Electrical Burns

OKWEREKWU FRANCIS .
Introduction
Epidemiology
Aetiology Pathophysiology
Clinical Features
Investigations Treatment
Prevention
Conclusion
Introduction
Burn injuries are a world wide problem.
They rank high among injuries suffered by man.

Since its inception in 1849, commercial use
of electricity has been one of the most potentially dangerous commodities in the world.
Introduction
Electrical injury includes electrocution,
electric shock, burns and secondary injuries.

The term electrical burn is used widely to
describe the variety of injuries created by supraphysiologic electrical energy interacting with living tissue.
Epidemiology
According to statistical data, 0.8-1% of
accidental deaths are caused by an electric injury.

Electric injury accounts for 1000 deaths each
year in the United States, with a mortality rate of 3-15%
Epidemiology
Approximately 20% of all electrical injuries occur in
children, with a bimodal peak incidence highest in toddlers and adolescents. Most electrical injuries that occur in children are at home, with extension cords (60-70%) and wall outlets (10-15%) being by far the most common sources in this age group. Electrical burns account for 2-3% of all burns in children that require emergency room care.
Epidemiology
Electrical burns constituted 2.8% of total
burn admissions. Male: Female ratio was 1.8:1 44.9% of the patients were children with age range between 22 days 14 years.
Department of Burns, Plastic & Reconstructive Surgery, National
Orthopaedic Hospital Enugu(Niger ian J Clin Pract. 2006 Dec;9(2):1247.)
Aetiology
Electrical burns are usually divided into low voltage
and high voltage injuries, the threshold being 1000volts.

a) Low voltage injuries: do not have enough energy to
cause destruction to significant amt of subcutaneous tissues. The entry and the exit points, normally in the fingers and toes suffer small deep burns.
b) High voltage injuries
Pathophysiology
Electrical energy causing direct tissue damage,
altering cell membrane resting potential, and eliciting muscle tetany. Conversion of electrical energy to thermal energy, causing massive tissue destruction and coagulative necrosis. Mechanical injury with direct trauma resulting from falls or violent muscle contraction.
Pathophysiology
Factors that determine the degree of injury include
Type of current Resistance encountered Current pathway Magnitude of energy delivered Duration of contact.
Type of current
The repetitive nature of AC increases the
likelihood of current delivery to the myocardium, which can precipitate ventricular fibrillation.
In contrast, DC usually causes a single
violent muscle contraction, often thrusting the victim away from the source.
Resistance
In general, tissues with high fluid and
electrolyte content conduct electricity better. Bone is the tissue most resistant to the flow of electricity. Nerve tissue is the least resistant, and together with blood vessels, muscles, and mucous membranes offer a path of low resistance for electricity.
Resistance
Skin is the most important factor impeding
current flow. It is the primary resistor against electrical current, and its degree of resistance is determined by its thickness and moisture.
It varies from 1000 ohms for humid thin skin
to several thousand ohms for dry calloused skin.
Pathway
Transthoracic currents can cause fatal
arrhythmia, direct cardiac damage, or respiratory arrest. Transcranial currents can cause direct brain injury, seizure, respiratory arrest, and paralysis.
Magnitude
The current intensity will also determine the
magnitude of injury. There may be individual variation on the energy dose for a specific effect. Less energy is generally required in children, who have more water content and thin skin and, hence, better conductivity and less resistance.
Current intensity 1 mA 3-5 mA 7-9 mA 16-20 mA 20-50 mA
Expected clinical manifestation Probable tingling sensation "Let go" current for an average child "Let go" current for an average man Tetany of skeletal muscles Paralysis of respiratory muscles (respiratory arrest)
50-100 mA Greater than 2 A

15-30 A 240 A
Threshold for ventricular fibrillation Threshold for ventricular fibrillation

Common household circuit breakers Maximal intensity of US household current
Clinical Features

Skin burns/Mouth burns Unconscious Bleeding Skeletal injuries Shock Dark coloured urine/ARF Respiratory arrest Tissue oedema/ Compartment syndrome Numbness/Paraesthesia Seizures
HAND TO HAND CURRENT FLOW
Management
Acute emergency, shout for help. Secure yourself. Separate the victim from the current's source. The
safest way to do so is to shut off the current e.g by throwing a circuit breaker or switch or by disconnecting the device from an electrical outlet. Treat as multi-trauma patient with cervical immobilisation at least until the full extent of injuries has been quantified
Management
ABCs
IV access IV fluids-Ringers Lactate
Monitor urine output -100ml/hr

ARF prevention(in case of myoglobinuria) Tetanus prophylaxis Analgesia, ulcer prophylaxis, antibiotics Wound dressing
Management
Defribillation
Associated injuries-Splint limb, refer Extremities Fasciotomies for compartment syndrome Debridement/amputation -non-viable tissue Reconstructive surgery for mouth burns
Investigations
FBC E,U,Cr ECG x 24 hrs CXR ABG X-ray, CT Wound swab- MCS
Complications
Seizures Peripheral nerve damage Psychiatric problems from depression to aggressive
behaviour Cataracts Paraplegia/Quadriplegia Deformities
Prevention
Education about and respect for electricity are
essential. Ensure electrical devices are properly designed, installed, and maintained. Electrical wiring should be installed and serviced by properly trained personnel. Outlet guards reduce risk in homes with infants or young children.
PREVENTION CONTD.
Any electrical device that touches or may be touched
by the body should be properly grounded. Three-pronged outlets are safest. Circuit breakers that interrupt (trip) circuits when current as low as 5 milliamperes leaks are advisable in areas that get wet, such as kitchens and bathrooms and outdoors.
CONCLUSION
Although electrical burns represent only a small
proportion of burn injuries, the incidence of complications, mortality and morbidity, and disability is high. Such injuries can be prevented with proper educational programmes designed to suit the community.
THANK YOU FOR LISTENING

Electrical Burns

Uploaded by

Copyright:

Available Formats

Electrical Burns

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Electrical Burns

Uploaded by

Copyright:

Available Formats

OKWEREKWU FRANCIS .

They rank high among injuries suffered by man.

electric shock, burns and secondary injuries.

accidental deaths are caused by an electric injury.

year in the United States, with a mortality rate of 3-15%

Orthopaedic Hospital Enugu(Niger ian J Clin Pract. 2006 Dec;9(2):1247.)

and high voltage injuries, the threshold being 1000volts.

to several thousand ohms for dry calloused skin.

Current intensity 1 mA 3-5 mA 7-9 mA 16-20 mA 20-50 mA

50-100 mA Greater than 2 A

Threshold for ventricular fibrillation Threshold for ventricular fibrillation

HAND TO HAND CURRENT FLOW

Monitor urine output -100ml/hr

behaviour Cataracts Paraplegia/Quadriplegia Deformities

THANK YOU FOR LISTENING

You might also like