Electrical Burns Symptoms And Treatments

  • Deepika RanaBachelor of Dental Surgery(BDS), Dentistry , H.P.Government Dental College, IGMC Shimla.Himachal Pradesh

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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. 

Burns from an electric arcBurns from an electric current
When electrical energy is released explosively due to a short circuit or other electrical fault, it results in a quick, intense burst of heat and light

Direct contact with an electrical source can result in this
The current flows from the contact point to the ground outside the body in electric arc injuries. The hands and the skull are where the current usually makes contact, with heels as a common ground areaAn electric current that travels from the power source to the anatomical point of contact (the entrance wound) and from the patient to the grounding mechanism (exit wound) might cause burn injury by inducing hidden destruction of deeper tissues
The circumscribed deep wound on the volar surface of the forearm combined with contact wounds of the palm is the most prevalent of these lesions. A flame complicates this injury if the flashes of an arc burn the victim's clothing
These thermal injuries result from the transformation of electric energy to heat energy. The intensity of the electric burn depends on the volume and resistance of the tissue alongside the strength, frequency, and duration of the current flow3

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.

DepthAppearanceSensationHealing time
Superficial burn (epidermal)Dry, red and blanches with pressurePainful3 to 6 days
Superficial partial-thickness burn Moist, red, weeping with blisters. Blanches with pressurePain from temperature, air, and contact7 to 21 days
Deep partial-thickness burn Easily unroofed blisters, waxy, wet, dry, varied colour (from red, cheesy white to spotted) and pressure-induced blanching could be sluggishPainful to pressure only>21 days, typically needs surgical therapy
Full-thickness burnsBlack and burned to leathery grey to waxy white colour, dry, inflexible and no bruising under pressureDeep pressure causes painRarely unless surgically corrected
Deeper injury burn (i.e. fourth-degree) Extends into a muscle or fasciaIntense pressureNever heals unless treated surgically5

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

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

Psychological

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

Ocular

Physical

Prevention strategies

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

Created by: Deepika Rana10,11

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.

References

  1. Bounds EJ, Khan M, Kok SJ. Electrical burns. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Sep 18]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK519514/
  2. Lombardi B. Electrical safety in your home [Internet]. Rosebery Housing Association. 2022 [cited 2023 Sep 18]. Available from: https://www.rosebery.org.uk/2022/07/26/electrical-safety-in-your-home/
  3. Electrical burn injuries: overview, physics of electricity, low-voltage electric burns. 2023 Apr 26 [cited 2023 Sep 18]; Available from: https://emedicine.medscape.com/article/1277496-overview#showall
  4. Zemaitis MR, Foris LA, Lopez RA, Huecker MR. Electrical injuries. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Sep 19]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK448087/
  5. Rice PL, Orgill DP. Assessment and classification of burn injury [Internet]. Evidence-Based Clinical Decision Support System| UpToDate | Wolters Kluwer. UpToDate; [cited 2023 Sep 19]. Available from: https://www.uptodate.com/contents/assessment-and-classification-of-burn-injury?searc#H4218372011
  6. eMedicineHealth [Internet]. [cited 2023 Sep 19]. 3 types of electrical burns: symptoms, causes & treatment. Available from: https://www.emedicinehealth.com/what_are_the_three_types_of_electrical_burns/article_em.htm
  7. Toon MH, Maybauer DM, Arceneaux LL, Fraser JF, Meyer W, Runge A, et al. Children with burn injuries-assessment of trauma, neglect, violence and abuse. J Inj Violence Res [Internet]. 2011 Jul [cited 2023 Sep 19];3(2):98–110. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134932/
  8. Culnan DM, Farner K, Bitz GH, Capek KD, Tu Y, Jimenez C, et al. Volume resuscitation in patients with high-voltage electrical injuries. Ann Plast Surg [Internet]. 2018 Mar [cited 2023 Sep 19];80(3 Suppl 2):S113–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5860824/
  9. Varol E, Ozaydin M, Altinbas A, Dogan A. Low-tension electrical injury as a cause of atrial fibrillation. Tex Heart Inst J [Internet]. 2004 [cited 2023 Sep 19];31(2):186–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC427385/
  10. Electrical injuries in emergency medicine treatment & management: prehospital care, emergency department care, further inpatient care and transfer. 2020 Mar 9 [cited 2023 Sep 20]; Available from: https://emedicine.medscape.com/article/770179-treatment#d7
  11. Abhishek A, Abraczinskas D, Albrecht MA, Alter H, D Anawalt B, J Arnold S. Patient education: Electrical burns (The Basics) [Internet]. Evidence-Based Clinical Decision Support System| UpToDate | Wolters Kluwer. UpToDate; 2022 [cited 2023 Sep 20]. Available from: https://www.uptodate.com/contents/electrical-burns-the-basics#

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Deepika Rana

Bachelor of Dental Surgery(BDS), Dentistry , H.P.Government Dental College, IGMC Shimla.Himachal Pradesh

Hi, I am Deepika Rana Dentist by profession finished my Clinical Research Certification Programme from Duke NUS Medical school, Singapore in 2022. I joined Klarity’s internship because of my ongoing desire to learn and educate others about medicine through Writing. I enjoy producing articles that give readers detailed information about a variety of ailments that can be accessed through the Health Library created by Klarity.

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