Ohm’s Law states that current is directly proportional to voltage and inversely proportional to resistance. All three contribute to the pathophysiology of how electricity creates burns to the body. Contributing factors to the severity and pattern of injury include body position compared to the direction of current entering the body and duration of exposure to current.

Low-frequency alternating current (AC) causes more extensive injury to tissues than does high-frequency AC or direct current (DC). This is because low-frequency AC causes ongoing local muscle contraction (flexor muscles greater than extensor muscles) at the site of contact with the electrical source, often rendering the victim unable to let go of the offending object. In addition, AC injuries are much more common, as AC powers households and other buildings.

DC causes a single strong muscle contraction, often throwing its victim away from the energy source. The most common examples of DC injuries include lightning strike and contact with a car battery.

Burns can be classified as high or low voltage. High voltages greater than 500-1000 Volts cause deep burns and extensive deep tissue and organ damage. Low voltage exposures tend to result in lesser injury.

Electricity, the path of least resistance; thus, most injuries occur to tissues with the least amount of resistance. Skin is the tissue with the most amount of resistance in the human body, followed by bone. Nerves, muscle, and blood have the least amount of resistance. Further reinforcing this concept is that moist tissues (muscle) have much lower resistance than dry tissues (skin). Higher skin resistance results in more diffuse burns to the skin. Lower skin resistance results in deeper burns that are more likely to involve internal organs. Whether skin is relatively dry or moist, electricity passes through the highly-resistant skin tissue and then spreads out through the underlying tissues with less resistance. Therefore, skin burns can appear mild when internal tissues and organs are severely damaged.

EKG, cardiac enzymes, CBC, and urinalysis (to check for myoglobin due to rhabdomyolysis) should be obtained. Any patient that was in contact with a high voltage source should have continuous cardiac monitoring during evaluation. One may also consider CT imaging of the head if the patient has altered mental status or associated head trauma from a fall or being thrown in a blast.

Remove the patient from the source of electricity (shut off the power source)

Remove the patient's clothing, especially any metal that is in contact with the body (jewelry or equipment).

In a conscious patient, pain control and fluid management (preferably Lactated Ringers) would be priorities.

Large-bore IV access and large-volume fluid resuscitation is important in patients with anything more than a very minor low-voltage injury.

Fluids should be titrated to produce adequate urine output (75 to 100 mL/hr in adults or 1 mg/kg/hr in children). Avoid hypothermia in these patients. Patients who are pregnant, have chest pain, have a history of cardiac arrhythmias, or have a history of heart disease, or those with high voltage exposure should be placed on a cardiac monitor and observed for 6 to 12 hours. Pregnant patients at greater than 20 weeks gestation should also be placed on a fetal monitor, especially if exposed to high voltage. Patients with severe burns should be referred to the nearest burn center.

Since internal injuries are more difficult to interpret in patients with electrical injuries vs simple thermal burns, one should have a lower threshold for transfer to a burn center overall. If the patient is stable during monitoring, has no concerning findings on labs, and has unremarkable EKG, he or she may be discharged after the burns have been treated, injuries have been addressed, and the tetanus vaccination has been updated.

Electrical injuries usually cause burns but do not always, thus if one has no external burns, but the history is consistent with an electrical injury, one should not rule out electricity as a differential.

Prognosis varies widely depending on the direction that the current travels through the body, the duration of exposure, the type of current, voltage and amperage of the electrical source, and the resistance of the tissues through which the current travels

Complications from electrical injuries are similar to those of other thermal burns, such as infection (which can progress to sepsis), compartment syndrome, and rhabdomyolysis (due to extensive muscle damage from internal burns). Additionally, one may have associated injuries from being thrown from the electrical source or from falling from a height (roof, bucket truck, ladder) due to the electrical shock, and these injuries (long bone fractures, spinal fractures, lacerations, pneumothorax, etc.) should be assessed and treated appropriately.

Cardiac complications can occur. One can have an arrhythmia, possibly even a fatal arrhythmia, at the time of the injury. Anyone who experiences an arrhythmia or any chest pain or other typical cardiac-related symptoms is also at risk of arrhythmia in the 24 to 48 hours following the injury. Thus these patients should be kept on a cardiac monitor at all times. Any high voltage injury should have continuous cardiac monitoring for a minimum of 8 hours

A special consideration is pediatric electrical injuries that occur as the result of a child putting a cord in the mouth and biting down, causing burn injury to the corners of the mouth. These patients can be sent home if there are no other associated injuries, however, the complication in this case to warn parents about is delayed bleeding from the labial artery, which can occur about 7 days following the date of injury.

Trauma luka bakar listrik dibagi menjadi 3 berdasarkan
penyebabnya
1) Voltase rendah
2) Voltase tinggi
3) Tersambar petir