ELECTRICAL INJURY, ANGGRAINI BARUS
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DEFINITION, ETIOLOGY & RISK FACTOR
Defenition & Etiology
- Electrical injuries are when high-energy current travels through the body due to contact with an electrical source. Injuries occur due to either the flow of current through the body, arc flash, or clothing that catches fire. With the former two, the body converts electricity to heat, which results in a thermal burn.
- Age <6 years
- Male sex
- Wet skin exposure
- Voltage >600-1000
- Transthoracic electrical pathway
- Construction industry workers
COMPLICATION & PROGNOSIS
- 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).
- Cardiac complications can occur. One can have an arrhythmia, possibly even a fatal arrhythmia, at the time of the injury.
- 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. This is discussed more under the Pathophysiology section above.
- Patients with electrical burns should be examined and treated following trauma patient treatment protocols with priority to ABCDEs with a primary and secondary survey.
- A thorough history should be obtained, including the source of patients electrical injury, the voltage and current type (AC or DC) of the energy source, the duration of electrical exposure, and how the injury was incurred. It is also important to obtain the patient's cardiac history, including any history of prior arrhythmias.
- A head-to-toe examination should also be completed, giving particular attention to the skin, including the scalp.
- Patients may also present with injuries from falls caused by the electrical shock, such as long bone fractures, spinal fractures, or joint dislocations
- EKG, cardiac enzymes, CBC, and urinalysis (to check for myoglobin due to rhabdomyolysis) should be obtained.
- ne 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.
- Skin offers resistance to low current, but with enough current a burn hole through the skin is established
- Burn allows current to pass bypass intact skin via Electrolytes into nerves, muscles, vascular structures
- Skin resistance is lowered by a factor of 100 when it is wet (i.e. wet skin is a much reduced barrier to Electrical Injury)
- Electrical Injury results in Thermal Burn injury
- Chemical Burns
- Emergent Thermal Burns
- Lightning injury
- Status epilepticus
- 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)
EDUCATION & PREVENTION
- Keep all electric appliances away from places where there is water, such as a sink, toilet, or bathtub.
- Do not handle extension cords or electric appliances and do not plug anything into an electrical outlet while you are wet or if the appliance is on a wet surface.
- Keep electric appliances, outlets, and light bulbs away from flammable liquids or products that produce vapors.
- Make sure that children do not play or climb near electric lines on a power pole or where the lines enter a house.
- Do not handle fallen wires.