Electrical Injury

From Anvita Health Wiki

Contents 1 Epidemiology 2 Pathology 3 Management 4 More General Terms 5 Additional Terms 6 References

Epidemiology

• 1000 death/year in USA
• 1% of deaths due to trauma
• 60% of fatalities are in males, most commonly age 20-34
• 1/2 of low voltage injuries occur in young children

Pathology

• electrical burns occur due to conversion of energy to heat
• at low voltages alternating current is 3 times more dangerous than direct current
• death many occur due to:

• ventricular fibrillation
• central respiratory arrest
• asphyxia due to tetanic respiratory muscle contractions

• death may occur from as little as 50 volts; conversely individuals may survive shocks of > 100,000 volts
• high voltage shock is associated with more extensive tissue necrosis
• all tissues & organs may be affected by electrical injury

• skin burns are typically full-thickness

• flexor surfaces of wrist, elbow & axilla are most commonly involved because the hand is the most commonly involved part of the body

• nervous tissue is highly susceptible to injury

• neurologic deficits may be seen initially or up to 3 years later
• spontaneous resolution of early deficits is common
• permanent deficits

• may be delayed days to months
• gradual onset with slow progression
• spinal cord damage is the most common permanent sequella of electrical injury (seldom complete)

• peripheral neuropathies can develop in unburned limbs
• reflex sympathetic dystrophy ( RSD)
• causalgia

• cataracts may occur following high-voltage injury

• generally head injury
• usually bilateral
• onset of blurred vision ranges from a few weeks to 3 years

• vascular injury
• smaller vessels unable to dissipate heat are susceptible to thrombosis
• larger vessels are susceptible to mural necrosis & delayed hemorrhage
• vascular injury contributes to high amputation rate from electrical injury

Management

• cardiopulmonary support during acute phase as necessary
• treat as burn injury

• fluid replacement
• burn center referral may be indicated
• silver sulfadiazine has antimicrobial activity
• sulfamylon (a burn cream) may have better tissue penetration

• low voltage injuries

• evolution of tissue injury & vascular necrosis is complete within 7-10 days
• wounds are allow to slough & heal by contracture

• high- voltage injuries

• surgical debridement as needed
• formal amputation & surgical debridement delayed for 2-4 days following injury

More General Terms

• trauma

Additional Terms

• burn
• causalgia; complex regional pain syndrome type 2
• complex regional pain syndrome type 1; reflex sympathetic dystrophy; RSD; hand shoulder syndrome
• electrical resistance
• peripheral nerve disease; peripheral neuropathy
• silver sulfadiazine (Silvadene)
• sulfamylon

References

Harrison's Principles of Internal Medicine, 14th ed.  Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 2557-58

electrical injury