Electrical Burn Injury: Characteristics and Management
Electrical burn injuries require close cardiac monitoring due to the risk of cardiac arrhythmias, which are a primary cause of immediate death from electrocution. 1
Severity Assessment and Characteristics
- Electrical burns vary widely in severity, ranging from mild tingling sensations to fatal injuries, with the extent of injury often not correlating with visible skin damage 1
- Unlike thermal burns, electrical injuries cannot be accurately estimated by the extent of skin damage alone, as significant internal damage may occur with minimal external evidence 1, 2
- Electrical current preferentially affects the extremities rather than the trunk, with the most common pathway being from upper limb to lower limb 3
- The severity of electrical injury is directly (not inversely) related to tissue resistance - tissues with higher resistance (like bone) generate more heat and sustain greater damage when current passes through them 2
Cardiac Complications and Monitoring
- Cardiopulmonary arrest is the primary cause of immediate death from electrocution, making cardiac monitoring essential 1
- Cardiac arrhythmias including ventricular fibrillation, ventricular asystole, and ventricular tachycardia may result from exposure to both low and high-voltage current 1
- The frequency of alternating current increases the likelihood of current flow through the heart during the vulnerable period of the cardiac cycle, potentially precipitating ventricular fibrillation 1
- All victims of electric shock require medical assessment because the extent of injury may not be apparent, with cardiac complications potentially developing later 1
Other Systemic Complications
- Respiratory arrest may result from electric injury to the respiratory center in the brain or from tetanic contractions or paralysis of respiratory muscles 1
- Significant tissue destruction can lead to rhabdomyolysis with release of myoglobin, putting patients at risk for acute renal failure 2, 4
- Neurologic complications are common and may present early or late (up to 2 years after injury), requiring thorough neurological examination and follow-up 2, 5
- Approximately 15% of electrical burn victims also sustain traumatic injuries from falls or being thrown against objects 2
Management Approach
- Initial management includes ensuring scene safety by turning off the power source before approaching the victim 1
- Once power is off, assess the victim who may need CPR, defibrillation, and treatment for shock and thermal burns 1
- Early intubation should be considered for patients with evidence of extensive burns, particularly those involving the face, mouth, or anterior neck 1
- Rapid IV fluid administration is indicated for victims with significant tissue destruction to counteract shock and correct ongoing fluid losses 1
- Standard burn resuscitation formulas based on body surface area may not provide enough fluid due to hidden musculoskeletal damage 2
- Monitor for compartment syndromes requiring surgical decompression, especially in high-voltage injuries 2, 3
Common Pitfalls and Caveats
- Underestimating the severity of electrical injuries based on visible skin damage can lead to delayed recognition of serious complications 1, 2
- Failure to monitor cardiac function can result in missed arrhythmias, which are a significant cause of mortality 1
- Inadequate fluid resuscitation may lead to acute renal failure, particularly in patients with myoglobinuria 2, 4
- Delayed neurological complications may be missed without appropriate follow-up and serial neurological examinations 2, 5
- High-voltage injuries (>1000 volts) are associated with greater risk of loss of consciousness, cardiac arrest, and need for amputation compared to low-voltage injuries 5