
  18. 18. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 18 https://safety.lovetoknow.com/Electrical_Safety_Tips_for_Children
  19. 19. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 19 https://www.phase1electricalservices.co.uk/advice/how-keep-children-safe-electrical-danger
  20. 20. Electrical Burn on Mouth. Shown is an electrical burn caused by a 110-volt household current. The injury resulted from the patient's sucking on an extension plug 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 20
  21. 21. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 21 Minor electrical burns (Cont.) Usually involve the portion of upper and lower lips May involve or spare corners of the mouth
  22. 22. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 22 Minor electrical burns (Cont.) They are nonconductive injury Hospitalization is not necessary
  23. 23. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 23 Minor electrical burns (Cont.) Care is focused on the area of the injury visible on the mouth Ensuring it is low voltage and does not cause entry and exit wounds or cardiac issues
  24. 24. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 24 Minor electrical burns (Cont.) Treatment:  Topical antibiotic creams  Referral to burn unit in the outpatient department if needed
  25. 25. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 25 High-tension electrical wire burns Result from high voltage(>1,000 V) Occur at high-voltage instillations Mortality rate for children who arrive to the hospital :3 -15 %
  26. 26. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 26 High-tension electrical wire burns (Cont.) Deep muscle injury is typical and can’t be readily assessed initially Survivors have a high rate of morbidity including major limb amputations
  27. 27. Combination of contact and flash burn .Involvement of head and neck in high voltage injuries 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 27
  28. 28. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 28 High-tension electrical wire burns (Cont.) Points of entry of current through the skin and the exit site show characteristic features Majority of entrance wounds in upper extremity with small exit wounds in the lower extremity
  29. 29. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 29 High-tension electrical wire burns (Cont.) The electrical path takes the shortest distance between the 2 points May produce injury in any organ or tissue in the path of the current
  30. 30. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 30 High-tension electrical wire burns (Cont.) Damage to: - abdominal viscera - thoracic structures - the nervous system can happen
  31. 31. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 31 High-tension electrical wire burns (Cont.) Cardiac abnormalities manifested as ventricular fibrillation or cardiac arrest are common Initial ECG and cardiac monitoring until stable is essential Higher risk patients have: + abnormal ECG + history of loss of consciousness
  32. 32. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 32 High-tension electrical wire burns (Cont.) Renal damage Results from deep muscle necrosis myoglobinuria  Need forced alkaline diuresis
  33. 33. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 33 High-tension electrical wire burns (Cont.) Compartment syndrome  Results from soft tissue injury of an extremity  Aggressive removal of all dead tissues is the key to effective treatment  Early debridement facilitates early closure of the wound
  34. 34. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 34 Lightning burns Occur when: High-voltage current directly strikes a person ( most dangerous) The current strikes the ground or an adjacent (in-contact) object.
  35. 35. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 35
  36. 36. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 36 Lightning burns (Cont.) Depend on: The current path The type of clothing worn The presence of metal Cutaneous moisture
  37. 37. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 37 https://toonclips.com/design/1460
  38. 38. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 38 Lightning burns (Cont.) Entry, exit and path lesions are possible The prognosis is poorest for lesions of the head or legs Internal organ injury along the path is common
  39. 39. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 39 Lightning burns (Cont.) Linear burns are in the locations where sweat is present Feathering or arborescent patterns, is characteristic Ignition of clothing can produce serious cutaneous burns
  40. 40. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 40 https://sciencebasedlife.wordpress.com/2011/04/28/the-science-and-myths-behind-lightning-strikes/
  41. 41. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 41 Lightning burns (Cont.) Internal complications include:  Cardiac arrest (caused by asystole)  Transient hypertension  Premature ventricular contractions  Ventricular fibrillation  Myocardial ischemia
  42. 42. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 42 Lightning burns (Cont.) CNS complications include:  Cerebral edema  Mood changes  Hemorrhage  Depression  Seizures  Paralysis of lower extremities
  43. 43. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 43 Lightning burns (Cont.) Other complications include:  Rhabdomyolysis and myoglobinuria  Renal failure  Ocular manifestations include:  Vitreous hemorrhage  Iridocyclitis  Retinal tearing or retinal detachment
  44. 44. Electrical injury : Clinical manifestations and management 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 44
  45. 45. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 45 General: Management 1. Extricate the patient • Perform ABCs of resuscitation • Immobilize the spine if an injury is suspected 2. Obtain history: voltage, type of current 3. Obtain CBC ,platelet counts ,electrolytes, BUN, creatinine and glucose
  46. 46. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 46 Cardiac manifestations • Dysrhythmias  Asystole  Premature atrial contractions  Ventricular fibrillation  Premature ventricular contractions  Sinus tachycardia  Conductive defects  Sinus bradycardia  Atrial fibrillation  St-T wave changes
  47. 47. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 47 Cardiac management • Treat dysrhythmias • Provide cardiac monitor, ECG, and radiographs (suspect thoracic injury) • Perform creatinine phosphokinase with isoenzyme measurements if indicated
  48. 48. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 48 Pulmonary manifestations • Respiratory arrest • Acute respiratory distress • Aspiration syndrome
  49. 49. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 49 Pulmonary management • Protect and maintain the airway • Provide mechanical ventilation if indicated • Chest radiograph • Arterial blood gas levels
  50. 50. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 50 Renal manifestations • Acute kidney injury • Myoglobinuria
  51. 51. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 51 Renal management • Provide aggressive fluid management unless central nervous system injury is present • Maintain adequate urine output :> 1 ml/kg/hr. • Consider central venous or pulmonary artery pressure monitoring • Measure urine myoglobin • Perform urinalysis • Measure BUN , creatinine
  52. 52. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 52 Electrical injury : Neurologic manifestations & management
  53. 53. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 53 Immediate neurologic effect Manifestations • loss of consciousness • Motor paralysis • Visual disturbance • Amnesia • Agitation • Intracranial hematoma Management • Treat seizures • Provide fluid restriction if indicated
  54. 54. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 54 Secondary neurologic effect Manifestations • Pain • Paraplegia • Brachial plexus injury • Syndrome of inappropriate antidiuretic hormone secretion • Autonomic disturbance • Cerebral edema Management • Consider spine radiographs and MRI especially cervical
  55. 55. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 55 Delayed neurologic effect Manifestations • Paralysis • seizures • Headache • Peripheral neuropathy Management • Perform CT or MRI scan of the brain if indicated
  56. 56. Electrical injury :cutaneous /oral manifestations 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 56
  57. 57. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 57 Cutaneous /oral manifestations:1 Manifestations • Oral commissure burns • Tongue and dental injuries • Skin burns resulting from ignition of clothes • Entrance and exit burns • Arc burns
  58. 58. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 58 Cutaneous /oral manifestations:1 Management • Search for the entrance and exit wounds • Treat cutaneous burns • Determine patient’s tetanus status • Obtain consultation for plastic surgery of ear ,nose ,and throat, if indicated
  59. 59. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 59 Cutaneous /oral manifestations:2 Manifestations • Electrical burns to mouth could include oral commissures and lips • Low-voltage electrical burns secondary to high conductivity of saliva
  60. 60. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 60 Cutaneous /oral manifestations:2 Management • Ensure no entry or exit wounds and no cardiac involvement • Confirm all injuries are localised • Management is observation until eschar sloughs off and granulation tissue fills in • Obtain plastic surgeon evaluation after first healing usually with scar formation
  61. 61. Electrical injury :abdominal manifestations and management 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 61 Clinical manifestations Management • Viscus perforation and solid-organ damage • Ileus • Abdominal injury rare without visible abdominal burns • Place nasogastric tube if patient has airway compromise or ileus • Obtain serum ALT,AST ,amylase ,BUN and creatinine measurements and CT scans as indicated
  62. 62. Electrical injury :Musculoskeletal manifestations 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 62 Clinical manifestations Management • Compartment syndrome from subcutaneous necrosis and deep burn • Monitor patient for possible compartment syndrome • Long bone fractures , spine injuries • Obtain radiographs and orthopedic / genera; surgery consultations as indicated
  63. 63. Electrical injury :ocular manifestations 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 63 Clinical manifestations Management • Visual changes • Optic neuritis • Cataracts • Extraocular muscle paresis Obtain an ophthalmology consultation as indicated
  64. 64. Answers to An electrical safety quiz  Q1. B: Electricity travels through conductors such as metal, concrete, water, wet wood, and even people.  Q2. B: The longer a person is exposed to an electrical shock, the more dangerous the situation becomes. A low- voltage electrocution for a mere 3 seconds can do the same amount of damage as a high-voltage electrocution does in 0.03 seconds. Either way, human bodies are damaged by electric voltage - high or low - so please be careful. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 64
  65. 65. Answers to An electrical safety quiz (Cont.)  Q3. A: Water is a good conductor of electricity, which means that wet hands can conduct electricity from the electrical object into your body. Use extreme caution when doing electrical work around water or in wet conditions.  Q4. B: No. An extension cord that is covered by carpeting can overheat and cause a fire. Running an extension cord along a baseboard is better than underneath a rug, but you should only use extension cords for temporary work situations. For long-term needs, hire a qualified electrician to install a new permanent outlet. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 65
  66. 66. Answers to An electrical safety quiz (Cont.)  Q5. B: The safest thing to do is remove the source of electricity by turning off the main switch of the circuit breaker. Touching your friend is not a good idea because he or she may conduct electricity into your body and then you will both be shocked. Using a broomstick isn’t the best idea either because if the wood is wet or dirty, it may also conduct electricity into your body.  Q6. A: Make sure to keep a distance of at least 10 feet between you, your tools and ladders and the power lines. You should call your utility company to see what safety measures can be taken if you're working near power lines. And remember, power lines may have a weather coating on them for protection against the elements, but this will not protect you from shock. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 66
  67. 67. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 67 Pinterest
  68. 68. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 68 http://shrinerschildrens.org/safetybeginsathome/
  69. 69. References  Arnoldo B, Purdue GF, Kowalske K ,et al .Electrical injuries :a 20- year review. j Burn Care Rehabil.2004;25:479-484  Chen EH , Sareen A. Do children require ECG evaluation and inpatient telemetry after household electrical exposures? Ann Emerg Med.2007;49:64-67  https://www.medscape.com/content/2004/00/47/28/472812/472812_fig.html  https://www.barnardhealth.us/forensic-pathology/electrical-burns-and-other-external-trauma.html  http://www.ijburns.com/article.asp?issn=0971- 653X;year=2013;volume=21;issue=1;spage=67;epage=70;aulast=Kasana  https://www.networx.com/article/electrical-safety-quiz 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 69
  70. 70. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 70 vectorstock.com

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