Electrical injuries

Background

1. Tissue damage occurs via electrical energy, heat, and mechanical injury from trauma
2. Types:
   1. Low-Voltage
   2. High-Voltage (>1000V)
      1. Associated with electrical burns
   3. Electric Arc
      1. Associated with high voltage sources
      2. May radiate enough heat to burn persons 10ft or more away from the arc
      3. Blast force may result in trauma
3. Burn from biting an electric cord a/w delayed labial bleeding (5d later) in ~10% of peds

Clinical Features

Immediate Effects

1. Cardiac dysrhythmias
2. Respiratory arrest
3. Seizures

Cardiac Dysrhythmias

1. Fatalities due to asystole or V-fib usually occur prior to arrival
   1. Asymptomatic pts w/ normal ECGs do not develop later dysrhythmias after <1000V injuries

CNS Injury

1. Occurs in 50% of pts w/ high-voltage injuries
2. Brain injury ranges from transient LOC to CVA

Orthopedic Injury

1. Forceful muscle contractions can cause fx and joint dislocations (especially shoulder)
   1. May occur with voltages as low as 120V
2. Compartment Syndrome
   1. Usually a/w high-voltage injuries
   2. May occur even with 120V shocks if contact is sustained for longer than few seconds
   3. Pt experiences ongoing muscle pain with movement
   4. Need for fasciotomy predicted by:
      1. Myoglobinuria
      2. Burns >20% BSA
      3. Full-thickness burn >12% BSA
3. Rhabdomyolysis
   1. Associated with:
      1. Contact with >1000V
      2. Prehospital cardiac arrest
      3. Crush injury
      4. Compartment syndrome
      5. Full-thickness skin burns

Ocular Injury

1. Cataract formation has been described weeks to years after electrical injury
   1. Document presence or absence of cataracts following all electrical injuries

Auditory Injury

1. May be damaged by current or hemorrhage
2. Check hearing in all pts

Cutaneous Burns

1. Often seen at electrical contact areas
   1. Seriously injured pts often have burns on either arm or skull + feet
2. Most pts w/ burns from electrical injury require admission and care by burn specialist

GI Injury

1. Suspect in pts with:
   1. Electrical burns of abdominal wall
   2. History of a fall, nearby explosion, or other mechanical trauma

Treatment

1. Usual trauma evaluation and resuscitation applies
2. Use Parkland formula as starting point for fluid resuscitation
3. Treat rhabdo and compartment syndrome in usual manner

Disposition

1. Discharge
   1. Asymptomatic pts w/ normal ECG on presentation after a <600V injury
2. Admit
   1. All pts with high-voltage injuries (even if asymptomatic)
   2. Pts w/ low-voltage injury if symptomatic (e.g. chest pain, burns, abnl ECG, abnl CK)

Source

Tintinalli's