What is the typical degree of a high voltage electrical burn?

High Voltage Electrical Burns in Adolescents

High voltage electrical burns typically cause 4th-degree burns in a 15-year-old boy, involving damage to deep tissues including muscles, tendons, bones, and nerves beyond the skin layers. 1

Characteristics of Electrical Burns by Voltage

High voltage electrical burns (≥1000 volts) differ significantly from other burn types:

• 1st degree burns: Superficial, affecting only epidermis - NOT typical of high voltage injuries
• 2nd degree burns: Partial thickness, affecting epidermis and part of dermis - NOT typical of high voltage injuries
• 3rd degree burns: Full thickness, affecting epidermis and entire dermis - May occur at contact points
• 4th degree burns: Extends beyond skin into subcutaneous fat, muscle, tendons, and bone - MOST COMMON with high voltage electrical injuries 1

Pathophysiology of High Voltage Electrical Burns

High voltage electrical injuries cause damage through multiple mechanisms:

• Current flow damage: Electricity follows path of least resistance through body tissues
• Arc injuries: Current jumps from source to body, creating extreme heat (up to thousands of degrees)
• Thermal burns: From ignition of clothing or direct heating of tissues 1

Different tissues have varying resistance to electrical current:

1. Bone (highest resistance)
2. Fat
3. Tendon
4. Skin
5. Muscle
6. Blood vessels
7. Nerves (lowest resistance)

Clinical Presentation in Adolescents

High voltage electrical injuries in adolescents like a 15-year-old boy typically present with:

• Entry and exit wounds that appear as small, deep, charred areas 2
• Extensive internal damage disproportionate to visible external burns
• Possible tetanic muscle contractions causing fractures
• Risk of compartment syndrome from muscle swelling
• Potential cardiac arrhythmias including ventricular fibrillation 2
• Neurological complications that may appear immediately or delayed 3

Assessment and Management

1. Initial assessment:

   • Ensure scene safety - power must be turned off 2
   • Assess ABCs (Airway, Breathing, Circulation)
   • Evaluate for cardiac arrest - primary cause of immediate death 2

2. Immediate management:

   • CPR if cardiac arrest present
   • Early intubation if facial/neck burns present due to risk of airway swelling 2
   • Aggressive fluid resuscitation to maintain urine output and prevent myoglobin-induced renal failure 1

3. Wound assessment:

   • Look for entry and exit wounds
   • Assess depth of tissue damage - high voltage typically causes 4th-degree burns 1
   • Evaluate for compartment syndrome

4. Surgical considerations:

   • Early decompression through fasciotomies within 10 days of injury 4
   • Debridement of devitalized tissue
   • Possible amputation for non-viable limbs 3
   • Vascular reconstruction if major vessels damaged 5

Complications and Prognosis

• Early complications:

  • Cardiac arrhythmias
  • Rhabdomyolysis and acute kidney injury
  • Compartment syndrome

• Late complications:

  • Neurological deficits (may appear up to 2 years after injury) 1
  • Psychological symptoms
  • Cataracts

Key Differences from Thermal Burns

Unlike typical thermal burns where severity is based on depth and TBSA (Total Body Surface Area), electrical burns:

• Have damage that extends beyond visible injury
• Require more aggressive fluid resuscitation than calculated by burn formulas
• Often require surgical intervention for decompression and debridement
• Have higher amputation rates (23.6% for high voltage vs. 5.5% for low voltage) 3

Pitfalls to Avoid

• Underestimating injury extent: External appearance often masks severe internal damage
• Delayed fasciotomy: Can lead to preventable tissue loss
• Inadequate fluid resuscitation: Standard burn formulas may be insufficient
• Missing associated traumatic injuries: 15% of electrical burn victims have additional trauma from falls or being thrown 1
• Failure to monitor for delayed complications: Neurological issues may appear months after injury

Remember that high voltage electrical burns in adolescents are true medical emergencies requiring immediate specialized burn center care due to their complex nature and high risk of complications.