(1) Electrical and lightening injuries can cause devastating burns, arrhythmias, and neurological complications. (2) Low voltage injuries often involve minor burns, while high voltage injuries pose greater risks of internal damage along the current path. (3) Resistance, current, voltage, and duration of contact all impact injury severity. Proper management involves evaluating for cardiac, neurological, and musculoskeletal injuries.

1. Project: Ghana Emergency Medicine Collaborative
Document Title: Electrical and Lightening Injuries
Author(s): Rashmi Kothari, M.D.
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3. Rashmi U. Kothari MD
Associate Professor
KCMS/MSU
BotMultichillT,
Wikimedia Commons
Maksim,
3
Wikimedia Commona

4. ¨
Electrical Injuries
¡ Low
Voltage
¡ High Voltage
¨
Pathophysiology
¨ Complications
¨ Management
¨
Lightening Injuries
4

5. ¨
Electrical burns:
1000 deaths annually
¡ 4-6.5% of all burn admissions
¡ Almost all involve litigation (negligence,
product liability, workmen’s compensation)
¡
¨
Lightening Injuries:
50-300 deaths annually
¡ 4-5 X as many lightening strikes
¡ 2nd leading cause of weather related deaths
¡
5

6. ¨
Voltage:
electrical pressure in a
circuit
¨ Resistance: tissues resistance to flow
of electrons
¨ Current:
amount of energy
in a circuit
¨
Current = Voltage/Resistance
6

7. Current Strength (I)= Voltage/Resistance
Thermal Power (J)=(I)2 X Resistance X
duration
Severity =(Voltage) 2 X duration
Resistance
7

8. ¨ Current
(Amperage)
¨ Type of current
¨ Resistance
¨ Duration of contact
¨ Voltage
¨ Pathway of current
8

9. Physical Effect
Tingling
Let go current
Children
Women
Men
Freezing to circuit
Thoracic muscle tetany
Ventricular fibrillation
Milliamperes (mA)
1-4
4
7
9
10-20
20-50
60-120
*at 50-60 Hz (frequency of household AC current)
9

10. ¨
Which is more dangerous?
¡ AC
¨
3X more dangerous than DC
How do their mechanisms of
injuries differ?
¡ AC
causes tetany
¡ DC throws you away
10

11. ¨
Source:
¡ Power
lines
¡ Household current
¨
Clinical Presentation
¡ 3X
more dangerous than DC
¡ Continuous tetany
¡ V-fib
¡ Contact wounds
11

12. ¨
Source:
¡ Power
generating stations
¡ Long distance transmission lines
¡ Submarine cable connections
¡ Portable generators
¨
Clinical Presentation
¡ Single
contraction
¡ Associated blunt trauma
¡ Arrhythmias cardiac phase dependent
¡ Entrance/Exit wounds
12

13. Amount tissue resists flow of
electrons
¨
resistance the greater potential
to convert electric energy to heat
energy
¨ Tissue resistance changes with
charring
¨
13

14. Resistance of Body Tissues
Least
Nerves
Blood
Mucous membranes
Intermediate
Dry skin
Most
Tendon
Fat
Bone
14

15. Tissue
Resistance (W/cm2)
Calloused hands
Soles of feet
Other skin
Sweaty skin
Bathtub
Mucous Membranes
1-2 million
100-200K
10-40K
2500
1200-1500
100
15

16. Resistance
Dry hands
vs. Wet hands
2,000,000 W/cm2 è1,200 W/cm2
Injury=Voltage2 x Duration
Resistance
16

17. ¨
Child puts key in socket
110V AC current
¡ Dry skin (10-40K W/cm2 )
¡ current = 2.75-11 mA
¡
¨
Chris Phan, Flickr
Injury=(V)2 X t
R
Child in tub, key in socket
110V AC current
¡ Wet skin (1,200-1,500 W/cm2 )
¡ current =73-92 mA
¡
17

18. Physical Effect
Tingling
Let go current
Children
Women
Men
Freezing to circuit
Thoracic muscle tentany
Ventricular fibrillation
Milliamperes (mA)
1-4
4
7
9
10-20
20-50
60-120
2.75-11
73-92
*at 50-60 Hz (frequency of household AC current)
18

19. ¨
¨
duration
destruction
AC increases duration due to grip
strength
19

20. ¨
¨
¨
Difference in electrical potential between
two points
Low Voltage <500-1000 V
¡ 24 V=Long distance communication lines
¡ 65 V Telephone lines
¡ 110-220 V Household current
High Voltage >500-1000 V
¡ Transformers, Power lines
20

21. ¨
Determines tissue at risk
¡ Thorax:
V-fib, myocardial damage
¡ Head: resp. arrest, seizure, paralysis
¡ Eye: cataracts
Anetode, Wikimedia Commons
21

22. ¨ Current
(Amperage)
¨ Type of current
¨ Resistance
¨ Duration of contact
¨ Voltage
¨ Pathway of current
22

23. ¨
¨
Usually minor:
¡ Tingling
¡ Local contact burns
Exception:
¡ Lower resistance (moisture)
¡ Ocular involvement
¡ Oral injuries
¡ Appliance capacitor (microwave,
¡ Pregnancy
Source Undetermined
monitor, TV)
23

24. ¨ Child
bites electrical cord
¨ Arc burn
¡ Electricity
jumps from high to low
potential region
¡ High temperatures
¡ Delayed bleeding
¨ Cosmetic
Source Undetermined
& Dental deformity
24

25. Evaluate for any burns
¨ Cardiaorespiratory complaints
¨
¡ ECG/monitor
¡ Isoenzymes
¨
Consider ocular involvement
¡ Ophthalmology referral
Short ED observation
¨ Discharge home
¨
25

26. Devastating burns
¨ Electrical injuries
¨ Blunt trauma
¨ Renal complications
¨
Source Undetermined
Xy01, Wikimedia Commons
26

27. ¨
Direct contact
¡ Electrothermal
¨
heating
Indirect contact
¡ Arc
¡ Flame
¡ Flash
27

28. Source Undetermined
¨
Heating of tissue secondary to current
¡ Low
voltage injuries with local burns
¡ High voltage
ú Damage anywhere along current path
ú Prolonged exposure due to inability to
release
7mike5000,
Wikimedia Commons
28

29. Achgro,
Wikimedia Commons
Spark between unconnected objects
¨ Most destructive indirect burn
¨ Temperatures of 2,500° C
¡ Oral cord burns
¡ Lightening strikes
¨
Source: Brown
Medical School
29

30. Occur when external objects catch on
fire and cause the burn.
¨ Most commonly, clothes
¨
30

31. Current flashes over the body, rather
than going through the tissues
¨ Seen primarily in lightening injuries.
¨
Source Undetermined
31

32. Head
¨ Cardiac
¨ Skin
¨ Extremities
¨ Neurological
¨
7mike5000,
Wikimedia
Commons
32

33. EyeMD,
Wikimedia
Commons
Common point of contact
¨ Burns
¨ Blunt trauma
¨ Cataracts
¨
Batholith,
Wikimedia
Commons
¡ Days,
weeks, months
¡ Complete eye exam
¡ Outpatient Ophthalmology
Source
Undetermined
33

34. ¨
Arrhythmias
¡ V-Fib
or Asystole
¡ Sinus Tach/ A-fib/BBB
¨
ECG changes
¡ ST
elevation
¡ Prolonged QT
¨
AMI
¡ Rare
¡ Elevation
of CPK & CPK MB%
34

35. Guyprocter,
Wikimedia
Commons
Common contact sites
¡ Head/hands/heels
¨ Internal flow of current
¡ Deep muscle injury
¡ Can’t estimate damage
from surface burn
¨
Magnus Manske,
Wikimedia Commons
35

36. Damage distant to skin burns
¨ Arterial injury
¨
¡ High
¨
delayed injury
Venous injury
¡ Slow
¨
flow è
flow è acute thrombosis & edema
Severe muscle necrosis
¡ Fasciotomy
¡ Rhabdomyolysis
¨
Kissing burns
Source Undetermined
36

37. Transient loss of consciousness
¨ Concussive type symptoms
¨
¡ Difficulty
concentrating
¡ Dizziness
¡ Flat
¨
affect
Spinal Injuries
¡ Fractures/ligamentous
Source Undetermined
injuries
37

38. ¨
Immediate
¡ Weakness/parasthesias
within hours
¡ Lower extremity >upper extremity
¡ Good prognosis
¨
Delayed
¡ Days to years
¡ Ascending paralysis/ALS/Transverse
myelitis
¡ Motor>sensory
¡ Poor prognosis
38

39. Current impulse
¨ High voltage/Short duration
¨
¡ Very
minimal skin damage
¡ Flash over
Maksim, Wikimedia Commons
39

40. ¨
Direct strike
¡ Orifice
¨
Contact
entry
Ambika Kilaparthi, Flickr
¡ Side
flash, “splash”
¡ Ground current or step voltage
¡ Blunt trauma
40

41. Enters eyes, ears, mouth
¨ High incidence of:
¨
¡ cataracts/uveitis/detached
retina/
optic atrophy
¡ ruptured TM/hearing loss, tinnitus,
vertigo
41

42. object è person è ground
42

43. Source Undetermined
43

44. ¨
¨
Thrown 2° to massive contraction of
current passing through body
Air superheats then quickly cools è
explosive force
44

45. ¨
Cardiovascular
¡ Cardiac
arrest 2° electrical shock or
vascular spasm
¡ Respiratory arrest > Cardiac arrest
¨
Skin
¡ <5% deep burns
¡ Linear lesions
¡ Punctate lesions
¡ Feathering
¡ Thermal
45

46. Source Undetermined
Source Undetermined
Source Undetermined
46

47. ¨
Extremities
¡ Transient
vasospasm
¡ Cold, blue, mottled, pulseless
¡ Resolves within hours
47

48. ¨
Common
¡ LOC,
confusion, antegrade amnesia
¡ Paresthesias
¨
Less common
¡ ICH,
seizure, paraplegia
¡ Delayed muscle atrophy
48

49. ¨
Keraunoparalysis
¡ 2/3
of patients
¡ Extremities mottled, cold, blue
¡ Legs>arms
¡ Transient (clears w/in hours)
¡ Vascular spasm & sympathetic instability
49

50. ¨
Evaluate for other injuries
Other burns
¡ Ocular involvement
¡
¨
Admission
Pain or poor oral intake
¡ Poor compliance or follow-up
¡
¨
Discharge home
Educate parents regarding bleeding
¡ Burns follow-up
¡ Dental referral
¡ ±Plastics referral
¡ ±Ophthalmology referral
¡
50

51. ABC
¨ Fluids & foley
¨
¡ Urine
output 0.5-1.0 cc/kg/hr
¡ Heme in urine 1-1.5 cc/kg/hr
Cardiac monitor/ECG
¨ Trauma Evaluation
¨ Labs
¨
¡ CBC
& CMP
¡ Serum Myoglobin, U/A
51

52. ¨
Trans-abdominal current
¡ Hepatic,
¨
Altered MS
¡ CT
¨
lipase, PT/PTT
head
Cardio-respiratory complaints
¡ Troponin,
CPK with Isoenzymes
¡ Poor correlation: CPK MB, Angio, echo,
thallium studies with AMI
52

53. Status post arrest
¨ Concomitant severe injuries
¨ Loss of consciousness
¨ Suspicion of conductive injury
¨ Abnormal ECG or dysrhythmia
¨ History of CAD
¨ Significant CAD risk factors
¨ Chest pain
¨
53

54. ¨
Inhospital
¡ Trauma
¡ Burns/Plastics
¨
Outpatient
¡ Ophthalmology
¡ Neurology
54