Electrical Burns Symptoms And Treatments

I recently read a piece on BBC News about a 10-year-old boy who died four days later, after receiving an electric shock at a Tiffany's Hotel in Blackpool. The minor, apparently from Wales, had injuries consistent with having received a "high voltage of electricity," according to the police. There has been a rise in the number of incidents of electricity burns, hitting main-page headlines worldwide. Implementing appropriate preventive measures requires detailed information.

The skin, tissues, and other organs can sustain temporary or permanent damage caused by electrical burns and injuries. Electrical burns and injuries can range in severity triggered by contact with exposed electrical components of appliances, wiring, or lightning strikes.

Going further into this subject will provide you with the knowledge you need for prevention and response, from comprehending the different types of burns to knowing about emergency first aid procedures and long-term care. Continue reading to learn in-depth knowledge that will help you treat electrical burns effectively.

Introduction

Electrical injuries occur when a high-energy current passes through the body as an effect of coming into touch with an electrical source. Arc flashes, the body's natural current flow, or clothing that catches fire can result in injuries. With the first two, the body produces heat by converting electricity, which causes a thermal burn. It's crucial to remember that the depth of an electrical burn can differ by how it looks on the outside because internal tissues and organs are damaged far more severely than the skin.

It is vital to understand that "electrocution" solely refers to fatalities brought on by contact with electricity. Therefore, if someone gets exposed to electricity but survives, they have not been "electrocuted."

For example, a utility worker may fall from a bucket truck and impulsively grab a power line to stop himself, resulting in electrical injury; conversely, the worker may be holding a pole that comes into contact with a power line, resulting in electrical damage. 

More frequently, an electrical injury occurs at home when an appliance's exposed electrical cord makes contact with a person's body or when an electric source comes into contact with water that a person is also touching, such as a hair dryer falls into a bathtub. 4% to 5% of burns treated in a hospital are electrical burns. In the United States, there are roughly 1,000 electrical deaths per year.

Around 70 fatalities and 350,000 injuries in United Kingdom households are annually brought on by malfunctioning electrical systems or equipment. Electrical accidents strike primarily in the workplace for adults, whereas for children, strike primarily at home. . People who are assigned males at birth (AMAB) are more likely to get injured by electricity than people who are assigned females at birth (AFAB). The head is the most common source, then the hands. The ground's reference point is typically the feet.^1,2

Types of electrical burns

Created by: Deepika Rana

Based on the degree of the injury and the route the electrical current travels through the body, burns from electricity can be divided into two basic categories:

Low-voltage electric burns (110 to 120 volts)

Hands or the mouth are always the sites of these kinds of burns. Hand contact with an extension cord that recently had its insulating material removed is the most common cause of low-voltage electric burns. The common manifestation of a low-voltage burn to the hand is a minor, deep burn that may also affect nearby tendons, nerves, and blood vessels. Though these burns only affect a tiny portion of the hand, they could be so severe as to necessitate the amputation of a finger. Children under five years comprise a large proportion of these patients.

High-voltage electric burns (greater than 500 to 1000 volts)

Burns by contact with high-voltage electric circuits fall into two types - burns from an electric arc and burns brought on by an electric current. 

Classification and symptoms of electrical burns

A system indicating the necessity for surgical intervention replaced the old classification of burns as first, second, third, and fourth-degree. The following table illustrates the burns classification by the level of injury.

Electrical burn symptoms vary depending on the extent of the burn and the parts of the body damaged. Regardless of the patient's appearance, it is crucial to determine the source of the electrical injury (such as high versus low voltage, alternating current (AC) versus direct current (DC)), the duration of contact, and any potential resulting trauma.

Low-voltage AC injuries

• Superficial burns
• Muscle tetany
• Cardiac or respiratory arrest 
• Arrhythmias (ventricular fibrillation)
• Seizures

High-voltage AC injuries

• Even though they cause serious internal injuries, electrothermal burns can appear mild
• Loss of consciousness

Electric arc and flash burns

• A crowded rim encircling a dry, parchment-like centre separates skin lesions from other types
• Depending on the arc's path, the heat from flash burns can reach more than 50,000 degrees Celsius. However, the flash may only touch the skin's surface, resulting in diffuse superficial or partial-thickness burns without any internal injury

Oral burns

• Oral burns in paediatric individuals are sometimes the result of biting or sucking on an electrical wire or appliance
• Potential lip distortion if the burn reaches the oral commissure
• Two to three days later, oedema and eschar develop
• When the eschar peels off after two to three weeks, if the eschar affected the labial artery, there may be significant bleeding

A secondary electrical injury that results in blunt trauma

• Musculoskeletal or head injuries, tympanic membrane, cervical spine, face injuries and potential neurological impairment
• Circumferential burns
• Vascular abnormalities
• Neurologic or motor dysfunction⁴

Diagnosis

A comprehensive severity assessment by a medical practitioner is necessary to diagnose electrical burns. The image below shows tools to determine the severity of the injury if the burn is fatal.

Created by: Deepika Rana

CBC, electrolytes, creatinine, serum myoglobin, CK levels, arterial blood gas (ABG) and urinalysis

Imaging studies

Chest X-rays examine patients who have experienced cardiac or respiratory arrest, shortness of breath, chest pain, low blood oxygen levels, on-scene cardiopulmonary resuscitation (CPR), or blunt trauma from a fall.

Head computed tomography (CT) scans assess mental status, substantial trauma, seizures, unconsciousness, or focal neurologic deficits.

Cervical/spine imaging evaluates patients exhibiting signs of spinal cord injury, significant trauma, specific neurologic abnormalities, or loss of consciousness. Ultrasounds are used to check for internal injuries and ECG/EKG for cardiac monitoring.⁶

Treatment of electrical burns

The patient's care comes first, without threatening the safety of the rescuers. The following constitute the immediate treatments:

• Disconnect the patient from the power source by turning it off
• Take off the patient's clothes, especially any items made of metal that are in contact with the body (such as jewellery or medical equipment) 
• Patients who don't have a pulse should practise advanced cardiovascular life support (ACLS)
• Controlling pain and managing fluids (ideally lactated ringers) should be primary considerations in a conscious patient
• Any patient with an injury other than a minor low-voltage injury needs a large-bore IV access and large-volume fluid resuscitation

When treating these patients, avoid hypothermia. Pregnant patients who experience chest pain, have a history of cardiac arrhythmias, have a history of heart disease and are exposed to high voltages should be monitored for 6 to 12 hours with a cardiac monitor. A foetal monitor must be used for expectant birthing parents (mothers) more than 20 weeks along, especially if subjected to high voltage.

Sending patients with severe burns to the nearby burn centre is recommended. One should generally have a lower threshold for transfer to a burn centre since internal injuries in individuals with electrical injuries are more challenging to interpret than thermal burns. The patient can be released from the hospital after receiving burn treatment, having any wounds taken care of, and having their tetanus vaccine updated if they remain stable throughout monitoring, with no alarming lab results and an ordinary EKG.¹

Long-term complications

The following long-term effects of electrical injuries are possible:

Neurological

• Neuropathy
• Seizures
• Syncope
• Tinnitus
• Paresthesias
• Weakness
• Loss of balance, poor coordination and gait ataxia

Psychological

• Memory or attention difficulties
• Irritability
• Depression
• Post-traumatic stress disorder (PTSD)

Ocular

• Cataracts

Physical

• Pain
• Fatigue
• Contractures
• Muscle spasms
• Pruritus
• Headaches
• Fever or night sweats
• Reduced range of motion or stiffness in the joints
• Severe muscle injury may lead to rhabdomyolysis, myoglobinuria, electrolyte imbalance and dehydration (with associated hypovolemia and hypotension)
• Massive tissue oedema leading to compartment syndrome⁴

Prevention strategies

The following are necessary for electrical injury prevention, as shown in the illustration below:

Created by: Deepika Rana^10,11

FAQ's

Are children more susceptible to electrical burns?

Children under the age of six have thinner skin compared to older kids and adults, making them more prone to burn injuries even from brief exposures.⁷

What is the urine output for electrical burn?

The current American Burn Association (ABA) protocols suggest titrating fluids to ensure a urine production of 75–100 mL/hour or 1 mL/kg/hour in adult electrical burn patients before reducing fluids.⁸

What is the most common arrhythmia in electrical burns?

Direct myocardial necrosis or cardiac dysrhythmia is possible from electrical damage. The most severe cardiac complications from electrical injury include asystole and ventricular fibrillation.⁹

Summary

Keep an eye out for indications of infection, tissue degeneration, or other consequences, as electrical burns can be more complicated than they appear to be. Accurate diagnosis and therapy require follow-up care from a healthcare professional.

Due to the possibility of hidden internal injuries, electrical burns ought to be treated by healthcare professionals. If you or someone you love gets an electrical burn, stay cautious and take care immediately for the best outcome.