Burn Injury, Electrical

Low-voltage burns (<1000 V) commonly occur in children at home.

High-voltage burns (≥1000 V) are more common in adults and characteristically occur in outdoor environments near power sources and lines.

Lightning electrical burns carry highest rate of mortality and usually have energy >30 million volts.

Pts with an acute burn or a history of burns may present an additional challenge to securing the airway. Fluid resuscitation in acutely burned pts may cause severe facial and airway edema; pts with a history of burns, especially facial, may have limited mouth opening and neck extension.

Difficult IV access is a common problem. Two large-bore IVs are commonly needed for major burn surgery; however, depending on length of stay and surface area burn, central access and intra-arterial monitoring of blood pressure may be necessary.

Arrhythmias and cardiac arrest from direct electrical energy or metabolic derangements.

Respiratory failure and edematous airway; respiratory failure may occur from tetany of respiratory muscles or cerebral injury.

Blunt injuries, fractures, and dislocations if patients were jolted from electrical shock or fell from high structures.

Compartment syndrome: Delayed exploration and decompression may result in increased amputation rates along with increased organ failure and mortality.

Rhabdomyolysis and myoglobinuria from muscle injury leading to acute kidney injury.

Hypothermia remains a serious concern despite that electrical injuries may not result in a large surface area burn.

Acute hyperkalemia due to large muscle destruction and cellular breakdown.

Severity of electrical burn depends on current, route taken by the current, and the duration of contact with the electrical source.

Entry wounds occur often in the hands, with a leathery, charred appearance. Exit wounds are often explosive.

Extent of injury may be misleading, as the visibly burned area is often small. Large amounts of destroyed tissue may be present under normal-appearing skin, leading to under resuscitation.

Signs of electrical injury include loss of consciousness, extremity mummification, loss of pulses in an extremity, myoglobinuria, elevated serum creatinine kinase, and cardiac arrest.

The electrical current in most households is between 110–220 V, which may produce a low-voltage burn and dysrhythmias. High-voltage burns often cause immediate cardiac arrest and/or respiratory paralysis.

Direct lightning strikes are rarely survivable.

Of all burns, 3–5% are electrical.

Causes vary greatly from electrical appliances in water to work-related accidents.

Children may be involved in low-voltage burns at home. One cause is chewing electrical cords, causing oral mucosa burns.