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Outcome
An electrical burn is a tissue injury caused by contact with an electric current such as live wires or lightning.
Electrical burns are divided into:
A severe or fatal injury caused by an electric shock is known as electrocution.
Electrical injuries are a relatively uncommon cause of burns but result in approximately 1000 deaths each year in the US. Anyone in contact with an electric current can get an electrical burn. Typically, a low-voltage electrical injury/burn patient is a healthy young man at home or in the workplace. High-voltage injuries are less commonly occupational. One third of high-voltage electrical injuries are due to lightning. A recent art-form, fractal wood burning, is being reported to cause high-voltage electrical burns.
Electricity is defined as a flow of electrons. Electrons flow when there is a difference of electrical potential between by two points (voltage). The higher the voltage, the higher the current of electrons (the Law of Ohm).
The extent and severity of skin damage depends on:
Electrical injury results in tissue/organ damage through three mechanisms:
Low voltage electric current results in 2 well-circumscribed deep partial-thickness or full-thickness electrothermal burns:
High voltage injury may be due to direct contact or flashing.
An electric arc or spark, including a lightning strike, is produced between a highly-charged source and the ground, reaching temperatures of up to 2500C.
A kissing burn is an electric arc generated between two skin surfaces facing each other and sandwiching a joint, typically the elbow and knee flexures. The arc crosses the flexor crease and burns the two 'kissing' skin surfaces causing vast underlying tissue destruction.
Assessment of cutaneous involvement alone may underestimate the extent of underlying tissue damage.
Preceding electrical exposure confirms the diagnosis of an electrical burn.
In an unconscious patient in an appropriate environmental setting:
Note:
There are several ways to determine the TBSA.
Electrocardiography (ECG) should be performed in every electrical burn case. Continuous cardiac monitoring is required if there is documented arrhythmia and signs of ischaemia, history of loss of consciousness, or suspected high voltage electrical injury.
Complete blood count, electrolytes, blood urea nitrogen, and creatinine are ordered for patients with substantial injuries or if there is a risk for conductive electrical injuries (presence of entry and exit wounds or rhythm abnormalities).
Urinalysis for the presence of blood without red blood cells may indicate myoglobinuria due to muscle destruction.
Creatinine kinase level should be measured in high voltage injuries because its peak concentration predicts extent of muscle injury, amputation risk, mortality, and length of stay.
In the pre-hospital setting, priorities are to:
Management of electric burn wounds should include:
Early decompression procedure is required for a contracted and tight compartment of extremity (eg, forearm, leg) based on a peripheral neurovascular evaluation.
Surgical debridement of unhealthy tissue followed with definitive wound closure is done at day 3 to 5 once the injured tissue is well demarcated.
Excision and grafting may be required for contractures a few weeks following deep partial thickness and full thickness burns.
Deep partial-thickness or full-thickness wounds inevitably cause scarring. Other potential long-term complications of electrical burn injuries include:
Electrical burns can be immediately fatal particularly if due to low-voltage exposure or lightening. High-voltage injuries cause more morbidity than low-voltage burns including more medical complications, require more surgical interventions, and have a greater psychological impact.
