Abstract

Electrical burns are among the most devastating of burn injuries. High voltage electrical
injuries result in extensive deep tissue damage and are associated with multiple
complications, long term morbidity, and a high mortality rate. We describe the case of a 47
year-old electric company linesman who suffered a high voltage electrical injury (HVEI) of
14,000 volts to bilateral hands and wrists managed by the Division of Plastic and
Reconstructive Surgery at the McGill University Health Center in Montreal, Quebec,
Canada. His management included multiple operative procedures, including escharotomies,
fasciotomies, serial debridements, and bilateral pedicle groin flaps, and amputation of his left
hand.
 Introduction

Electrical injuries have become a more common form of trauma with a unique
pathophysiology and with high morbidity and mortality. They encompass several types, as
follows: lightning injury, high-voltage injury, and low-voltage injury. Clinical manifestations
range from transient unpleasant sensations without apparent injury to massive tissue
damage. Some electrocutions are instantly fatal. Familiarity with the mechanisms of injury
and the principles of therapy improves patient care.

Four classes of electrical injuries are as follows :

• True electrical injuries - The person becomes part of the electrical circuit and
has an entrance and exit site
• Flash injuries - Superficial burns caused by arcs that burn the skin; no
electrical energy travels through the skin
• Flame injuries - Caused by ignition of the persons clothing by arc; electricity
may or may not travel through the person’s body
• Lightning injuries - A unique type of injury that occurs at extremely high
voltages for the shortest duration; the majority of electrical flow occurs over the
body
 Contact electrical burns, 120-V alternating current nominal. The right knee was the
energized side, and the left was ground. These are contact burns and are difficult to
distinguish from thermal burns. Note entrance and exit are not viable concepts in alternating
current.

Electrical burns to the hand.

Contact electrical burn. This was the ground of a 120-V alternating current nominal circuit.
Note vesicle with surrounding erythema. Note thermal and contact electrical burns cannot be
distinguished easily.

Arcing electrical burns through the shoe around the rubber sole. High-voltage (7600 V)
alternating current nominal. Note cratering.
 Statement of problem

To fully understand such injuries, understanding certain basic electrical principles is

necessary.
Direct current (DC) flows in a constant direction. Batteries, for example, deliver direct
current. High-voltage direct current is used as a means for the bulk transmission of electrical
power.
Alternating current (AC) is an electric flow that regularly reverses its direction. Each
forward-backward motion interval is called a cycle. Electric current in the United States
alternates with a frequency of 60 hertz (Hz). The usual waveform of an AC power circuit is a
sine wave, because this results in the most efficient transmission of energy, but, at the same
time, it is also more dangerous than DC. AC is standard in US electrical outlets.
A volt is a unit of electromotive force or pressure that causes current to flow. In US
household wiring, 120 volts are present between the hot wire and the ground wire. Most
electrical shocks come from constant voltage sources; that is, the actual number of volts
present does not change appreciably over time, despite variable current drainage from the
source. Nonconstant voltage sources, such as cardiac defibrillators and capacitors, deliver
varying voltages.
The use of a higher voltage leads to more efficient transmission of power; therefore, it is
advantageous when transmitting large amounts of power to distribute the power with
extremely high voltages (sometimes as high as hundreds of kilovolts). However, high voltages
also have disadvantages, the main ones being the increased danger to anyone who comes
into contact with them, the extra insulation required, and the increased difficulty in their safe
handling.
An ampere is a unit of electrical current. More precisely, it is the flow of a certain number of
electrons per second.
An ohm is a unit of electrical resistance. Conductance is defined as 1/resistance (ie, the
inverse of resistance). The resistance of a material to current flow depends on the physical
and chemical properties of the material. The amount of current flow often determines the
magnitude of injury. Ohm law states that current is directly proportional to the voltage and
inversely proportional to resistance (I=V/R) and can be useful for calculating the current
flow during electric shock.
Heat generated in a material due to current flow is an indication of power. A watt is the unit
of electrical power that is delivered when 1 ampere flows through 1 ohm for 1 second. Power
is equal to voltage multiplied by current (P=VxI). Energy is defined in terms of a watt-
second. One watt-second is equal to 1 joule. One watt of power delivered for 1 second
produces 0.24 calories of heat.
 Study Objective

To examine the spectrum of electrical injuries and develop guidelines for management.
 Discussion and suggestion

Case 2 : You are called to the scene of a lightning strike on a golf course with four male
victims in their sixties. One victim is in cardiorespiratory arrest. His two friends, who also
report being struck, have been performing CPR. The fourth, who has an extensive cardiac
history, is sitting nearby, diaphoretic and complaining of chest pain. Lightning is visible on
the horizon, and the rain is just starting to fall as paramedics arrive on the scene.

Discussion :Although there are two high-acuity patients in this scenario, scene safety must
remain the first priority. Evacuation of the patients to the ambulances for further evaluation
and treatment should be the first action taken. The patient with the cardiac history
experiencing active chest pain will require urgent assessment and treatment, but unlike
typical multicasualty trauma triage scenarios, the patient in cardiac arrest should be tended to
first, with rhythm evaluation for potential defibrillation and appropriate airway management.
Appropriate spinal immobilization precautions should be observed. The man with chest pain
should be treated next, according to usual BLS and ALS protocols. Although the third and
fourth victims are not experiencing symptoms debilitating enough to prevent them from
performing CPR, they also should be transported for hospital evaluation even without any
specific complaints.
 Conclusion

Diffuse electrical injury is a class of electrical injury that defies the common theories that
explain tissuedamage from electrical contact. Thermal andelectroporation type injuries
require that symptomatology bepath related and proportional to either the energy delivered
during the electrical contact or the field strength. In DEI,the injuries can occur even in the
absence of any traditionalthermal or path related injury. Such diffuse injury might
best be characterized as “disproportionate” DEI. It is furtherobserved that DEI type injuries
occur without correlation tothe voltage of the contact or the immediate injury from the
contact. The result is an injury that presents withsymptomatology both on and beyond the
theoretical currentpathway. Most interesting is the presence ofneuropsychological
symptomatology absent any observed ortheoretical brain involvement. Finally, this
researcher that most often it is reported that DEI type symptomatoogyflies below the level of
modern diagnostic technologyleading to a broad array or organic and non-
organicdiagnoses. Given the statistical fingerprint associated withDEI, it is likely that there
exists as of yet undefinedmechanisms of injury from electrical contact.
 Finding

When you come in direct contact with electricity, it can pass through your body and cause
injuries. These electrical injuries can be external or internal. You may have one or both
types. External injuries are skin burns. Internal injuries include damage to your organs,
bones, muscles, and nerves. You could also have abnormal heart rhythms and cardiac arrest.
How bad your injuries are depends on how strong the electric current was, what type of
current it was, how it moved through your body, and how long you were exposed. Other
factors include how healthy you are, and how quickly you get treatment.

Causes of electrical injuries include

 Lightning strikes
 Faulty electrical appliances
 Work-related exposures
 Contact with household wiring or power lines
 Accidents in small children, when they bite or suck on electrical cords, or stick objects in
outlets
If you get an electrical injury, you should see a doctor. You may have internal damage and
not realize it.
Electric Shock Injuries in Children

When the human body comes into direct contact with a source of electricity, the current
passes through it, producing what's called an electric shock. Depending on the voltage of the
current and the length of contact, this shock can cause anything from minor discomfort to
serious injury (even death).

Young children, particularly toddlers, experience electric shock most often when they bite
into electrical cords or poke metal objects such as forks or knives into unprotected outlets
or appliances. These injuries can also take place when electric toys, appliances, or tools are
used incorrectly or when electric current makes contact with water in which a child is sitting
or standing. Christmas trees and their lights are a seasonal hazard.

Prevention
The best way to prevent electrical injuries is to cover all outlets, make sure all wires are
properly insulated, tuck wires away from your child's reach, and provide adult supervision
whenever children are in an area with potential electrical hazards. Small appliances are a
special hazard around bathtubs or pools.

What You Can Do

 Disconnect the power supply before you touch an injured child who is still receiving
current; pull the plug or turn off the main switch.
 Never touch a live wire with your bare hands. If you have to lift a live wire from a
child, use a dry stick, a rolled-up newspaper, thick clothing, or another sturdy, dry,
nonmetallic object that won't conduct electricity.
 Move the child as little as possible because severe electric shock may have caused a
spinal fracture.
 If you can't remove the source of the current, try to move the child, but don't use your
bare hands. Insulate yourself with rubber or with any of the nonconductive items
suggested for lifting a live wire so that the current doesn't pass from the child's body
to yours.
  Once the current is off, quickly check the child's breathing, pulse, skin color, and
alertness. If the child isn't breathing or there is no heartbeat, begin CPR immediately
while someone else goes for medical help.
 Once the child is safely removed from the current, check him for burns and call 911,
your local emergency number, or your pediatrician right away.
Treatment
 A child who has received an electric shock should be seen by a pediatrician because
shock may cause internal damage that can't be detected without a medical
examination.
 Your pediatrician will clean and dress surface burns and order tests for signs of
damage to internal organs.
 Mouth burns (such as from biting an electric cord) are often much deeper than they
appear. Your child may require surgery after the initial healing. Parents must be alert
to the possibility of bleeding from mouth burns hours or even days after the injury. If
bleeding occurs, apply a clean pad and call your pediatrician immediately. See First
Aid for Burns: Parent FAQs.
 If a child has severe burns or any sign of brain or heart damage, she will need to be
placed in a hospital.
Diagram
Exit wound

Arc or flash burn

Internal injuries

A few days later

Involuntary Muscle Contraction
 References

1. http://electricalinstallationwiringpicture.blogspot.com/2010/02/electric-shock-injury-
pictures.html

2. https://www.slideshare.net/jameswheeler001/electrical-injuries-57307019

3. https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/Electric-
Shock.aspx

4. https://medlineplus.gov/electricalinjuries.html

5. https://www.emergencymedicine.pitt.edu/sites/default/files/Electricution%20Emergencies.pdf

6. https://www.sciencedirect.com/science/article/pii/S0196064495700129

7. https://www.rcemlearning.co.uk/references/electrical-injuries/

8. https://emedicine.medscape.com/article/433682-overview

9.https://www.emedicinehealth.com/wilderness_electrical_injuries/article_em.htm#electrical_injury
_symptoms
Facts on Electrical Injuries

 Electrical injury occurs when an electric current runs through a portion of the body,
usually from either a man-made source or lightning.
 The outside of the person’s body may appear to have only minor injuries, but internal
injuries may still be significant.
 As current enters the body (source), it causes surface to deep burns, damages muscle
and organs as it passes through the body, and eventually exits at another distant point
(ground), which causes a second burn or wound.
 The electrical current may trigger irregular heartbeat or stop the heart entirely.
 Among man-made sources, direct current (DC) tends to throw people from the source
after one shock.
 Alternating current (AC) is more dangerous. AC causes muscle spasms that often
prolong contact with the power source, which increases the extent of the injury.