The document discusses electric injuries, detailing their definitions, pathophysiology, epidemiology, injury mechanisms, and treatment protocols. It highlights the significance of understanding the effects of both low and high voltage electric injuries, including the risks of cardiac, respiratory, neurological, and dermatological complications. Management strategies emphasize careful assessment, red flag identification, and prevention measures, especially targeting vulnerable populations like children.

1. Department of Plastic And
Reconstructive Surgery
Sher i Kashmir Institute of Medical
Sciences Srinagar
Seminar Topic: Electric Injuries

2. Electrical Injuries
Presentor : Dr Junaid khiurshid
Moderator : Dr Haroon Rashid Zargar

3. Definition
An electrical burn is a burn that results from
electricity passing through the body causing
rapid injury

4. Physics
• I= V/R ohms law
• Intensity expressed in amperes
• DC lightning, rails, autos, batteries
• AC most power lines
• E=IVR (Joules Law)

5. The higher is the resistance of tissue the greater
transformation of electrical to thermal injuries
• Muscles & blood vessels has low resistance &
good conductor
• Bone tendon & fat have high resistance &
tend to heat & coagulate rather than transmit
the current
Callosed skin > >normal skin>> Moister & sweaty

6. Resistance of body tissues
• Most
• tendon
• Fat
• Bone
• Intermediate
• Dry skin
• Least
• Nerve
• Blood
• Muscle Membrane
• Muscle

7. Electrical Burns -
Pathophysiology
• Joule Effect:
Passage of current through a solid conductor
results in conversion of electrical energy to heat
• Ohm’s Law: I =V/R
Intensity of the current (amperage) is directly
proportional to the potential flow (voltage) and
inversely proportional to the resistance

8. Epidemology
• Accounts for 3% of all burn related injuries
• Estimated 3000 annual admits to burn units in USA
• 30 % fatal 1000 deaths in USA

9. Age distribution
• Bimodal distribution
• 1/3 in children <6 years
• 2/3 in adult electrical, construction
workers and miners
• Common cause occupational deaths

10. • In children usually occurs at home associated with
electrical and extension cords (in about 60–70%)
and with wall outlets (another 10–15%)

11. • One unique entity that affects children
(particularly < 5 years of age) is electrical burns
due to biting a live wire from an electric
appliance or mouthing the female end of a
connected extension cord.
• Injury pattern consists of burn to the oral
commissure.

12. • Can lead to poor outcomes, both functionally and
aesthetically.
– The low voltage nature of these injuries typically spares
the deep tissues.
– Can injury local labial artery and develop significant
bleeding, even in a delayed fashion when scab sloughs
off.

13. Wall outlet injury

14. • Most deaths in adults due to electrocution are
work related (5–6% of all workers’ deaths)
• Miners and construction workers account for most
of these cases, with rates of 1.8 to 2.0 deaths per
100 000 workers

16. Allmost all of current transmission is via AC
lines which are more dangerous than DC of
same voltage

17. Alternating more dangerous than direct

18. "let go" current
The maximum current at which a person can grasp the
current and then release it before muscle tetany
makes letting go impossible.
For child it is 3-5 mA; this is well below the 15-30 A of
common household circuit breakers.
For adults, the "let go" current is 6-9 mA, slightly higher
for men than for women

19. Once this is surpassed
• Tetany
• Respiratory arrest
• Ventricular fibrillation
• Occurs more readily at higher currents,
and alternating current (AC)

20. Extent of injury depends on:
• Direct vs Alternating current
• Pathway of flow
• Local tissue resistance
• Duration of contact

21. Low-voltage
• <1000 volts
• Alternating current
• Prolonged contact
• Ventricular Fibrillation
• Tetanic contraction
• Superficial Burns
• Rhabdomyolysis unlikely
High-voltage
• >1000 volts
• AC or DC
• Brief Contact
• Asystole
• Tetanic Sometimes
• Deep Burns
• Rhabdomyolysis Likely

22. High Voltage Accidental Electric Burn

23. • Mortality of electrical burns
Low voltage injuries Alter the cardiac cycle
• High-voltage injuries Cause concomitant
tissue damage
• Survival of contact with voltage greater than
70,000 volts uncommon

24. Mechanisms of injury
• Direct effect of current
• Thermal burns
• Mechanical trauma
• Post trauma sequel

25. • May be the result of contact with high- or low-
voltage electricity
• For electricity to flow, there must be a
complete circuit between the source and the
ground.
– Any substance that prevents this circuit is called
an insulator.
– Any substance that allows a current to flow is
called a conductor.

26. Completion of circuit needed

27. A burn injury appears where the
electricity enters and exits the body.

28. Histological changes
• Coagulation necrosis of muscles (periosteal ,
shortening of sarcomers)
• Vascular damage ( hemorrhage , thrombosis,
progressive tissue necrosis)
• Neural tissue damage ( Coagulation necrosis ,
compartment syndrome)

29. Cardiac
• Incidence of arrhythmia ranging from 4–17%
• VF more common in low voltage DC shocks.
Asystole more common in High voltage events.
• Virtually any abnormality possible: Increased
PR/QT, Ectopics, St segment, bundle branch blocks,
etc
• Also: Direct myocardial injury

30. Respiratory
• Respiratory arrest
• Tetanic contractions of thoracic muscles
• Autonomic nerve dysfunction
• Blunt chest trauma

31. Neurological
• CNS damage: High voltage injuries
• Temp paralysis (keraunoparalysis)
• Loss of consciousness, agitation, coma, seizures
• Spinal cord damage, secoundry to muscle contraction
• PNS damage: Low voltage injuries
• Parasthesiae, Brachial plexus injuries

32. Orthopaedic
• Direct thermal energy leading to coagulation
necrosis.
• Secondary rhabdomyolysis, compartment
syndrome.
• Osteonecrosis.
• Secondary fractures/dislocations from tetany
and falls.

33. Dermatological
• A kissing burn is an electric arc generated between
two skin surfaces facing each other and
sandwiching a joint, typically the elbow and knee
flexures. The arc crosses the flexor crease and burns
the two 'kissing' skin surfaces causing vast
underlying tissue destruction

35. Others
• Abdominal: Stress (Curling) ulcer, abdominal
perforation
• Renal: AKI secondary to rhabdomyolysis
• Ocular: Delayed onset cataracts in 6% high voltage
injuries, higher in lightning strike
• Auditory: Perforated TM, cochlear damage, VIII
CN damage

36. Ocular manifestation of electric injury

37. Post-trauma sequelae
• Crush injury syndrome (rhabdomyolysis,
myoglobinuria)
• Multi-organ ischemic injury secondary to vascular
coagulation or dissection
• Hypovolemic shock secondary to massive 3rd space
loss
• Iatrogenic injuries from acute resuscitation,
Abdominal compartment syndromeand ARDS

38. ARC BURN

39. Electrical Arc Burn
• Formed between two objects differing in potential ,
not in contact
• Occurs when high amperage current travels or arc
through the air temp as high as 36000 f have been
noted
• Result in deep thermal injury because of high temp of
the electrical arc or sometimes flame burn or
splashing across the entire body

40. • Arc burns do not require direct contact with an
electrical source. The burn is caused by electrical
energy travelling from an area of high resistance
to an area of low resistance. The circuit is
completed when the air particles are ionized

41. Some ARC flash injury statistics
• Five to ten ARC flash explosions occur in electrical
equipment every day in the United States.
• Injuries from arc flash events range from minor
injuries to third degree burns and potential death
due to the energy released.

42. • Other injuries include blindness, hearing loss,
nerve damage, and cardiac arrest.
• The average cost of medical treatment for
survivors of arc flash incidents is $ 1,500,000, Total
costs including litigation can be $8M - $10M

43. Lightning Injuries

45. Lightning Strikes
• 150 to 300 deaths annually in the USA causes
cardiac and respiratory arrest, resulting in a 25%
to 30% mortality rate
• High voltage but short duration
• Amount of energy delivered may be less than with
other high-voltage electrical injuries because of
the short exposure

46. Lichtenberg Figures
• Rare pathognomonic “flower-like” branching skin
lesions in persons struck by lightning
• Caused by “flashover” effect of non-penetrating
current
• Rapidly fade, not typically serious

48. Keraunoparalysis
• A specific form of reversible, transient
paralysis that is associated with sensory
disturbances and peripheral
vasoconstriction and is seen in some
patients following lightning injury

49. Secoundary to massive catecholamine release
• Typically after lightening injury
• Clinical manifestation
– Paraplegia/quadriplegia
– Autonomic instability
• Hypertension
• Peripheral vasospasm
• Mydriasis and anisocoria
• Resolves within a few hours

50. Mechanical Trauma
• Trauma can result from fall or muscle contraction
• Classic example is shock wave of lightning causing blast injuries
Even at low V, tetanic muscle contraction can result in bone fracture
• Cord injury can result from severe muscle contraction, w/o any
external signs of trauma
• Acute hypotension should always prompt search for thoracic or
intra-abdominal bleeding

51. Management

52. No treatment just assurance
• Low voltage injuries <240 volts:
• Asymptomatic patients with a normal ECG on
arrival, no abnormal clinical findings on
examination
• Can be discharged with advice.
• No other investigations needed

53. Red flags in low voltage
• chest pain, palpations
• loss of consciousness, altered mental status,
confusion, weakness
• dyspnoea, abdominal pain, weakness, burn with
subcutaneous damage
• vascular compromise, or abnormal results on ECG

54. Management in the ED
Further investigations in red flag patients:
• Urinary and serum myoglobin
• CK
• FBCs, U&Es, LFTS, Lipase, Coag studies
• Imaging where appropriate
• Admit these patients

55. • Admit all high voltage (>600 volts) injuries
• These patients will likely need transfer to a
burns centre if not immediate life threatening
injuries

56. Asessmernt
• Often see superficial burns
– Rule of 9’s, but not the full story
• Not able to asses internal burns along path of
electricity
• Often extensive internal organ injury
• Third spacing is often significant and ongoing

57. So how do you decide how much fluid
to give?
• Titrate to normal urine output (0.5 cc/kg/hr)
• How much is too much?
– Klein et al.
• 5ml/ % BSA = increased pneumonia + death
– Compartment syndromes
• Abdominal
• Extremity
• Ocular
Physicians tend to over resuscitate follow BP, unwilling to
decrease when good U/O

58. • Standard ABCDEs of any major trauma
• Pulmonary, Low threshold for intubation, as
respiratory failure is common
• Cardiac, Serial monitoring if high V, abnormal ECG,
LOC, respiratory arrest, or PMH of CV dysfunction

59. • Neuro, C-spine and log-roll precautions; CT head &
spine often warranted, Thorough serial neurological
exams, as vessel coagulation can result in late
sequelae
• Musculoskeletal, Thorough evaluation for fractures,
Serial evaluations of limbs for compartment,
syndrome requiring emergent decompression, Even
in absence of compartment syndrome, persistent
aciduria or myoglobinuria may require limb
amputation

60. Fasciotomy

61. • Skin, Early debridement and later reconstruction
Antibiotic prophylaxis (controversial)
• Renal, Fluid resuscitation key, as 3rd spacing
common & myoglobinuria sec to rhabdomyolysis
can cause ARF

62. • GI, Ulcer prophylaxis, as gastric ulcers (Curling’s
ulcers) can develop Ileus uncommon, but should
prompt evaluation for other injury Serial
evaluation of liver, pancreatic, & renal function for
traumatic/anoxic/ischemic injury, Judicious
management of fluid and electrolytes to avoid
acidosis and compartment syndromes

63. Prevention

65. Prevention
Have basic knowledge about electricity
Cover sockets and outlets
Replace worn out or damaged equipment
Find out electricity
Avoid water

67. Protective Gear

68. • Children who are younger than 10 years are more
prone to suffer from electrical injuries from power
cords. So families with children of that age group
should take precautions by inspecting the power
and extension cords and replacing any broken or
cracked outer covering of the cords, which expose
the internal wire.

69. • Never allow your children to play with electrical
cords/appliances.
• Always use outlet covers over the electrical outlets
to protect infants from harm.
• Replace any old, ungrounded electrical outlets to
grounded systems.

70. • Ensure that the power is off before starting any
work on electrical systems.
• Never use any electrical device located near the
water.
• Never ever stand in water while working with
electricity equipment.
• Be careful when outside during a thunderstorm and
lightning. Seek shelter during lightning strikes. Also
steer clear from trees and metal objects.

71. While helping others take care of yourself

72. Prognosis
• Highly variable, depending on severity of both
initial injury and subsequent complications
• High morbidity/mortality in patients with
multisystem organ failure
• Advances in surgical interventions (early excision,
fasciotomy, skin grafts, etc…) have improved
outcome

73. Thank you