Diagnosis

Electrical injury

Etiology

Cause [r7z]

• Arc flash

• Flame (arc flash ignites clothes --> thermal burns)

• Lightning (extremely short-duration, high-voltage electrical energy)

• True electrical injuries: the patient becomes part of an electrical circuit

Pathophysiology [r7z]

1. Thermal energy --> Tissue damaged

2. Extent of injury depends on:

   • Voltage of current:

     • Low voltage <1000 volts: Increased resistance --> heating of tissue

     • High voltage >1000 volts: Passage of current is not limited and tissue injury can continue

   • Current quantity (amperes) and type (AC/DC)

   • Duration of contact

3. Damage occurs due to resistance (Ω) along the course of current

4. Tissues with high concentrations of water and electrolytes (blood vessels, neurons, and muscles) have low resistance and are excellent conductors of electricity

5. Bone, fat, and skin have high resistance and are poor conductors of electricity

6. Tissue damage:

   • Extensive thermal burns

   • Deep tissue damage

   • Organ failure

Complications [r7z]

• Respiratory arrest

• Ventricular fibrillation

• Compartment syndrome

• Shoulder dislocation

• Cataracts

• Loss of consciousness

• Seizure

• Tinnitus

• Neuropathy

• Paresthesia

• Ataxia

Epidemiology

Incidence per 100.000 [r7z]

Approach

• Blood test: myoglobin, creatinin kinase

• Urine test

• ECG

Treatment

1. Initial treatment:

   • Airway protection

   • Fluid resuscitation

   • Burn care

   • Preventing complications: rhabdomyolysis, renal failure and delayed neuropathy

2. Surgical revision

3. Escharotomy

4. Fasciotomy

Differential diagnoses

Arrhythmia, Burn wound, Compartment syndrome, Epilepsy, Febrile seizure, Intracranial hemorrhage, Polyneuropathy, Respiratory failure, Rhabdomyolysis, Syncope