Treatment of Arc Flash Injuries
Arc flash injuries should be managed as severe thermal burns with extensive underlying tissue damage, requiring aggressive fluid resuscitation, early surgical debridement, and fasciotomy when indicated—these are fundamentally crush injuries with thermal components, not simple burns. 1
Immediate Assessment and Stabilization
Arc flash injuries result from electrical arcing that generates intense heat without current passage through the body, causing primarily thermal burns when clothing ignites. 2 The key distinction is that true arc flash burns (without current passage) have significantly lower mortality (1.1%) compared to high-voltage electrical injuries with current passage (5.3% mortality). 3
Primary Survey Priorities
- Assume all arc flash victims have inhalation injury given the mechanism of clothing ignition and should receive early airway assessment and potential intubation before edema develops. 2
- Assess for associated traumatic injuries from blast force or falls, which occur in 23% of electrical injury cases and may include fractures or polytrauma. 1
- Cardiac monitoring is mandatory even in pure arc flash injuries, as cardiac arrhythmias occur in 16.6% of electrical injury patients, though less common when no current passes through the body. 1, 3
Burn Wound Management
Initial Wound Care
- Cleanse and debride burn wounds promptly under sterile conditions as the foundation of treatment. 4
- Apply silver sulfadiazine cream 1% to a thickness of approximately one-sixteenth of an inch once to twice daily, covering all burn areas at all times. 4
- Reapply cream immediately after hydrotherapy and to any areas where patient activity has removed it. 4
Surgical Intervention
Arc flash burns ranging from 24-79% body surface area typically require multiple debridement procedures and split-skin grafting. 2 The surgical approach should include:
- Early radical debridement to remove all nonviable tissue, recognizing that the extent of injury cannot be judged by skin appearance alone as underlying muscle necrosis may be extensive. 1
- In 30% of cases, additional free or pedicled flaps are needed to cover soft tissue defects beyond what split-skin grafts can address. 1
- Continue silver sulfadiazine treatment until satisfactory healing occurs or the burn site is ready for grafting, maintaining coverage while infection risk remains. 4
Critical Pitfalls to Avoid
- Do not underestimate tissue damage in arc flash injuries—while these lack the deep electrical current pathway injuries, the thermal component can cause deep partial to full-thickness burns over large body surface areas. 2
- Do not confuse arc flash burns with high-voltage electrical injuries—arc flash patients do not require the aggressive fasciotomies and early amputations needed for true electrical injuries with current passage. 1, 2
- Dressings are not required for silver sulfadiazine application, though they may be used if individual patient requirements necessitate them. 4
Complications and Long-Term Management
- Neurological complications occur in 30% of electrical injury patients including peripheral paresis, though these are less common in pure arc flash injuries without current passage. 1
- Mean length of hospital stay for severe electrical injuries averages 18.9 days with approximately 3 operations required. 3
- Never withdraw silver sulfadiazine from the therapeutic regimen while infection risk remains, unless a significant adverse reaction occurs. 4