Electrical injuries can be serious fatal injuries or accident causing high morbidity and mortality. They can be caused due to high voltage current due to electrical circuits or wires or low voltage current in household appliances like extension cord, iron or electric heaters. Lightening can also cause electrocution injury resulting high mortality. The severity of injury and complications are related to the voltage of electric current. High voltage electric current results more severe organ damage causing cardio-respiratory failure with high mortality. Even if low voltage electric current may result complicated injury if the length of electric current is for prolonged period resulting muscular tetany.
Different varieties of electrical injuries are flash, flame, lightening and true. Flash injuries are superficial burns without penetration of deep to skin. Flames are localized burn of tissue along clothing with or without penetration to deeper layers of skin.
Lightening are fatal variety that involve entire body. They are also called as “Lichtenberg figures”. They resemble the pattern of feathering as branches of tree. It often due to rupture of capillaries underneath the skin. Usually lightening causes asystole or respiratory failure.
True electrocution injury have entry and exit points completing an electrical circuit.
Electrical injuries may cause compartmental syndrome due to tissue injury or tissue edema. Tissue inflammation and and necrosis results increase in compartmental pressure. This is elicited by passive pain in movement of joint. There may be muscle ache or soreness.
All electrical injuries are dealt with absolute precautions. Before touching the electrified person we have to ensure the body is cut off from the power source. Then emergency helpline number of the locality must be dialled for fast and easy transportation of the victim to a nearby well equipped hospital with specialized trauma care.
Photo credit- electrocuted.com
Symptoms and signs of electrical injuries–
• Superficial to deep burn
• Tingling sensation, headache, confusion
• Hearing loss
• Seizure
• Cardiac arrhythmia to asystole
• Respiratory failure
Investigations done in electrical Injuries–
• Complete blood count
• ECG- To rule out cardiac arrhythmia
• X- ray- For fracture dislocation
• CT scan in case of thoracic injuries or injury of any internal organ
Management of electrocution injuries-
• All electrical injury patients treated as trauma patients means airway, breathing, circulation are secured.
• Suspected cervical spinal injury cases are immobilised first with neck support and transferred with ambulance to a trauma care centre.
• In case of lightening or high voltage current, victim is usually found in asystole with respiratory failure. They are given cardio-respiratory resuscitation(CPR). If breathing ensues, then shifted to a hospital with cardio-pulmonary support or ventilator.
• Electrical burn cases are managed by proper dressing of the wound with or without fasciotomy or escharotomy.
• Fluid of choice is isotonic balanced salt solution like Ringer’s lactate.
• In case of tetanic muscle spasm or myoglobinuria, diuresis done to maintain a urine output of 0.5ml to one ml per kg per hour.
