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    Electrical Injury: By: Mohd Khairul Izzati Omar

    Uploaded by

    Insyirah Qalbi
    1. Electrical injuries can cause direct tissue damage from heat generated by electrical current as well as indirect injuries from muscle contractions and falls. The severity depends on voltage, resistance of the pathway, amperage, and duration of contact. 2. Management involves assessing airway, breathing, circulation, disability, and exposure. Indications for cardiac monitoring include abnormal ECG, arrhythmias, loss of consciousness, or high voltage injury. Fluid resuscitation is critical to prevent renal failure from rhabdomyolysis. 3. Burns, fractures, and compartment syndrome require monitoring. High risk patients may require admission, while low voltage injuries without signs of injury can be discharged with instructions to follow up if symptoms

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    Electrical Injury: By: Mohd Khairul Izzati Omar

    Uploaded by

    Insyirah Qalbi
    105 views28 pages
    1. Electrical injuries can cause direct tissue damage from heat generated by electrical current as well as indirect injuries from muscle contractions and falls. The severity depends on voltage, resistance of the pathway, amperage, and duration of contact. 2. Management involves assessing airway, breathing, circulation, disability, and exposure. Indications for cardiac monitoring include abnormal ECG, arrhythmias, loss of consciousness, or high voltage injury. Fluid resuscitation is critical to prevent renal failure from rhabdomyolysis. 3. Burns, fractures, and compartment syndrome require monitoring. High risk patients may require admission, while low voltage injuries without signs of injury can be discharged with instructions to follow up if symptoms

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    Electrical Injury

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    1. Electrical injuries can cause direct tissue damage from heat generated by electrical current as well as indirect injuries from muscle contractions and falls. The severity depends on voltage, resistance of the pathway, amperage, and duration of contact. 2. Management involves assessing airway, breathing, circulation, disability, and exposure. Indications for cardiac monitoring include abnormal ECG, arrhythmias, loss of consciousness, or high voltage injury. Fluid resuscitation is critical to prevent renal failure from rhabdomyolysis. 3. Burns, fractures, and compartment syndrome require monitoring. High risk patients may require admission, while low voltage injuries without signs of injury can be discharged with instructions to follow up if symptoms

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    105 views28 pages

    Electrical Injury: By: Mohd Khairul Izzati Omar

    Uploaded by

    Insyirah Qalbi
    1. Electrical injuries can cause direct tissue damage from heat generated by electrical current as well as indirect injuries from muscle contractions and falls. The severity depends on voltage, resistance of the pathway, amperage, and duration of contact. 2. Management involves assessing airway, breathing, circulation, disability, and exposure. Indications for cardiac monitoring include abnormal ECG, arrhythmias, loss of consciousness, or high voltage injury. Fluid resuscitation is critical to prevent renal failure from rhabdomyolysis. 3. Burns, fractures, and compartment syndrome require monitoring. High risk patients may require admission, while low voltage injuries without signs of injury can be discharged with instructions to follow up if symptoms

    Copyright:

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    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 28

    ELECTRICAL INJURY

    By:
    Mohd Khairul Izzati Omar
    PATHOPHYSIOLOGY
    • The nature and severity of electrical burn injury are
    directly proportional to the current strength, resistance,
    and duration of current flow
    • Based on Ohm’s Law
    • Damage depends on:
    - voltage
    - resistance of tissue
    - amperage
    - type of circuit
    - current pathway
    - duration of contact
    • VOLTAGE
    high voltage results in greater current flow and
    therefore has a greater potential for tissue
    destruction

    • TISSUE RESISTANCE
    The higher the resistance of a tissue to the flow
    of current, the greater the potential for
    transformation of electrical energy to thermal
    energy at any given current
    Skin Resistivity
    Least Nerves
    Blood
    Mucous membranes
    Muscle
    Intermediate Dry skin
    Tendon
    Fat
    Most Bone
    • AMPERAGE
    • A very narrow range exists between the threshold
    of perception of current (0.2to 0.4 mA) and let-go
    current (6 to 9 mA)
    • Let-go current = the level above which a person
    becomes unable to release the current source
    because of muscular tetany.
    • Thoracic tetany can occur at levels just above this
    let-go current and result in respiratory arrest
    owing to paralysis of the muscles of respiration
    1 mAmp Threshold of perception
    5 mA Maximum harmless current
    10 mA “Let-go” current
    20 mA Possible tetany of resp muscles
    100 mA VF threshold
    6A Defibrillation
    20 A Household circuit breaker opens
    • TYPE OF CIRCUIT
    • 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
    • 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
    • entry and exit points – source and ground point
    • DURATION
    the longer the duration of contact with high-
    voltage current, the greater the electrothermal
    heating and degree of tissue destruction

    • PATHWAY
    pathway that a current takes determines the tissues
    at risk, the type of injury seen, and the degree of
    conversion of electrical energy to heat
    Low vs High Voltage
    Low voltage injury High voltage injury
    Voltage Less 1000 More 1000
    Type of current AC AC/DC
    Duration of contact Prolonged Brief (if DC)
    Cause of cardiac arrest VF Asystole
    Cause of respiratory arrest Thoracic muscle tetany Thoracic muscle tetany or
    indirect trauma
    Muscle contraction Tetanic Tetanic (if AC)
    Single (if DC)
    Burns Superficial Deep
    Rhabdomyolysis Less common More common
    Blunt injury Does not usually occur Cause by falls and violent
    muscle contractions
    Clinical presentation of electrical injury
    1. Direct trauma from the electric coursing
    through the body
    2. Trauma from the conversion of the electrical
    energy
    3. Mechanical effects of the electric current
    System Presentation

    Skin Cutaneous burns

    Cardiac Arrhythmias, cardiac arrest

    Respiratory Respiratory arrest due to muscle tetany or central


    nervous system causes

    Vascular Aneurysm formation, tissue ischaemia

    Neurologic Loss of consciousness, transient paralysis or


    paraesthesia, peripheral neuropathy, spinal cord injury

    Musculoskeletal Fractures or dislocations secondary to muscle spasm or


    falls, muscle necrosis, compartment sysndrome

    Renal Myoglobinuria leading to renal failure

    Other Cataracts, neurophysiological effects


    MANAGEMENT
    DANGER
    RESPONSE
    AIRWAYS + C SPINE
    BREATHING
    CIRCULATION
    DISABILITY
    EXPOSURE
    • PREHOSPITAL:
    - ensure the safety of the medical personnel
    - aggressive and persistent CPR, even if the
    victims appear dead
    - in case of defibrillation or cardioversion
    needed, no adjustment of the voltage is
    needed
    - immobilized with cervical collar and spinal
    board.
    • EMERGENCY DEPARTMENT:
    - maintaining airway with cervical collar
    - difficult airway evaluation should be made
    (burns involving the face, mouth or neck)
    - aggressive fluid resusscitation (especially if
    heme pigment present in the urine)
    - physical examination (size of burns,
    neurovascular check – compartment syndrome)
    Diagnostic Studies
    • ECG
    - all patients receive an initial ECG to assess
    for cardiac injury
    Characteristics Cardiac monitoring Cardiac monitoring
    NOT required if ALL IS requird if ANY of
    the following the following
    present present
    ECG Normal Arrhthmias or
    evidence of
    ischaemia
    History loss of No Yes
    consciousness
    Type of injury Low voltage High voltage
    ( <1000 volts) ( >1000 volts)
    Cardiac Monitoring
    List of Indications for Electrocardiographic Monitoring
    • Cardiac arrest
    • Documented loss of consciousness
    • Abnormal ECG
    • Dysrhythmia observed in prehospital or ED setting
    • History of cardiac disease
    • Presence of significant risk factors for cardiac disease
    • Concomitant injury severe enough to warrant admission
    • Suspicion of conductive injury
    • Hypoxia
    • Chest pain
    • Radiology
    - c spine
    - any area that patient has pain, obvious
    deformity or decreased range of movement
    Treatment
    • Cutaneous injury
    - burns should be cleaned and covered with
    sterile dressings
    - mafenide acetate: localised full thicness
    burns
    - sulfadiazine silver: extensive burns
    - may need transfer to burn center
    • Injury to the extremities
    - electrothermal burns affect upper extremity,
    limb should be splinted in ‘Z’ position,
    elevated above the heart level
    - neurovascular check for compartment
    syndrome (progressive neurological
    dysfunction, vascular compromise)
    • Myoglobinuria
    - do urine analysis (patients with electrical
    injuries has risk of renal failure due to
    myoglobinuria)
    - fluid resuscitation (aim for 1.0 – 1.5 mls/kg/hr
    till urine clear of myoglobin)
    • Pain management
    - pethidine (50 – 75 mg)
    - diclofenac sodium (75 mg)
    Special Situations
    • Paediatrics
    - oral commissure burn
    • Obstetrics
    - fetal injury depends on the flow of current
    through the mother’s body
    - need fetal monitoring
    Disposition
    • Admission
    - high voltage injury
    - specific organ system involvement
    - neurovascular compromise to the
    extremities
    - oral commissure burns
    - deep hand burn
    • Discharge
    - low voltage injury, no evidence of burns
    - normal ECG
    - no history loss of consciousness
    Summary
    • ECG for all patients
    • Cardiac monitoring when indicated
    • Fluid resuscitations to prevent hypovolaemia
    and renal failure
    • Frequent neurovascular checks – for
    compartment syndrome
    Thank You

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