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Key Features

Essentials of Diagnosis

  • The extent of injury is determined by

    • Amount and type of current

    • Duration and area of exposure

    • Pathway of the current through the body

  • Clinical findings of death are unreliable; therefore, resuscitation must be attempted before assuming the electrical injury victim is dead

  • Skin findings may be misleading, and not indicative of the degree of deeper tissue injury

General Considerations

  • With alternating currents (AC) of 25–300 Hz

    • Low voltages (< 220 Hz) tend to produce ventricular fibrillation

    • High voltages (> 1000 Hz) cause respiratory failure

    • Intermediate voltages (220–1000 Hz) cause both

  • More than 100 mA of domestic house current (AC) of 110 V at 60 Hz can cause ventricular fibrillation

  • Direct current (DC) contact is more likely to cause asystole

  • Lightning injuries differ from high-voltage electric shock injuries

    • Lightning usually involves higher voltage

    • It usually has a briefer duration of contact

    • It may cause asystole, nervous system injury, and multisystem pathologic involvement

  • Electrical burns are of three distinct types

    • Flash (arcing) burns

    • Flame (clothing) burns

    • Direct heating effect of tissues by the electric current

Clinical Findings

Symptoms and Signs

  • May vary from tingling, superficial skin burns, and myalgias to paralysis, massive tissue damage, or death

  • Skin damage does not correlate with the degree of injury

    • Not all electrical injuries cause skin damage

    • Only very minor skin damage may be present with massive internal injuries

  • Lesions caused by direct heating of tissues are usually sharply demarcated, round or oval, painless yellow-brown areas (joule burn) with inflammatory reaction

  • Loss of consciousness

Diagnosis

Laboratory Tests

  • Obtain the following immediately

    • Complete blood count

    • Electrolytes

    • Kidney function tests

    • Liver biochemical tests

    • Creatine phosphokinase or urine myoglobin

    • Urinalysis

    • Cardiac enzymes

Diagnostic Procedures

  • Obtain an ECG immediately

Treatment

  • Pain management with acetaminophen, nonsteroidal anti-inflammatory drugs, opioids

Therapeutic Procedures

Emergency measures

  • Separate victim from the electric current before initiation of CPR or other treatment; the rescuer must be protected

  • Turn off the power, sever the wire with a dry wooden-handled ax, make a proper ground to divert the electric current, or separate the victim using nonconductive implements such as dry clothing

  • Resuscitation must be initiated on all victims of electrical injury since clinical findings are deceptive

Hospital measures

  • Evaluate for

    • Hidden injury (eg, ophthalmic, otologic, muscular, compartment syndromes)

    • Organ injury (myocardium, liver, kidney, pancreas)

    • Blunt trauma

    • Dehydration

    • Skin burns

    • Hypertension

    • Posttraumatic stress disorder

    • Acid-base disturbances

    • Neurologic damage

  • Fluid resuscitation is important to maintain adequate urinary output (0.5 mL/kg/h if no myoglobinuria is present, 1.0 mL/kg/h if myoglobinuria is present)

  • Early debridement of devitalized tissues and tetanus prophylaxis may reduce the risks of ...

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