The document discusses electrical burns in children, categorizing them into three types: minor burns, high-tension wire burns, and lightning burns, detailing their causes, effects, and management options. It underscores the dangers associated with electrical exposure, including potential cardiac and neurological complications, and emphasizes the importance of safety precautions in preventing such injuries. Additionally, the document includes an electrical safety quiz to educate about safe practices around electricity.

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. 06/07/2019
Electrical burns in children Prof. Dr. Saad S Al
Ani 2
https://www.networx.com/article/electrical-safety-quiz

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. 06/07/2019
Electrical burns in children Prof. Dr. Saad S Al
Ani 4
http://clipart-library.com/clipart/1839625.htm

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. 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. 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
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Electrical burns in children Prof. Dr. Saad S Al
Ani 7

8. 06/07/2019
Electrical burns in children Prof. Dr. Saad S Al
Ani 8
https://twitter.com/singletrackelec

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
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Electrical burns in children Prof. Dr. Saad S Al
Ani 9

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.  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.
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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.  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.
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Electrical burns in children Prof. Dr. Saad S Al
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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. 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. 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

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Ani 17
https://www.healthline.com/health/electric-shock

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Electrical burns in children Prof. Dr. Saad S Al
Ani 18
https://safety.lovetoknow.com/Electrical_Safety_Tips_for_Children

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. 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
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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. 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. 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. 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. 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. 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. Combination of contact and flash burn .Involvement of
head and neck in high voltage injuries
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Electrical burns in children Prof. Dr. Saad S Al
Ani 27

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. 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. 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. 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. 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. 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. 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.

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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. 06/07/2019
Electrical burns in children Prof. Dr. Saad S Al
Ani 37
https://toonclips.com/design/1460

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. 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. 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. 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. 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. 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. Electrical injury :
Clinical manifestations and
management
06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 44

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. 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. 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. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 48
Pulmonary manifestations
• Respiratory arrest
• Acute respiratory distress
• Aspiration syndrome

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. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 50
Renal manifestations
• Acute kidney injury
• Myoglobinuria

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. 06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 52
Electrical injury : Neurologic
manifestations & management

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. 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. 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. Electrical injury :cutaneous /oral
manifestations
06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 56

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. 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. 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. 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. 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. 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. 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. 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
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Ani 64

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.
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Electrical burns in children Prof. Dr. Saad S Al
Ani 65

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.
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67. 06/07/2019
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Pinterest

68. 06/07/2019
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http://shrinerschildrens.org/safetybeginsathome/

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
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vectorstock.com