What are the key steps in managing electrical burns?

From the Guidelines

Managing electrical burns requires immediate and specialized care, prioritizing scene safety, assessment, and prompt medical intervention to minimize morbidity, mortality, and improve quality of life. The first step is to ensure the scene is safe by turning off the power source before approaching the victim, as emphasized in the guidelines for first aid 1. Call emergency services immediately, and for initial treatment, assess the victim's vital signs and begin CPR if necessary, as electrical injuries can cause cardiac arrest. It is crucial to identify entry and exit wounds, as electricity travels through the body causing internal damage that may be more severe than visible external burns.

Cooling the burn areas with clean, room-temperature water for about 10-15 minutes is recommended, but avoid ice or very cold water which can worsen tissue damage. According to the most recent guidelines 1, covering burns with a nonadherent bandage or clean cloth protects the wound and reduces pain while avoiding heat entrapment until the burn can be assessed by a healthcare professional. Do not apply creams, ointments, or butter to burns as these can trap heat and increase infection risk. Administer pain medication such as acetaminophen or ibuprofen as needed.

Key considerations in the management of electrical burns include:

• Monitoring for signs of compartment syndrome (severe pain, pallor, paresthesia, paralysis, pulselessness) which may require surgical intervention.
• Recognizing that electrical burns often require hospitalization for monitoring of cardiac rhythm, assessment of internal damage, and specialized wound care.
• Understanding that high-voltage injuries (over 1000 volts) typically cause more severe damage and may require fluid resuscitation to prevent kidney damage from myoglobin released by damaged muscles.
• Ensuring tetanus prophylaxis is administered if the patient's immunization status is not up to date, as part of comprehensive care to prevent additional complications.

From the FDA Drug Label

Prompt institution of appropriate regimens for care of the burned patient is of prime importance and includes the control of shock and pain. The burn wounds are then cleansed and debrided; The key steps in managing electrical burns include:

• Control of shock: immediate action to prevent or manage shock
• Pain management: addressing the patient's pain
• Cleansing and debridement: cleaning and removing dead tissue from the burn wounds
• Application of topical cream: applying a topical cream, such as silver sulfadiazine cream, USP 1% to the burn areas 2

From the Research

Key Steps in Managing Electrical Burns

The management of electrical burns involves several key steps, including:

• Assessment of the patient's airway, breathing, and circulation, as electrical burns can cause significant morbidity and mortality 3, 4
• Evaluation of the location, size, and depth of the burns to determine the optimal setting for management 4
• Surgical excision, fasciotomy, escharotomy, and amputation may be necessary in some cases 5
• Debridement is an essential step in the management of electrical burns 5
• Pain management is crucial, with acetaminophen being the first-line treatment for minor burns and opioids being used for severe burns 4
• Topical therapies, such as silver sulfadiazine, may be used to facilitate healing and minimize scarring 4
• Extracorporeal life support (ECLS) may be considered in cases of mixed distributive-obstructive shock secondary to pulmonary embolism and sepsis 6

Specific Considerations for Electrical Burns

Electrical burns can be catastrophic, threatening severe disability or mortality 6

• The spectrum of electrical injury is broad, ranging from minimal injury to severe multiorgan involvement 5
• Initial management of electrical burn is imperative to optimize function and minimize long-term scarring 5
• Further studies are required regarding flap repair and microsurgery to minimize the rate of amputation 5

General Principles of Burn Management

Burns, whether caused by thermal, chemical, or electrical exposure, are common and often preventable 4

• All patients with burns should undergo primary and secondary assessment, including assessment of airway, breathing, and circulation 4
• Goals of therapy are to manage pain, facilitate healing, minimize scarring, and achieve return to function 4